While the Trump Administration’s latest executive orders on immigration are expected to continue threatening fragile gains in the nursing home workforce, providers are successfully using refugee workers to bolster their staff.
The nursing home workforce is “infused with foreign-born workers,” Janine Finck-Boyle, vice president of health policy at LeadingAge, said in an email to Skilled Nursing News. And, issuance of work visas to new overseas workers is just one avenue to help alleviate workforce challenges, Finck-Boyle noted.
So while Trump’s orders may slow down the stream of new immigrant workers even more going forward, many states have been finding creative ways to increase their staff by hiring foreign-born workers already in the United States. States with large pools of migrants and refugee workers, including Massachusetts and Wisconsin, respectively, are taking advantage of their presence by training such workers and helping them overcome various barriers.
Robin Wolzenberg, vice president of clinical and regulatory services for LeadingAge Wisconsin, told Skilled Nursing News about its refugee workforce initiative launched more than two years ago to address the long-term care workforce shortage exacerbated by the pandemic.
Retention rates for refugees are between 80% to 90%, she said, double the retention rate for domestic workers, which is closer to 40%. About 20 to 30 refugees have been placed by the program to fulfill ancillary roles including, dietary and housekeeping, that bypass language barriers. The sector has faced competition from other industries willing to pay higher wages, said Wolzenberg, especially the manufacturing sector.
Bethel Home, a skilled nursing facility operated by Miravida Living in Wisconsin, signed up for refugee placements after hitting a brick wall with international placement of clinical roles. Kari Hawkinson, vice president of human resources at Miravida, said the operator had an agreement to receive 20 international clinical workers, but ran into hurdles.
“We’re not any closer, in my mind, to receiving those employees today than we were back then, even though, out of the 12 CNAs that we contracted for, one has had an interview at the embassy, but none of them are moving,” said Hawkinson.
When the opportunity to look within their own communities for additional resources came up, the operator jumped at the chance.
“We are rich in the Fox Valley area in having two very strong and present resettlement organizations who could help us through that process,” she said. “As far as retention, these are incredible employees and wonderful contributors to our environment, and we’re certainly happy to have them.”
The ultimate goal is to offer refugees working in the long-term care industry permanent residency with full green card permission, and everything else they would need to stay, said Hawkinson.
Uncertainty of work authorizations
Massachusetts Senior Care Association (MSCA), meanwhile, has been working to match work authorized migrants living in emergency shelters with nursing home jobs. Nearly 40% of front-line staff in the state are immigrants, filling crucial nursing assistant roles, as well as licensed nurse positions, housekeeping and dining services.
Tara Gregorio, president of MSCA, expressed concern that the Trump administration’s targeting of the Temporary Protected Status (TPS) program might impact such workers, the care they provide, and even worsen bottlenecks at hospitals in the state.
Similar to the situation in Wisconsin with Afghan refugees, the state’s migrant arrivals have surged since 2023 and the MSCA has been working with the state to determine how facilities can help with the migrant housing crisis. One way has been by matching them with positions in nearby nursing homes, which provide housing.
Gov. Maura Healey declared a state of emergency in August of that year as the number of migrant families arriving in the state in need of shelter and resources were met with a lack of availability.
At the beginning of 2024, nearly 3,000 migrants living in the state’s emergency shelter system obtained work authorizations. Work Ready Massachusetts was launched and members of MSCA were encouraged to participate as the workforce shortage persisted.
However, President Trump’s executive orders on immigration could put pressure on providers to increase wages, along with creating an uncertain future for migrants with work authorizations. That is, if the Trump administration continues with its termination of TPS.
Seizing an opportunity
The timing of the U.S. exit from Afghanistan coincided with workforce shortages at nursing homes reaching peak levels, Wolzenberg said. The arrival of the Afghan refugees presented an opportunity to add more staff, but their lack of fluency in English was a barrier along with competition from other industries.
“We saw all the Afghan refugees coming to Fort McCoy … there was a huge number of Afghan refugees that were in Wisconsin, and we knew that they all wouldn’t stay here,” said Wolzenberg. “However, that sparked me to think: this is a great workforce. Why not tap into that?”
Wolzenberg reached out to the Department of Child and Family Services, which oversees the state’s refugee resettlement and job agencies, introducing agency staff to the long-term care sector and expanding the roster of of jobs that refugees could fill.
LeadingAge Wisconsin took on the task of “selling” the industry to refugees and the agencies that support them, while also convincing nursing homes to take them in.
“The initial concerns are always language barriers. How are they going to communicate? We’re a very regulated industry,” said Wolzenberg. “How are we going to make sure that they understand all the training needs and requirements, with the goal ultimately being to fill those direct care workforce positions such as CNAs?”
Operators were convinced thanks to the state agencies’ work with language learning classes, as well as setting up basic needs for refugee workers such as housing and bank accounts, she said.
The association ended up creating an 8-week learning collaborative for interested operators, discussing what could be done to attract newcomers, detailing positions open in various departments, wage ranges, retirement benefits and health insurance. The program also highlighted useful services for workers like a bus pass and ESL classes taking place in the nursing home community.
Miravida had housing available on campus for refugees. Of its five buildings, its assisted living complex would have been offered up as temporary housing between 90 days to six months if needed, Hawkinson added.
“We didn’t need to provide them with anything. It’s a reflection that in our community … housing was available and relationships had already been set up with landlords through the resettlement programs to work through that housing scenario with them,” said Hawkinson.
The collaborative started with about 26 communities and ended with 12 to 13, ensuring those that stayed were fully committed to the program.
Refugee program expansion
Wolzenberg said further funding and technology are needed to support expansion of the program and integration of refugees into direct care roles. At any rate, the association is looking to run another collaborative for operators that maybe weren’t ready the first time around.
There’s a certified direct care professional program in Wisconsin, which is sponsored by the states as well as the University of Wisconsin at Green Bay.
“It’s a CNA class for non-CNAs. It’s geared towards home and community-based services, assisted living, where they teach you how to be a caregiver. Right now, they offer it in English, Spanish and Hmong, and our goal is working with the department to try to find some funding opportunities so we can get that program translated into other languages commonly seen in refugee populations in Wisconsin.”
At the same time, the association is seeking funding for different types of technology that can help with translation in real time.
“We’re two and a half years into this, but it still feels like infancy to me, because I think there’s a long way to go, and there’s barriers that we need to overcome, but I’m hopeful about those,” said Wolzenberg.
Hawkinson echoed these thoughts, adding that there’s a lot of untapped potential within the refugee community in Wisconsin. Many are looking to have family members work at the same location but there are only so many dietary and housekeeping positions available.
Ultimately, the flow of incoming refugee workers can be aided by breaking down language barriers and providing paths to clinical positions which are sorely needed in the nursing home sector, along with modifications to the education content to become a resident caregiver.