As featured on the Wall Street Journal
DALLAS—In an economy where nearly every industry is short of labor, nursing homes represent an extreme. Their employment has fallen 16% since 2019, and 99% of homes said last fall they didn’t have enough staff.
Burnout and stress are leading causes, but so is a less-known contributor: fewer immigrants.
Emeka Nwaokolo, 36 years old, came to the U.S. from Nigeria for a business trip and met a woman from Dallas he eventually married. He ended up working as a manager for Manchester Care Homes, which runs a network of nursing homes around Dallas.
Over the years, he has referred other Nigerian immigrants from his church to Manchester. In the past few years, though, it has become much tougher for Nigerians to emigrate to the U.S. because of more-stringent visa screening at American consulates abroad. The situation has worsened with pandemic-related backups in immigration processing.
For several years after the 2007-09 recession, roughly a million people moved to the U.S. annually. That pace started to slow during the Trump administration and fell to a trickle after the Covid-19 pandemic started.
The slowdown has left the U.S. with 2.4 million fewer immigrants of working age—about 1% of the working-age population—than if pre-2017 immigration trends had continued, according to Giovanni Peri, a labor economist at the University of California, Davis. The change is being felt like the economy rebounds and many employers struggle to replace workers who were laid off or quit since early 2020, contributing to wage pressure and inflation.
Labor shortages stem from a wide variety of factors, including early retirement, Covid-19 sickness or fear of it, lack of child care, and a desire to start a business. Additionally, Mr. Peri noted, that fewer immigrants are a factor. Industries with above-average levels of foreign-born workers are likelier to have high job-opening rates.
San Antonio home builder Ed Berlanga used to be able to call up his framer or painter and ask if they could assemble an additional crew of two or three workers to take on a new project. “They would say, ‘I have three cousins in Mexico, I’d like to get them to come work with us,’ ” he said.
Now, no one is coming, Mr. Berlanga said, and he faces more competition for his subcontractors’ time as home demand booms. He is also paying more for almost every service. Paint jobs, which routinely cost him $6 a square foot before the pandemic, now cost $7.50.
The smaller number of immigrants appears to be one reason wages are growing briskly in industries where vacancies are high, from hospitality to long-term care. “The numbers suggest it’s a small contributing factor to what’s happening with wage growth,” though likely dwarfed by factors such as the opportunities low-wage employees have to switch to different lines of work, said Daniel Costa, director of immigration law and policy research at the Economic Policy
Institute, a left-leaning think tank.
The slowdown in immigration began in 2017, when the Trump administration adopted a broad range of policies to curb both illegal and legal immigrants, including refugees, foreign recruits, international students, and family members of American citizens.
Those already-reduced flows were then cut in half in 2020 by the onset of the pandemic and the related restrictions. The U.S. closed consulates around the world stopped processing refugees and began turning away most adult migrants at the Southern border under a new public-health authority known as Title 42.
In the 12 months ended last June 30, about 247,000 people moved to the U.S., less than a quarter of the 2016 level and half that of 2019, according to U.S. census data. Those figures don’t distinguish between people who came to the U.S. legally and those who didn’t.
In five top countries where people receive green cards to work in the U. S.—Mexico, the Dominican Republic, Vietnam, the Philippines, and China—the fiscal year ended last September saw decline of the half to two-thirds in green-card issuance from two years prior, according to Department of Homeland Security figures.
Further crimping the availability of foreign-born workers are pandemic-related delays in processing work permits for those already in the U.S. There were 1.6 million pending work permit applications at the U.S. Citizenship and Immigration Services at the end of December, up from 646,000 in 2019. It takes an average of nine to 11 months to process applications, versus three to four months at the end of 2019, according to government data.
Guito Tata who fled violence in Haiti and now lives in Indianapolis received a work permit in 2017 as part of his asylum application and became certified as a commercial truck driver. In 2020 he bought his own truck and began working for an Illinois trucking company, where he estimates he made $7,000 a month after truck payments.
When he applied to renew his work permit in February 2021, the immigration agency didn’t get to his case before his permit—and driver’s license—expired in August.
“I’m sitting at home right now doing nothing,” Mr. Tata said in February. “My truck is just parked somewhere. I’m losing money.”
On March 18, some seven months after the exp01Ktion, he finally got his new work permit.
A spokesman for the immigration agency said it couldn’t comment on an individual case but is aware of unprecedented processing delays and is working to fix them. Last week, the Biden administration said it plans to make expired work permits valid for many immigrants who rely on them. The change wouldn’t help Mr. Tata, whose driver’s license is tied to a valid work permit.
The administration, in a move it said, was to address labor shortages, this year made 55,000 additional visas available for temporary seasonal employers such as landscapers, hotels, and ski resorts, nearly doubling the total available.
A political backlash to the administration’s handling of illegal immigration at the Southern border this year has made officials reluctant to take bigger steps to increase legal immigration, according to people familiar with the administration’s thinking.
About a fifth of consulates still isn’t processing most visas, and even those that are open are buried under a backlog of 7.5 million applications, according to State Department data.
As global travel rebounds, the department aims at “reintroducing appointments for the full range of nonimmigrant visas, including for tourism and business travel,” said a spokesman for the department’s Bureau of Consular Affairs. “We will do so in a manner consistent with science and public health.”
In long-term care, the outlook is especially striking. Demand for home health aides and nursing home care is increasing as baby boomers age. Over the past decade, an average 18% of the sector’s workforce has been foreign-born. That is close to the national average, but a disproportionate share of those with hands-on jobs such as orderlies are foreign-born, according to nursing home operators.
Employment in nursing-care facilities fell to 1.34 million in March from 1.6 million in mid2019. While the U.S. has some visa programs to help foreign doctors or engineers immigrate, operators of long-term-care homes can’t recruit from abroad because the jobs they are filling wouldn’t qualify for any existing visa program.
A September survey by the American Health Care Association and the National Center for Assisted Living, sister trade groups, found 99% of nursing homes and 96% of assisted-living facilities reported staffing shortages.
Because of those shortages, 58% of nursing homes and 28% of assisted-living facilities limited how many new clients they could take on. With fewer caregivers, industry officials say, people looking for homes or health aides sometimes can’t even get their calls to agencies returned.
Adam Lampert, chief executive of Cambridge Caregivers and Manchester Care Homes in Dallas, said that immigrants from Africa make up roughly 80% of his workforce. Many were referred to him through a church. Photo: Zerb Mellish for The Wall Street Journal
Adam Lampert, the chief executive of Mr. Nwaokolo’s Dallas employer, Manchester Care Homes, and a sister company employing home health aides, said that African immigrants make up roughly 80% of his workforce, many referred to him through a church.
Recently, when his team tried to recruit through employee networks, it has come up short. There are fewer new arrivals, the people likeliest to take caregiving jobs.
“We’re not trying to discriminate against [native-born] citizens when we look for employees quite the opposite,” Mr. Lampert said. “We’re just looking for people to fill the roles that we need. And time and again, we find it is the immigrant population that tends to respond to us.”
Mr. Nwaokolo said caregiving can be demanding, such as when he needs to change clients’ adult diapers or help them go to the bathroom. It can be emotionally taxing, too, particularly working with those who have dementia.
Emeka Nwaokolo, an immigrant from Nigeria, is a manager at Manchester Care Homes in Dallas.Photo: Manchester Care Homes
“You have to learn how to be patient,” he said. “You have to watch your anger, because sometimes they can hit you or maybe spit in your face.”
Mr. Nwaokolo, who had been working as a local health official in Nigeria, came to the U.S. in 2015 for a health conference in Boston, where he met his future wife. That meant finding a new job. He wanted to work in healthcare but knew his experience likely wouldn’t transfer. Caregiving appealed to him, he said, because all the children in his village were taught to care
for their elders.
Among Mr. Nwaokolo’s colleagues at the Dallas company, many came to the U.S. on tourist visas and ended up staying, typically by marrying an American. Others were sponsored by immediate family members who are U.S. citizens.
His cousin Anthony Chidera Nwakor, who lives in Lagos, applied for a visa to the U.S. in 2019 and was rejected. He applied again last year and is still waiting for an appointment at the U.S. consulate in Lagos. “I want to come there and make some connections, maybe work or go to school,” he said.
Mr. Nwaokolo said he has received offers to work as a traveling home nurse for as much as triple the $15 an hour he currently earns. He has decided to stay put for now because he feels some loyalty to Mr. Lampert, the chief executive of Manchester Care Homes, who paid for his nursing training and has lent him money for his family’s medical care in Nigeria.
“This place is like a family to me,” Mr. Nwaokolo said.
Write to Michelle Hackman at [email protected]