Health Aff (Millwood). 2025 Aug;44(8):933-942. doi: 10.1377/hlthaff.2024.01495.
ABSTRACT
Persistent shortages of workers providing long-term services and supports (LTSS) for more than a dozen years have led to increased reliance on foreign-born workers to meet the growing demand. However, there is a dearth of empirical data on long-term changes in the composition of the direct care workforce by nativity status and care setting. Using data from the American Community Survey (2012-22), we examined the extent to which foreign-born workers contributed to LTSS workforce growth and how their participation was distributed across care settings. We found that foreign-born direct care workers have increasingly filled workforce gaps, particularly in the home and community-based services (HCBS) sector. The HCBS workforce grew by more than 24 percent during the period 2012-22, while the institutional workforce declined by 23 percent; this decline was primarily due to the exodus of native-born workers. Foreign-born workers accounted for approximately half of the increase in the direct care workforce in HCBS settings during this period. To address continued workforce shortages in LTSS and meet the demand for HCBS, policy makers should consider immigration reforms to support a sustainable supply of foreign-born workers, investments in training and career pathways, and improvements in job quality through higher wages and opportunities for career advancement.
PMID:40758931 | DOI:10.1377/hlthaff.2024.01495
