Immigration: Who Will Care for Our Elderly?

A recent New York Times article describes a disturbing scenario that is likely touching many families nationwide. In the article, a 93-year-old woman, “Joan”, lives in Texas and has depended on “Anna”, for more than a decade. Anna comes to her home four days a week to help with shopping, laundry, housecleaning and driving Joan to appointments. “Anna is a wonderful person whom I trust completely.”

Anna is also an undocumented immigrant from Mexico

Both women fear that Anna will be detained and deported. Joan’s daughter lives in Oakland and is concerned about what would happen if Anna gets pulled over; her mother can neither drive nor care for herself. She knows that finding another caretaker like Anna will be nearly impossible, and she’s now researching alternative solutions for her mother.

The Trump administration’s immigration policies are taking a toll

In Brooklyn, an HR director asked local employment agencies to find 20-25 new nursing assistants and practical nurses. It’s a typical request, and usually, “I’m flooded with applications the next day.” Not anymore; she received five applications in a 30-day period.

She thinks the Trump administration’s immigration policies and rhetoric have discouraged potential workers. The organization typically drew from immigrant communities. Contributing to her employment problems:

• A loss of 25 Haitian-American nursing assistants and practical nurses whose temporary protected status (TPS; temporary status given to eligible nationals of designated countries who are present in the U.S.) was terminated in November, and they must leave by July 2019.
• Those healthcare workers with DACA status remain in limbo.
• One in four of the direct-care workers in the nation’s nursing homes,
•  and homecare agencies are foreign-born, according to an analysis of census data by Paraprofessional Healthcare Institute (PHI), a New York research organization.
• In the gray market, where consumers hire home-care workers directly and pay them under the table, the proportion is likely far higher.

A growing workforce shortage in direct care

There is a growing work force shortage in direct care that affects the entire industry; it may be most visible as it impacts older and disabled people and their families.

• Long-term demographic changes drive labor shortages. The good news is that people are living longer, but they’re developing chronic diseases and disabilities along the way.
• The sheer size of the baby-boom generation ratchets up demand.
• The population of working-age women, who typically provide care both paid and unpaid, has shrunk, and has more career options.

Caring for old people dependent on a large number of immigrants

Caring for old people is a job that native-born Americans prefer not to take for a variety of reasons, including poor pay and benefits and the physical demands. As a result, nursing homes are frequently staffed by immigrant caretakers. With fewer immigrants available to fill these jobs, expect more system chaos. There are reports of nursing homes shutting down or stopping admissions altogether. The majority of aides and nursing assistants are American citizens, but nearly 35,000 come from Haiti, El Salvador, Nicaragua and Honduras, whose immigrants have had TPS status in the U.S.—now terminated under the Trump administration.

11,000 care workers from Muslim countries won’t be available

Immigrants from Sudan, whose TPS status was also terminated, will have to leave the United States as early as this fall. Nearly 11,000 care workers come from Muslim countries but will no longer be able to immigrate because of the Supreme Court’s new ruling on Trump’s travel ban.

Sociological side effects of this immigrant deportation

• Even when workers are legal residents, they may consider moving when relatives and friends are deported.
• Whole neighborhoods begin to feel targeted. When friends, colleagues and family are deported, it shatters communities, leaving families feeling vulnerable.
• Short-staffed nursing and care facilities mean that those already working there are putting in longer shifts, increasing pressure on the workforce.

Many families and healthcare workers fear that the Trump administration’s massive deportations will further undermine a system that is already poorly managed and regulated. Many believe it will get much worse over the coming months as we begin to feel the effects of these deportations.

The other side of the matter: The immigrants

There is, of course, the other side of this matter–that of the immigrants who have come to this country seeking better lives and a safe place to raise their families—just as our own ancestors did. Many have fled persecution, death threats, violence and gang wars. We’ve always found ways to integrate these immigrants into our communities, enriching our culture along the way.

Sadly, the current leadership is turning its back on them, holding them in detention, putting their children in cages and splitting up families that may never be reunited. These hardworking immigrants took the jobs that no one else wanted, and many of those jobs may now go unfilled. The consequences will be felt in nursing homes and homecare, agriculture and myriad other industries. We will all pay the price on many levels.

California Document Preparers’ assists our clients with the preparation of legal documents

Our servicesinclude Deed Transfers, Business Formation Packages, Uncontested Divorce and Probate. Our comprehensive Living Trust package includes a Power of Attorney and Advance Healthcare Directive. We also encourage our clients to update their Trusts for major life events. Contact us at one of our three Bay Area offices to schedule an appointment to create or update your Trust or find out how we work with our clients. We’re helpful, compassionate and affordable.

Assisted Living Centers: A Largely Unregulated, Booming Industry

Living Trusts are an important service for California Document Preparers, and many of our clients are retired or thinking about it. As a result, discussions frequently surface about a range of life-planning topics such as social security, financial planning and hospice. A recent New York Times article about assisted-living facilities got our attention.

Federal investigators have discovered significant gaps in the way that assisted-living facilities are being regulated, potentially jeopardizing the care of the growing number of people who rely on these services from a booming, poorly regulated industry.

Assisted Living: Little accountability or regulation

According to the Government Accounting Office (GAO), the federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid. Billions of dollars in government spending are flowing to the industry, yet it has only vague standards and limited supervision. States reported spending more than $10 billion/year in federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries. That’s an average of more than $30,000 a person, with very little accountability.

Individual states are supposed to keep track of cases involving the abuse, neglect, exploitation or unexplained death of Medicaid beneficiaries in assisted living facilities.

• More than half of the states were unable to provide data about the details of those cases.
• Out of 50 states, only 22 were able to provide data on “critical incidents—those cases of potential or actual harm.” These states reported more than 22,900 incidents, including physical, emotional or sexual abuse of residents.
• Many of the people involved in these “incidents” are older, with physical or intellectual disabilities. More than a third of residents have Alzheimer’s or other forms of dementia.

The National Center for Assisted Living, a trade group for providers, said states already had “a robust oversight system” to ensure proper care for residents. According to this group, California, Oregon, Rhode Island and Virginia have adopted laws to enhance licensing requirements and penalties for poor performance of facilities.

The report, “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” grew out of a two-year study requested by a bipartisan group of senators.

• The report concludes that the Centers for Medicare and Medicaid Services have provided “unclear guidance” and have done little to monitor the use of federal money that is being directed toward assisted living facilities.
• Without a clear process for evaluating and monitoring facilities, the committee has no way of knowing if states are meeting their commitments to protect the health and welfare of Medicaid beneficiaries in assisted-care facilities.

Standards for nursing homes

In 1987, Congress established standards for nursing home residents’ rights, imposed dozens of new requirements on homes, specifying the services they must provide. Yet assisted-living facilities have largely escaped scrutiny, even while the GAO says the demand is likely to increase with the aging baby-boomer population and increased life expectancy. Not surprising, the potential to make money off a needy population has attracted investors to an unregulated industry.

The report was commissioned by a bipartisan group of senators

Democrats and Republicans commissioned this report, and the Trump administration is recommending that federal officials should clarify the requirement for states to report on the abuse or neglect of people in assisted living facilities. The administration said it was studying whether additional reporting requirements might be needed.

Assisted living was not part of the original Medicaid program, but many states now cover it under waivers intended to encourage “home and community-based services” as an alternative to nursing homes and other institutions. The report said that assisted living could potentially save money for Medicaid because it generally costs less than nursing-home care.

Nothing in the report disputes the fact that there are many assisted living facilities that are doing an excellent job of providing high-quality, compassionate care for their residents.

The mission of assisted living facilities

Assisted-living communities can be a wonderful bridge between living at home and living in a nursing home. Residents live in apartments or houses; they have a high degree of independence but require help managing their medications and performing daily activities like bathing, dressing and eating.

Personal experience with assisted living

My own folks moved to a retirement community when their home became too much for them to manage. As their friends died, they also were becoming increasingly isolated. They  loved this busy new environment, the activities and the warm, friendly people. They lived happily in their own little unit for seven years.

When my stepfather had a stroke, my mother was too weak to care for him. As part of their contract with the community, they were able to move to assisted care when and if it became necessary. The stroke was the catalyst, and we moved both of my parents into assisted care. Before long, my stepfather moved into nursing care. Both of my parents died within six months. During this time, they were extremely well cared for by kind, generous caretakers to whom we were all very grateful.

We encourage everyone to create a Living Trust

But for those whose parents have been diagnosed with some form of dementia, the timing becomes much more critical. Our dedicated team is helpful, compassionate and affordable. Contact California Document Preparers at one of our three Bay Area offices today to schedule an appointment.