Can Immigration Help Solve the Nursing Home Staffing Crisis?

Research Corner
June 20, 2023

Soleil Shah, MD, MSc, Research Reporter

Soleil Shah writes Tradeoffs’ Research Corner, a weekly newsletter bringing you original analysis, interviews with leading researchers and more to help you stay on top of the latest health policy research.

This Saturday, June 24, marks the one year anniversary of the Supreme Court’s Dobbs decision overturning Roe v. Wade. We’ll be covering the topic on the podcast this Thursday so be sure you’re subscribed. I’ve also included three recent studies on abortion access and its consequences at the end of this newsletter. We’ll continue sharing research on this topic as more evidence of the ruling’s far-reaching implications emerges.

Can Immigration Help Solve the Nursing Home Staffing Crisis?

Almost 90% of nursing homes report struggling with moderate or severe staffing shortages, according to a recent industry survey. The COVID pandemic exacerbated the immense challenge of finding and retaining enough workers to care for the country’s 1.2 million nursing home residents.

Burnout from heavy workloadslack of advancement opportunities and decreasing wages has also contributed to high turnover rates, especially among nursing assistants.

One policy solution long supported by leaders within the nursing home industry is increasing immigration into the U.S. Immigrants currently comprise about 20% of workers in nursing home facilities.

How big of an effect would increased immigration have on staffing shortages — and would it change the quality of care nursing home residents receive? A recent NBER working paper by David Grabowski, Jonathan Gruber and Brian McGarry sought to find out.

Increased female immigration improves nursing home staffing and quality

To answer these questions, the researchers combined data on immigration patterns from 2005 through 2018 with data on staffing and quality from thousands of nursing homes.

Since most direct care workers are women, the authors looked only at female immigration patterns so they could better relate changes in immigration numbers with changes in staffing at nursing homes. After controlling for the characteristics of nursing home residents — including age, race, ethnicity and gender — the researchers found that:

  • For every 10% rise in the number of female immigrants in each examined region, there was a 0.8% rise in nursing home staffing. 
  • A 50% rise in female immigration could, by itself, offset about 30% of the predicted shortfall in nursing home staffing.
  • An increase in female immigration did not affect wages or the use of nurses with more advanced training — common concerns raised about immigration.

Significantly, the authors also considered how the rise of female immigrants affected the quality of care for nursing home residents:

  • For every 10% increase in female immigration, there was a 0.6% drop in hospitalizations within 14 days, but no significant impact on mortality rates.
  • Urinary tract infections, pressure ulcers, use of restraints and use of inappropriate psychotic medications all declined for ‘short-stay’ [about three months or less] residents.

Since the study focused entirely on female immigrants, one limitation is that we can’t be sure if more male immigrants could also positively impact nursing homes. And we shouldn’t assume women will carry the bulk of nursing home jobs in the decades ahead.

Solutions beyond immigration are needed to address the nursing home crisis

Immigration policy is contentious: Over 60% of Americans are dissatisfied with current immigration levels, but are split over whether they’re too low or too high.

Given how hard it has been to pass immigration reform in recent years, the industry and policymakers will likely need to consider other options. Improving working conditions, wages and opportunities for career advancement are a few of the possible paths forward.