The Growing Crisis in America’s Nursing Homes and How Immigration Could Be a Part of the Solution

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On August 23rd, 2023, a report by The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) painted a dire picture of the state of long-term care in America.

Representing more than 14,000 nursing homes across the country that care for approximately five million people each year, the report indicates a looming crisis due to ongoing labor shortages.

These statistics cannot be ignored, especially considering the forecast that the retiree population is set to grow significantly over the next two decades.

A Deepening Crisis

The AHCA/NCAL report highlights several alarming trends based on a survey conducted in June 2023:

  • 55% of nursing homes are turning away prospective residents and patients.
  • 48% of nursing homes have waitlists spanning at least a few days.
  • 21% are downsizing beds or units, and 24% have closed a wing, unit, or floor because of labor shortages.
  • 33% report their workforce situation has worsened since the end of 2022.
  • 77% face moderate to high-level staffing shortages requiring hiring agency staff or mandating staff overtime.
  • 72% are very or somewhat concerned that they will have to close due to persistent workforce challenges.

In addition, almost every provider (98%) has had to ask current staff to work overtime or extra shifts, 75% have had to hire expensive temporary agency staff, and over half have had to limit new admissions due to staffing shortages.

The biggest obstacles in recruiting new staff are financial constraints and the lack of interested or qualified candidates.

The situation is aggravated by demographic changes. A report from Boston Indicators expects the retiree population in the Boston area alone to increase by more than 50% in the next 20 years. This is a microcosm of a nationwide trend, underscoring the escalating demand for long-term care.

Even before the AHCA/NCAL report, in March 2022, the Centers for Disease Control and Prevention (CDC) reported that nearly 30% of the 14,000 surveyed nursing homes already faced staffing shortages.

Zach Shamberg, the Pennsylvania Health Care Association President and CEO, sums up the predicament succinctly: “We can’t be in a position where our population is aging, but, at the same time, long-term care providers are being forced to shutter their doors.”

Potential Solutions: A Multi-Faceted Approach

Increased Funding and Support

First and foremost, federal and state governments must prioritize increased funding to healthcare providers, including nursing homes. This could manifest as direct subsidies or tax incentives aimed at offsetting the cost of hiring and training staff.

Technology Implementation

Telemedicine and robotic assistance can help to alleviate some tasks traditionally performed by human labor. Although not a complete substitute for skilled nursing care, technology can certainly augment existing services.

Better Training Programs

Enhanced and accelerated training programs can help produce more qualified healthcare workers. Partnerships with educational institutions can facilitate this, offering vocational and on-the-job training.

Public-Private Partnerships

Forming partnerships between the public sector and private corporations can accelerate all the above solutions. For example, technology companies could work in tandem with healthcare providers to develop specialized solutions for nursing homes.

Immigration: An Untapped Resource

A less explored but potentially impactful solution could be a change in immigration policy to attract healthcare workers from abroad. The U.S. could speed up processing times for existing visa and permanent residence programs designed for foreign healthcare workers willing to work in underserved sectors like nursing homes. The program could offer a streamlined pathway to permanent residency, conditioned upon a certain period of service in these critical roles.

Countries like Canada and Australia already have such targeted immigration programs for skilled workers, and these could serve as models. Skilled nursing staff from other countries, who are often facing unemployment or underemployment in their home countries, could fill the gap.

The Role of Immigration

Considering the international pool of healthcare workers, immigration can be an essential tool for addressing the labor shortages in nursing homes. Immigration policy specifically targeted towards healthcare staffing would not only help the facilities but also offer qualified professionals from other countries a chance for a better life in the U.S.

Moreover, the process could be expedited for countries that have similar healthcare training standards as the U.S., making it easier for immigrants to integrate into the American healthcare system. For those from countries with different standards, a short adaptation course could be mandated to ensure quality care.

The crisis facing America’s nursing homes due to labor shortages is a ticking time bomb, especially in light of the country’s rapidly aging population.

While the situation is complicated and no single solution will be sufficient, a multi-pronged approach that includes targeted immigration could be a game-changer.

It’s time for policymakers, healthcare providers, and the community at large to come together and take swift, decisive action to avert a catastrophe that could affect millions of the nation’s most vulnerable citizens.


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