The availability of quality caregivers has been a challenge, and the onset of the Covid-19 pandemic in early 2020 caused a 10 percent decline in nursing home staff across the U.S. This has escalated from a mere staffing issue to a more severe nursing-care crisis. “We have an aging population, care for them is labor-intensive, and there are shortages everywhere in that supply chain,” says MIT economist Jonathan Gruber.<\/p>\n
Approximately 20 percent of healthcare support workers in the U.S. are immigrants. A new study of metropolitan areas indicates that shifts in immigration levels can influence the extent of nursing care received by the elderly. “When immigration rises in a city, it significantly increases the health care workforce,” explains Gruber, who co-authored the study and the accompanying paper.<\/p>\n
Research by Gruber and his team found that increased immigration leads to more hours worked by registered nurses and aides in nursing homes, enhancing patient outcomes without replacing existing caregivers. Specifically, a 10 percent rise in female immigrants in a metro area results in a 1.1 percent increase in registered nurse hours with elderly patients, alongside a reduction in hospitalizations. “Even if immigration actually increases labor supply to the medical sector, it was an open question if that would improve outcomes, and it does,” adds Gruber, the Ford Professor of Economics at MIT.<\/p>\n
The study, titled “Immigration, the Long-Term Care Workforce, and Elder Outcomes in the U.S.,” is published in the American Journal of Health Economics. It is authored by Gruber, David C. Grabowski from Harvard Medical School, and Brian E. McGarry from the University of Rochester. The researchers analyzed data from sources like the U.S. Census Bureau\u2019s American Community Survey from 2000 to 2018, and reports required for Medicare and Medicaid eligibility, covering 16 million Medicare beneficiaries across over 13,000 nursing homes.<\/p>\n
Gruber points out that immigrants are a key group in elder care. The study reveals that a 10 percent rise in immigration beyond the norm in metro areas results in a 0.7 percent increase in care hours by certified nurse assistants and a 0.6 percent decrease in hospitalizations for short-term nursing home patients. Additional findings show improved patient outcomes, such as less use of physical restraints, fewer psychiatric medication prescriptions, and a decrease in urinary tract infections.<\/p>\n
The findings highlight that more immigrant-staffed environments correlate with improved outcomes. “There\u2019s a lot of evidence that providing more labor supply to the elderly sector improves patient outcomes,” Gruber states. “But it wasn\u2019t clear whether more immigrants would work the same way, because of language issues or other factors.”<\/p>\n
This study emerges amid major U.S. immigration policy debates. Gruber notes that the impact of immigration on eldercare adds a new dimension to these discussions. “I think it provides a new lens on the debate over immigration,” Gruber says. “The debate over immigration has been solely about what will it do to native workers, what will it do to the crime rate, what will it do to tax collection. This adds a new element, which is: What will it do to our citizens\u2019 care? By having more immigration, we provide more care.”<\/p>\n
Gruber, Grabowski, and McGarry continue exploring this area. A recent working paper from February suggests that increased immigration correlates with lower mortality rates, partly by enabling more elderly people to receive home care. Gruber acknowledges ongoing policy disputes over immigration, but as the newly published paper highlights, “results paint a consistent picture of improved quality of care resulting from increased immigration.”<\/p>\n