Ageing and Care Giving in the United States: Policy Contexts and the Immigrant Workforce

The ageing population of the United States is generating an increasing demand for care and foreign-born workers will supply an important part of that demand. This article discusses the ways in which U.S. healthcare and immigration policies affect the supply of the foreign born to professional and lesser skilled, direct care jobs. The U.S. market for long term care is shifting away from hospitals and institutionalised facilities to the direct provision of private services and long term care in homes. A well designed immigration policy would complement the demand generated by the healthcare system. Yet, there are few dedicated avenues of legal admission that select for professional care workers and none at all that target direct care workers. There is concern over shortages of professional workers and a substantial number of unauthorized workers in direct care work that flag deficiencies in immigration policies. Our examination of data, nevertheless, finds that the foreign born play an important role in the supply of workers. In the provision of direct care they are roughly one-quarter of the workforce that provides 80% of all long term care. Among professional care workers they are highly concentrated in the home care industry. These national-level concentrations, however, do not fully reveal the remarkable concentration of immigrants in just a few metropolitan areas.