Anti lmmigrant Policies Are Worsening the Health-Care Labor Shortage: "Because of the extraordinary expense of long-term care, families turn to immigrants in the 'gray economy/meaning immigrants here without papers.... Inquiring about the person's legal status [is not a] first priority".

• Author: MacDonald, Marylee
• Position: POLITICAL LANDSCAPE

DEMAND for nurses and home health aides is growing, but anti-immigrant policies threaten to cut off the supply of labor. For decades, the U.S. has faced a shortage of nurses and home health aides, and the trend looks to be continuing, as the Conference Board's Labor Shortage Index rates registered nurses in the 94th percentile in terms of risk of labor shortage over the next decade.

To fill jobs, nursing homes, hospices, and home health agencies have recruited nurses from abroad and tapped the ready pool of immigrants already living here legally, but families of those who require long-term care often take that a step further. Because of the extraordinary expense of long-term care, families turn to immigrants in the "gray economy," meaning immigrants here without papers.

Three-and-one-half years into caring for a young father dying of ALS [amyotrophic lateral sclerosis, or Lou Gehrig's disease], our family faced a crisis. My son-in-law no longer could walk, dress, or feed himself. I had been his caregiver for 10 months, but the 16-hour days had worn me out. My daughter had a full-time job and two young children. She had not gotten a full night's sleep in two years. As the disease progressed and she and I became more and more exhausted, I had assumed that her gold-plated insurance would kick in the moment we asked.

I soon learned that insurance only would pay for a home health aide for three hours a day, but not weekends. Standard health insurance policies do not cover "custodial care," meaning the activities of daily living (ADL).

Long-term care insurance would have been an option, but only about eight percent of Americans have coverage, according to the Department of Health and Human Services. A person who no longer can perform ADL will not qualify for long-term care insurance--nor do those individuals with Alzheimer's disease, dementia, multiple sclerosis, Parkinson's disease, stroke, or metastatic cancer.

Moreover, long-term-care policies do not always provide the safety net the name implies. Premiums rise as the insured person ages, and long-term-care policies have caps on their coverage.

Diseases such as Alzheimer's wear out spouses and/or adult children. The longer the person lives, the more exhausted the caregiver becomes. For elderly patients or those with various forms of dementia, nursing homes provide one way to lessen the burden on caregivers and make care affordable. However, nursing homes are not an option for a young person...