http://www.philly.com/mld/inquirer/busi ... 980799.htm

Posted on Mon, Oct. 24, 2005

Foreign nannies for the elderly

Just as immigrants helped raise American children, skilled nurses from overseas will be needed soon.

By Ricardo Alonso-zaldivar

Los Angeles Times


WASHINGTON - Foreign nannies long have helped to raise American children. Now immigrants are moving into another aspect of caregiving: tending to the needs of nursing-home residents.

And they are winning a larger share of these highly skilled positions, according to a report released this week by AARP, the organization for senior citizens.

The ability to recruit nurses and other trained health workers overseas, the report said, will be a critical factor in determining whether millions of baby boomers receive high-quality care in their old age. The number of workers providing long-term care is expected to grow 45 percent, to 2.7 million, between 2000 and 2010, the report said.

"The quality of the long-term care received by older persons in developed countries will depend increasingly on the quality of engagement with the less-developed countries that are likely to supply more of the workers in the future," the report said.

In particular, by the time baby boomers reach their mid-70s and 80s, many nurses and aides may come from China, say industry officials, who regard that country as the new recruitment frontier.

Immigrants long have occupied such low-paying U.S. jobs as farm work, and in recent years they have moved into higher-paying construction jobs. But in big cities, they now account for more than one-fourth of the nurses and aides in nursing homes, the AARP report said.

Across the United States, the number of immigrant nurses providing long-term care has nearly quadrupled since 1990, while the number of nursing aides has more than doubled, the report found. About 64,000 immigrant nurses were working in nursing homes in 2003, along with 145,000 foreign-born aides.

Hiring immigrant workers has helped nursing homes meet staffing needs, but it has also raised concerns about language and cultural barriers between caregivers and elderly patients, some of whom suffer from debilitating illnesses such as dementia.

"We're talking about the care of the oldest and frailest people in the country, so it does raise questions about training and cultural exchange," said Elizabeth Clemmer, associate director of the AARP Public Policy Institute, which sponsored the study.

About 12 percent of foreign-trained nurses report problems understanding English-speaking patients and staff, according to research cited in the report.

Foreign nurses are seen as less likely to speak up if a doctor's orders seem confusing or wrong. "American-trained nurses are more assertive," said Louise Maus of the American Association of Homes and Services for the Aging, which represents nonprofit facilities. She said nurses coming from abroad "are well-trained clinically, but there still can be questions as to cultural differences."

There also are some concerns about the quality of training for foreign health-care-givers. "Some nurses are taught to international standards so that graduating nurses can be licensed in other countries," the new report said. "But in some countries such as the Philippines and India, the quality of new nursing schools to meet increasing demands is uneven."

In the United States, the demand for foreign caregivers is the result of historically low unemployment, said Ron Hoppe, a founder of WorldWide HealthStaff Association, a North Carolina company that recruits health-care professionals from overseas.

Low-skilled jobs are particularly hard to fill. "Burger King is paying as much or more as the local nursing home is able to pay nursing assistants," Hoppe said. "Employers just have a very, very difficult time."

Also, nursing-home work is demanding, and calls for overnight and weekend shifts. Many Americans see it as low-status employment.

"These kinds of jobs are considered unattractive," Clemmer, the AARP executive, said. "If the United States were to treat these jobs differently, there would be less of a need for immigration."