More Immigration Leads to Better Nursing Home Care, Says New Paper

Immigrants have a proven ability to address a mounting need for the aging American population. Politicians crafting immigration policy ignore this at their own peril.


During the COVID-19 pandemic, worker shortages hit American nursing homes particularly hard. A survey conducted last year by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) found that 87 percent of nursing home providers were grappling with moderate to high staffing shortages. According to a January AHCA/NCAL analysis of labor data, nursing homes have lost 210,000 jobs since the pandemic began—"the worst job loss of any health care sector."

That decline presents an obvious problem since the number of Americans 65 and older is projected to reach 80 million by 2040. But a new National Bureau of Economic Research paper points to a promising solution: immigration.

The paper found "strong and consistent evidence that increased immigration leads to improved patient care," as well as a decline in hospitalizations corresponding with an increase in female immigrants. That's according to new research from Harvard University's David C. Grabowski, the Massachusetts Institute of Technology's Jonathan Gruber, and the University of Rochester's Brian McGarry. Their paper relies on a sample of over 16 million Medicare beneficiaries in 13,000 nursing homes.

"Collectively, these results suggest that immigrants increase the quality of care of older adults residing in nursing homes," they write.

Adverse outcomes decline during short-term stays—especially restraints, which fall by 7 percent for every one-unit increase in female immigrants per nursing home residents. During longer stays, the researchers report "a strong negative impact on use of restraints" and "a very large and significant reduction in inpatient psychiatric medications." Immigration does not meaningfully impact mortality rates, they write, but it does lead to "significant reductions in hospitalizations in the short run."

The researchers found that increased immigration can lead to better outcomes for older adults outside of nursing homes as well. A 10 percent increase in the female immigrant population equated to a 0.4 percent reduction in a metropolitan area's nursing home population— "consistent with the fact that immigrants also often work as home health or personal care aides, professions that allow older adults to remain in their home longer." Bolstering that claim, the researchers write, is a 2021 study that found "influxes of immigrants between 1980 and 2000 likely reduced the lifetime risk of an older adult becoming institutionalized by 10 percent."

Immigrants now make up 25 percent of direct care workers in home health care and 19 percent of direct care workers in nursing home care, outpacing their overall share of the American labor force, which stands at roughly 17 percent. The upshot of all this is that immigrants have a proven ability to address a mounting need. Politicians crafting immigration policy ignore this at their own peril.