Barnes Britainy, Grabowski David C
Britainy Barnes (
David C. Grabowski, Harvard University.
Health Aff (Millwood). 2025 Aug;44(8):933-942. doi: 10.1377/hlthaff.2024.01495.
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.
十几年来，长期服务与支持（LTSS）领域的劳动力持续短缺，这导致对外国出生工人的依赖增加，以满足不断增长的需求。然而，关于按出生国籍和护理环境划分的直接护理劳动力构成的长期变化，缺乏实证数据。利用美国社区调查（2012 - 2022年）的数据，我们研究了外国出生工人对LTSS劳动力增长的贡献程度，以及他们的参与在不同护理环境中的分布情况。我们发现，外国出生的直接护理工人越来越多地填补了劳动力缺口，特别是在家庭和社区基础服务（HCBS）部门。在2012年至2022年期间，HCBS劳动力增长超过24%，而机构劳动力下降了23%；这种下降主要是由于本土出生工人的外流。在此期间，外国出生工人约占HCBS环境中直接护理劳动力增长的一半。为了解决LTSS领域持续存在的劳动力短缺问题，并满足对HCBS的需求，政策制定者应考虑移民改革，以支持外国出生工人的可持续供应，投资于培训和职业发展途径，并通过提高工资和职业晋升机会来改善工作质量。
