Why the eldercare workforce crisis is not just a nursing home problem

Millions of older Americans are entering their golden years, driving up demand for care at a pace the workforce is struggling to keep up with. Over the next decade, the number of people over the age of 85 is expected to double, meaning the demand for eldercare professionals isn’t going away anytime soon.

Nursing homes, assisted living communities and home care are all feeling the imbalance. But a recent Massachusetts Institute of Technology (MIT) study reveals an important opening to addressing this problem. It shows that in metro areas with higher immigration, nursing homes had more caregivers on staff, which led to better patient outcomes and fewer hospitalizations.

This is not an abstract research finding. Rather, it reveals to caregiving operators that this is a clear issue of staffing and care delivery. When facilities lack the staff needed to fill core roles, covering schedules becomes more difficult, overtime expenses rise, employee turnover unravels, and the burden lands on the already burdened staff that remains.

The end result isn’t just labor stress. It creates a level of operational instability that will be increasingly difficult to manage as this crisis deepens over the coming years.

This is no longer just a long-term care problem

In a health care industry rife with staffing issues across many sectors, it’s tempting to view the eldercare shortage as confined to nursing homes and assisted living. The reality, though, is that the shortage reaches much further, putting additional pressure on hospitals, home health, family caregivers and even primary care physicians who are often left helping patients navigate the consequences of weak support outside the exam room.

A stronger eldercare workforce makes it more likely that primary care practices can focus on treatment and continuity instead of constantly triaging gaps in the care environment.

That’s one reason MIT’s findings are so important. More staffing in long-term care settings was associated with better outcomes for residents, including fewer hospitalizations. Eldercare stability is important to physicians because avoidable hospital use and poor follow-up do not just increase costs; they also complicate continuity of care for older patients with chronic conditions.

The domestic workforce is not keeping pace

While MIT’s study shows the value of immigrant workers, local recruiting should remain an important piece of the equation. Improving retention of the workers who are already here is important as well, through things like better onboarding, stronger supervision, clearer pathways for advancement and more visible wage progression. Facilities can also help the crisis by doing more to show workers that caregiving can be a real career path rather than an exhausting job with little room to grow.

The data show, however, that domestic workers alone won’t be enough to close the gap, especially as demand keeps growing.

Medical Economics recently illustrated the depth of immigrant presence in the U.S. health care workforce, who make up 27% of today’s stable of physicians and 17% of nurses. Foreign-born workers are heavily represented across health care support occupations as well. These numbers matter in eldercare because these are among the hardest roles to fill and among the most physically and emotionally demanding.

If caregiving operators rely only on local labor in already tight markets, many will find themselves stuck in the current cycle of vacancies, overtime and churn.

A better response uses more than one lever

It’s important to consider that there is no single answer to solving this problem. Those in the strongest position are likely to use multiple strategies together.

One of those strategies is to improve support for entry-level caregivers. Rushed onboarding and chaotic schedules can make new hires more likely to leave before they ever really settle into the role. Another is creating internal ladders for advancement so workers can clearly see, for example, how an aide role can lead to increased responsibility, more training and better pay over time.

A more deliberate approach to workforce planning is another key that can unlock this crisis when used together with other tactics. It starts by not treating every vacancy like a one-off emergency. Creating pipelines and relationships, including broader planning that uses international caregivers, is easily one of the most overlooked tactics to help get out of this rut.

The point is not to replace domestic hiring, but to supplement it. Widening the pool and building a more durable staffing model means no source of legal labor should be off the table.

Where international caregivers and EB-3 fit

The MIT study provides a real-world case study of how immigrants are already helping reduce pressure in some eldercare systems. Those in leadership for caregiving providers should consider a practical response. Immigrant caregivers are not a theoretical option; they are already an important part of the system.

For some, lawful workforce pathways such as the EB-3 visa could be part of the answer that they didn’t even know existed. This visa allows employers to sponsor foreign workers for permanent, full-time roles when domestic workers cannot be found. While it’s not a quick fix and requires some planning, compliance and patience, it can help solidify a long-term workforce strategy.

At the end of the day, this isn’t only a crisis specific to caring for aging Americans. When eldercare is understaffed, the burden is extended across an already taxed health care system. It spills into physician offices through delayed follow-up, caregiver confusion, preventable complications and greater strain on clinical teams already stretched to their limits. A stronger eldercare workforce supports better continuity for patients and reduces some of that pressure upstream.

The entire health care sector will benefit from stronger eldercare staffing, especially as our oldest generations age. Those caregivers in the strongest position will be the ones who view this as a long-term workforce challenge, one that requires better retention, planning and even a willingness to use every lawful staffing tool available, including international caregivers where they make sense.

John Dorer is CEO of EB3.Work, a workforce solutions company that helps U.S. employers address labor shortages through lawful and compliant staffing strategies.