In the 1990s, our USA immigration policy allowed skilled nursing facilities (SNFs) to sponsor healthcare workers from the Philippines and other countries. Many of these additions to our SNF team in Sonoma County rapidly advanced to leadership positions. Coming from countries whose cultures highly value older adults, the caring part of their work in SNFs enhanced our care. 

I am so sad that in recent years, so many in our country now view immigrants as a burden who do not work, take advantage of our safety net, and often commit crimes. This has not been my experience. 

In the 1990s, I was privileged to be a part of Medical Educators who partnered with the Albanian government to support and improve the quality of their healthcare system. I developed many friends among the Internal Medicine Faculty in Tirana. In the fall of 1993, one of my friends, Dr. Bujar Bermema, who was Chief of the Infectious Disease Hospital Critical Care Unit, was remarkably busy caring for about ten persons with tetanus on ventilators, and his team had effectively trained their families to care for them as long-term vent patients. This tragedy was a consequence of the inconsistent refrigeration of the tetanus vaccine due to multiple electric power shortages throughout the country. In 1994, I worked with the State Department to bring Dr. Bermema to my home for advanced critical care training at our local UCSF Family Medicine program. Before going home, he asked if he could trace the keyboard on my home computer on a piece of paper, so his 12 y/o daughter could learn to keyboard. Of course, that was not necessary since I had keyboards to spare. About 4 years later, he and his family obtained a green card and immigrated to Ohio, where they had relatives. Because he was near retirement, he chose to work as a CNA in SNFs rather than go through the long physician licensing process here. Both of his daughters became successful businesspeople.

In February of this year, Dr. David Grabowski and colleagues released a working paper that examined the effect of immigration on older adult mortality in the USA. They found a strong impact of immigration on the size of the immigrant care workforce. Admitting 1,000 new immigrants would lead to 142 new foreign healthcare workers, without crowding out native healthcare workers. They also found that a 25% increase in the steady state flow of immigrants to the USA would result in 5,000 fewer deaths nationwide. The lower mortality was due to a stronger and more accessible healthcare workforce, including higher-quality care in nursing facilities. Here is the link to this important paper https://www.nber.org/system/files/working_papers/w34791/w34791.pdf

I hope that leaders in the Post-Acute and Long-Term Care Medical Association (PALTmed), CALTCM, and the industry will strive to more effectively educate our government and the public on the importance of immigrants for the care we provide to our older adults.