Why Immigration Falls Short as a Nursing Home Workforce Solution — And How to Fix It

Current immigration policies are creating unnecessary roadblocks that hinder the recovery and potential growth of the nursing home industry’s workforce by “leaps and bounds.”

And the situation has only become increasingly more dire as the sector faces a labor shortage at levels not seen in the last three decades.

The ability to bring over international nurses and other frontline staff to work in health care is, according to Grandison CEO Avi Lang, the biggest piece of the skilled nursing industry staffing puzzle.


“After Covid the burnout that’s impacted the American nurses is on the highest level I think that anybody’s ever seen,” Lang told Skilled Nursing News. “And in the same token, people are finding that … Hospitals are paying more than the skilled nursing facilities. A lot of the nurses feel they get more experience in the hospitals.”

The nursing home sector has lost nearly 229,000 caregivers nationally since February 2020, according to the Bureau of Labor Statistics (BLS) data.

New Jersey-based Grandison is a staffing company that sponsors physical therapists (PTs), occupational therapists (OTs) and registered nurses (RNs) from the Philippines to come to the United States and work in health care facilities, including hospitals and long-term care facilities.


Grandison currently works with at least 75 different companies across 28 states.

While Lang has seen “tremendous” expansion in the volume of nursing homes and other facilities that want to work with Grandison, he is quick to remind operators that this is not a short-term solution.

“This is about looking at the future, this is not about tomorrow,” Lang told SNN.

Currently, it can take an RN anywhere between seven and nine months to go through the approval process, become certified and arrive in the United States to be placed in a facility, which is considered “fairly quick” for immigration, according to Lang.

PTs and OTs, on the other hand, can take up to three years to become certified and able to work in the U.S.

The immigration barriers — and some successes

One of the reasons why Grandison does not focus its recruitment efforts on licensed practical nurses (LPNs) or certified nursing assistants (CNAs) is largely due to the time and cost it takes to obtain them.

LPNs are not considered “skilled enough” to qualify for particular visas, and they would have to go through additional immigration processes, Lang said.

“It’s one of the problems with immigration … Where all these different skills are needed, such as CNAs, LPNs, even home health aides, anything … The problem is the cost to bring them over costs us more than an RN, a PT or an OT,” he added.

Just a few months ago, however, some movement was made to expedite the process. Specifically, a portal was created for nurses in Manila to allow them to schedule their final interview with the embassy if all necessary paperwork had been filed, Lang said.

Without this portal, Lang believed the backlog would be much worse than it is today. He hopes to see similar efforts be implemented in other countries such as Saudi Arabia and Korea.

Another present barrier for PTs specifically is that they have to be flown to the U.S. on a tourist visa to take a particular exam – adding both cost and time to the mix. A tourist visa for the U.S. can take until May 2024 to obtain.

Ultimately what Lang would like to see is a separate immigration track for health care workers in hopes of creating a more streamlined, simplified process to help facilities bolster staffing.

Last year, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) asked lawmakers to amend the country’s immigrant visa prioritization to consider prioritizing the entry of foreign-trained nurses and health care workers into the U.S.

The likelihood of reform

On the heels of the midterm elections and the seating of a new Congress, the head of the industry’s largest trade group expects to see a “big push” for comprehensive immigration reform come 2023.

American Health Care Association President and CEO Mark Parkinson told Skilled Nursing News that the organization intends to be part of the conversation – all the while admitting that the chances of significant policy change are slim.

“We will try at the national level to get comprehensive immigration reform. Whenever there’s a new Congress, there’s always a window of time where something could theoretically happen,” Parkinson said.

He likened the odds to be in the 20 to 25% range.

Parkinson did, however, recognize some of the efforts being done to bring over international workers on the provider level.

Nursing home operator PruittHealth shared its plans earlier this year to recruit more than 1,000 nurses and CNAs primarily from the Philippines. The company has hired 202 nurses who are in various stages of the federal immigration process, and only one nurse had started working as of earlier this month at a facility in South Carolina.

“It’s not a quick fix, but we think it will supplement our other efforts that we have already,” Pruitt recently told SNN. “What hasn’t worked is the immigration process. A large number of those 202 that I mentioned are waiting on embassy interviews in their home country before they can be awarded a visa.”

And PruittHealth isn’t the only one. Both Brickyard Healthcare and the Evangelical Lutheran Good Samaritan Society have attempted efforts at using immigration as a workforce solution with varying degrees of success.

Legislation was introduced in recent months at the federal level with the goal of bringing more health care workers to the U.S., but it remains to be seen where — if anywhere — the bills will go.

“These are people that literally could help the industry by leaps and bounds and … All we need to do is make a few changes and literally we can have all these people that Grandison is holding on to, bring them over and help that much more,” Lang said.

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