National and state long-term care employers have been screaming alarms for months about a dire labor shortage at nursing homes, but a proposed “dramatic” increase in immigration costs could add to their woes.
Immigration Services has proposed hiking H-1B registration application fees from $10 to $215 per beneficiary. Saying they are “grappling with a historic workforce challenge,” 20 aging services advocacy groups now say they want the agency to come up with other ways to bolster revenue.
Skilled nursing facility workforce levels are at a 13-year low, and the sector lost more than 307,000 caregivers during the pandemic, according to a letter sent Monday from the groups to Ur M. Jaddou, director of the US Citizenship and Immigration Services.
“Increased fees take a toll on LTC communities that rely heavily on immigrants to care for their residents — yet the organizations themselves have limited funds and fixed government resources,” read the letter, signed by the American Health Care Association and LeadingAge among others. “Thus, we would ask USCIS to consider operational methods to save costs rather than increasing costs for the same level of service, as there is no indication that the proposed increased fees will improve service.”
Immigrants make up a significant portion of nursing home labor, with approximately one in four direct workers born outside the US, the letter explained. Providers have been calling for various immigration reforms that allow more workers in and speed up processing as a solution to demographic challenges in the LTC workforce.
AHCA / NCAL launched a national hiring campaign that gives its members access to research-tested methods to reach job candidates, messaging materials, social media tools, and other resources. They and LeadingAge also have petitioned lawmakers in nearly every state to boost Medicaid reimbursements so facilities can offer competitive wages and benefits.
Meanwhile, the sector is holding its breath on action from another federal agency that could have a significant workforce impact. The Centers for Medicare and Medicaid Services is expected to announce soon its proposed rule on minimum staffing, which many industry observers believe will be 4.1 hours per day per patient.
Many facilities are not currently at that level and would be extremely hard-pressed to meet that requirement.
A paper released last month by the National Bureau of Economic Research noted that more than half of all nursing homes in California applied for a waiver from a 2018 law that increased minimum staffing ratios. In 2019, the estimated median national staffing level was 3.7 hours per day and just 29% of facilities could meet it, paper authors said.
Their study noted that, for every 10% increase in female immigrations, short-term hospitalizations would decrease by 0.6%. Facilities could hire more workers, boosting care hours by 0.7% more nurse assistant hours per resident per day and 1.1% more hours from RNs.
Fees take a toll
The organization’s letter highlighted workforce projections estimating that an additional 3.5 million long-term caregivers will be needed by 2030 just to maintain current staffing requirements. That’s why an increase in immigrant labor costs is so heavily contested.
The letter expressed gratitude that there has been no proposal to hike the rate for premium processing, which currently stands at $2,500 per case. Immigration Services did recommend lengthening that processing timeframe from 15 calendar days to 15 business days.
Many healthcare employers use the premium process to expedite I-140 immigrant petitions for registered nurses, but while petitions are processed within the 15-day window at the Texas Premium Processing Center, for example, it takes four to six months for files to transfer to the National Visa Center. Nurses cannot move forward on other parts of the process such as paying visa fees and scheduling interviews until the files reach the visa center, effectively delaying a premium process by up to half a year.
“We hope that USCIE will place a key focus on ways to expediate immigrant visa processing to bring much needed healthcare workers to the US,” the letter said.
