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Current immigration policies are straining hospices ability to grow and retain their workforce amid widespread shortages.

Immigrant workers help to fill some of the biggest areas of need in the hospice and palliative care labor supply. But national policies are contributing to a diminishing pool of these workers, putting pressure on providers capacity to accept patients, according to OpusCare President and CEO Dr. Ismael Roque-Velasco.

Whats happening in our country during the last few years in immigration has really impacted the health care labor force, Roque-Velasco told Hospice News. What weve seen is that immigration policies arent helping, they are jeopardizing health care access without enough workers to provide care.

OpusCare offers hospice and palliative care in Florida, Texas and Georgia. Two of those states Florida and Texas along with California, are home to nearly half (45%) of the countrys overall immigrant population, according to Pew Research Center data.

National immigration policies are limiting the scope of hospice workforce growth in these states, as well as many others nationwide, said Roque-Velasco.

Foreign-born workers represent 38% of hospice and home health aides, a quarter of personal care aides and 28% of all highly-skilled health care professionals such as physicians and nurse practitioners, according to the National Immigration Forum.

Additionally, immigrant workers make up 22% of the nations nursing assistants and 17% of the entire health care and social services industry, reported the Migration Policy Institute.

With fewer immigrants available to take those jobs, hospices may be particularly vulnerable.

Immigration policies disproportionately impact hospice employees in comparison to other health care settings, according to Mollie Gurian, vice president of home based and home- and community-based services policy at LeadingAge.

Theres an extra step and levels to having qualified people, and immigration is a big part of that, Gurian told Hospice News. Weve heard from hospices that utilize immigration-specific programs to help with the soup to nuts process of obtaining worker visas that it can be harder to hire and train somebody whos just arrived in the country to provide the care needed at the end of life.

U.S. immigration laws are a complex web of rules. Generally, the federal government bases these on principles that include admitting workers with skills that are valuable to the U.S. economy and promote diversity, among others, according to the American Immigration Council.

Duration and eligibility requirements for visa classifications vary, but some allow employers to hire foreign-born workers on either a permanent or temporary basis.

The Immigration and Nationality Act (INA) requires annual caps for the number of working visa recipients across various business categories. The law stipulates that the president must consult with Congress each year on setting those thresholds. The annual limit for permanent employment-based immigrants is 140,000, including eligible family members.

Prospective employers can sponsor an individual for a visa, but the U.S. Department of Labor in some cases requires them to first prove a need in the labor market before even filing a petition.

Immigration processes can take considerable time and effort to complete. This, along with varying levels of eligibility requirements, can hinder hospices ability to recruit and retain this workforce, according to Ben Marcantonio, interim president and CEO, and COO of the National Hospice and Palliative Care Organization.

It can take years, even decades, to navigate your way through the system to get to the United States with a work permit, Marcantonio told Hospice News in an email. While there hasnt been significant immigration reform in decades, policies by the Trump administration, set during the COVID-19 pandemic, increased the backlog of individuals waiting to come to the United States for work. Our aging population and workforce has only exacerbated this worker shortage.

The Trump Administration tightened restrictions on immigration and stepped up deportations. Among other policies, the administration placed firmer limits on incoming workers from certain countries such as Mexico and India, among others.

All told, the White House implemented more than 470 administrative changes during Trumps presidency, an unprecedented pace compared to previous executive actions, reported the Migration Policy Institute.

The fluctuations in immigration policies are creating a self-perpetuating cycle of labor and patient access pressures, said Gurian.

Its important to have a domestic and international pipeline of workers, Gurian told Hospice News. We need all the people we can get specifically for aging services in our demographic reality and make it easier to come to the country by providing wrap-around funding and support when they get here.

Congress and the Biden Administration during the past two years have made attempts to expedite processes for bringing in immigrant workers, including some specific to health care.

In early 2021, the U.S. Citizenship Act died in committee. The bill would have raised the green card limit, eliminated per-country caps, and excluded dependents from the annual maximum on employment-related immigration.

Report language associated with the 2023 State Department appropriations bill, recently approved by the U.S. House of Representatives, urged the agency to streamline the visa process overall, as well as take action to improve processing of immigration applications from medical professionals.

Through report language, Congress makes recommendations to federal agencies on how to use their resources. However, agencies are not required to implement those recommendations.

The U.S. Department of Homeland Security 2023 appropriations bill contains similar language pertaining to the U.S. Citizenship and Immigration Services (USCIS) processing of backlogged and delayed applications. It also increased the USCIS budget by $273 million above 2022 levels, but falls below the agencys funding request by $230.0 million.

The current immigration environment is creating dangerous and detrimental situations for those who want to work in U.S health care, according to Roque-Velasco. Organized and controlled immigration is needed to help create pathways of staffing change in serious illness and end-of-life care, he added.

The only thing were doing is making a lot of criminals very rich, said Roque-Velasco. Some of these immigrants pay thousands just to get across the border and are risking their lives in some areas. If we had a way of bringing people into training and education programs with some kind of controlled immigration, to create some incentives for an immigration policy that will give legal pathways to licenses in different areas, then we might find a great solution to the problems were facing now.

In the absence of reform, hospices can take steps in their own training and education programs to include immigrant pathways to clinical, caregiving and other supportive roles, said Roque-Velasco.

For instance, they can offer sponsorship programs for hospice or home health aides to receive nursing or other clinical education in hopes of advancing their careers into those professions, he stated. The education process could begin remotely before they enter the United States, he added.

Advocates in the hospice space have said that training and education pathways need to be built into immigration policy.

If the current immigration system isnt fixed, then the nation could see more eligible patients die waiting for hospice care without enough workers to provide it, according to Marcantonio.

We need to renew a pathway specifically for those with a health background and training to come and work, said Marcantonio. The need for more health workers is more urgent.

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How Immigration Policy Impacts the Hospice Workforce - Hospice News