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Better pay, more training and options for career advancement may provide a solution

The people who make a living caring for older adults primarily women, typically women of color, often immigrants are critical to the smooth operation of the health care system. Yet home health aides and other direct-care providers are among the lowest-paid and least respected workers in the U.S.

The problem will only worsen if the jobs don't improve, advocates say. The solution? Better pay, more training and options for career advancement. Since immigrants make up a large portion of the direct-care workforce, immigration policy also needs to be addressed, some say.

"It's been about 20 years since our safety net was put into place."

"We have essentially added another generation onto our lifespan without adapting policies" to account for increasing longevity, said Ai-Jen Poo, president of theNational Domestic Workers Allianceand executive director ofCaring Across Generations, a coalition that advocates for caregivers.

"It's been about 20 years since our safety net was put into place," she told journalists at Columbia University's Age Boom Academy. Caregiving is "among the fastest growing occupations," and one that can't be outsourced or automated, said Poo, a Next Avenue Influencer in Aging.

"We know these are going to be a huge part of the jobs of the future. We simply have to make them good jobs."

"There's no way to meet the demand in this country without a strong immigrant workforce," said Poo. She said that a path to citizenship would help immigrants and the workforce. "Home care workers enable tens of millions of families to go to work; it really is the foundation of all other work."

No Improvement Without Better Pay?

The bottom line is wages, said Nicole Jorwic, chief of campaigns and advocacy for Caring Across America. According to coalition data, home health aides make minimum wage or less in most states. "The reality is these are jobs that are skilled jobs," Jorwic said in an interview.

"Caregivers are really badly prepared. Caregiving is not an easy task."

However, she said that even in states that use their American Rescue Plan funds to raise direct care workers' wages, people can still earn more at big-box stores. "Even states recognizing the importance of this workforce are still struggling with turnover and vacancy rate because of competition and decades of lack of investment," Jorwic said.

"Covid really brought home the inadequacies of the current system," John Beard, a University of New South Wales professor, told journalists at Columbia University's Age Boom Academy. "Caregivers are really badly prepared. Caregiving is not an easy task."

According to Beard, former director of aging and life course at the World Health Organization, "the stress is exacerbated by the fact that they've had inadequate training."

Israel, South Korea, Germany, Japan and the Netherlands have universal long-term care insurance, "structures that create jobs for younger people" in addition to a "care economy," he added.

Providing training to paid and unpaid caregivers alike, perhaps by "linking" family caregivers with professional caregivers, and providing adequate time off are supports that would make caregiving less of a burden, said Beard.

Pay Is Only A Part

The direct-care workforce is more significant than any other single occupation, with 1.2 million new jobs expected between 2020 and 2030, saidKezia Scales, vice president of research and evaluation at policy and advocacy firm PHI.

"There are very limited opportunities for people to progress beyond these entry-level positions."

"A combination of strategies" across the spectrum will be needed to ensure these jobs are filled, Scales said in an interview. For example, better pay is "one part of a broader strategy," she said.

"Another key aspect of the challenge we're facing with recruitment and retention is around training and career development," Scales said. "The training landscape for direct care workers is very fragmented" and often inadequate for the job's complexity.

"There are very limited opportunities for people to progress beyond these entry-level positions," Scales explained, adding that leads people to leave for other, more lucrative industries.

Many long-term care providers are investing in training, but "it's not consistent across the board," said Scales. And some states are targeting training with American Rescue Plan funds for home- and community-based services.

"A number of states are investing some of that enhanced funding in their training infrastructure to think about a system that provides good, solid, recognized entry-level training that includes additional potential credentials and career progression," she noted.

Wisconsin, for example, is launching a program for training and certifying direct care professionals to teach them skills they can take from one employer to another without retraining.

The state says the program, which aims to certify at least 10,000 new workers, will "professionalize the career" as employers officially recognize workers' skills and workers have a "career ladder" to climb.

Researchers say that direct-care jobs are physically and mentally taxing and can hurt workers' health. Scales studied these workers' health care experiences compared with those of other health care workers and found that direct care workers were less likely to have health insurance cost was cited as a primary reason and more likely to have health problems.

"The training landscape for direct care workers is very fragmented" and often inadequate for the job's complexity.

"These are low-wage jobs, and they are filled primarily by women, people of color, and immigrants who face structural barriers" to accessing health care, Scales said. "The work itself is very physically and emotionally demanding," and "it's stressful."

In addition, in-home work can be isolating, and nursing home jobs often come with crushing caseloads, she said. As a result, PHI has published a set of guidelines, "The 5 Pillars of Direct Care Job Quality," laying out elements that would help the direct-care workforce, including wages, training and support.

Immigrants Remain A Force

With immigrants making up one in four direct-care workers, the federal government may have to step up. Changes to immigration policy are still necessary to meet the growing demand for direct care,said Daniel Kosten, assistant vice president of policy and advocacy at the National Immigration Forum.

"I believe things are progressively getting worse," said Kosten, who published a report two years ago highlighting the shortage of direct-care workers and immigrants' vital role in filling the gap.

Limiting immigration has hurt the market in Britain, Beard noted."With Brexit, it became a lot harder to access the sorts of people who often fill caregiving roles," a situation that's been exacerbated by the current economic situation.

"Immigration into the U.S. the last several years, especially during the Trump administration but also going into the Biden administration, hasn't improved a whole lot," Kosten said."There are a lot of backlogs in terms of people waiting for their visas, and also in terms of just processing."

Kosten's group is part of a coalition planning to lobby the Labor Department to expand its list of Schedule A jobs hiring foreign workers would not hurt U.S. workers' wages or working conditions to include positions like home health aides.

Outgoing Labor Secretary Marty Walsh, Kosten noted, has spoken out in favor of immigration reform to address a worker shortage. Though the coalition hasn't yet engaged with the administration, "we think we have an open audience at DOL on this particular issue."

Trade associations are becoming more vocal about the issue, "recognizing the fact that the demand is so large they cannot meet it with native-born Americans," he said.

Editor's Note:This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and The Commonwealth Fund.

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Could Professionalizing the Caregiving Workforce Have Impact? - Next Avenue

The U.S. government's focus on technological competition with China may lead to new rules curbing foreign tech investments.

The Biden administration is allegedly working on an executive order limiting investments in certain technologies, such as artificial intelligence, in overseas countries, according to reporting by the Wall Street Journal earlier this month. Biden has yet to issue such an executive order, but his proposed FY 2024 budget released March 9 requested "discretionary and mandatory resources to out-compete China and advance American prosperity globally."

"China is the United States' only competitor with both the intent to reshape the international order and, increasingly, the economic, diplomatic, military and technological power to do it," according to the budget.

The Biden administration already imposed export controls in October 2022 limiting China's ability to acquire advanced computing chips and is considering further limiting exports to the country. But issuing rules on investments in the Chinese tech sector would be a "radical departure" from former U.S. industrial policy, said Chris Meserole, director of the Brookings Institution's Artificial Intelligence and Emerging Technology Initiative.

"In principle I'm not averse to cutting off nodes of funding from the U.S. to the Chinese tech sector," he said. "The devil will be in the details of how narrowly they are going to circumscribe different investments."

For Robert Atkinson, president of the Information Technology and Innovation Foundation, working closely with allies on export controls and tech transfer limits is "critical."

"Limiting exports of key technology to China can be an important tool to push back against unfair Chinese government technology policy," Atkinson said. "But unless our allies cooperate, we risk simply cutting off U.S. exports and ceding the marketplace to foreign firms."

Tensions between the U.S. and China have escalated as concerns about China's technological advancement are increasing fears among policymakers about how the country might use its position as a global leader in certain technologies. Meserole said that could include the country's use of AI for commercial surveillance or moving against Taiwan, a global leader in semiconductor manufacturing.

The U.S. government should've acted on the competitive threat in advanced technology development posed by China 10 years ago, but Meserole said it's not too late.

One of the Biden administration's first steps in competing with China on a technological front stemmed from legislation Congress passed last year. Before that, former U.S. president Donald Trump also took actions to counter China's growing influence.

Biden signed the Bipartisan Infrastructure Law and the CHIPS and Science Act of 2022 into law last year, which increased investments in domestic manufacturing of technologies like semiconductors as well as research and development into AI and quantum computing.

We created a regime that is very powerful economically. They are learning how to flex that economic might and convert it into political and strategic power. Chris MeseroleDirector, Brookings Institution's Artificial Intelligence and Emerging Technology Initiative

The legislation aims to stem the tide of more than 30 years of U.S. investment and interconnectedness with China, Meserole said. He described increasing U.S. efforts to compete with China as "the ocean liner that takes a while to turn around."

Meserole said U.S. investment in China over the years, particularly in the early 2000s, marked a historical moment where it seemed like investing in the country's industrial and technological development would also influence it, over time, to become more open and less authoritarian economically and politically.

At the time, U.S. leadership in advanced technology development was powerful enough that leaders didn't foresee the possibility of losing that position, he said.

However as Chinese President Xi Jinping came into power in 2013 and the country flourished economically, it didn't come with the kind of political change the U.S. anticipated, Meserole said.

"No administration prior to the Trump administration really thought there is a significant chance that China is going to get so good at this that they could surpass us in certain areas of technological development," Meserole said.

Since China has grown substantially without having liberalized, it means they're going to be a strategic competitor to the U.S., he added.

"We created a regime that is very powerful economically," he said. "They are learning how to flex that economic might and convert it into political and strategic power."

Beyond measures the U.S. has taken already, Meserole said, it's incumbent on both the U.S. and European Union to set standards for use of technology like AI to protect against its misuse by governments and corporations globally.

He said it's also crucial for the U.S. to focus on immigration reform as part of boosting its technological expertise while investments allow new semiconductor plants and other facilities to be built stateside. Immigration reform is a hot button issue that has long been a struggle for Congress to resolve.

"The only way we create a vibrant ecosystem domestically is by bringing in experts around the world to staff these facilities and then, hopefully, stay," he said. "We don't have that expertise in house right now."

Makenzie Holland is a news writer covering big tech and federal regulation. Prior to joining TechTarget, she was a general reporter for the Wilmington StarNews and a crime and education reporter at the Wabash Plain Dealer.

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Tech competition with China remains top of mind for U.S. - TechTarget

A dreamer and immigration reform advocate from West Chester will be Jill Bidens guest at the State of the Union  The Philadelphia Inquirer

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A dreamer and immigration reform advocate from West Chester will be Jill Bidens guest at the State of the Union - The Philadelphia Inquirer

Davos 2023: Immigration reform, reskilling, upskilling in green growth essential for future of work, say WEF leaders  People Matters

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Davos 2023: Immigration reform, reskilling, upskilling in green growth essential for future of work, say WEF leaders - People Matters

It is a moral failing and a national shame when a father and his baby daughter drown seeking our shores. When children are locked away in overcrowded detention centers and the government seeks to keep them there indefinitely. When our government argues in court against giving those children toothbrushes and soap. When President Trump uses family separation as a weapon against desperate mothers, fathers, and children seeking safety and a better life. When he threatens massive raids that would break up families who have been in this country for years and targets people at sensitive locations like hospitals and schools. When children die while in custody due to lack of adequate care.

Trump has waged an unrelenting assault on our values and our history as a nation of immigrants.

Its wrong, and it stops when Joe Biden is elected president.

Unless your ancestors were native to these shores, or forcibly enslaved and brought here as part of our original sin as a nation, most Americans can trace their family history back to a choicea choice to leave behind everything that was familiar in search of new opportunities and a new life. Joe Biden understands that is an irrefutable source of our strength. Generations of immigrants have come to this country with little more than the clothes on their backs, the hope in their heart, and a desire to claim their own piece of the American Dream. Its the reason we have constantly been able to renew ourselves, to grow better and stronger as a nation, and to meet new challenges. Immigration is essential to who we are as a nation, our core values, and our aspirations for our future. Under a Biden Administration, we will never turn our backs on who we are or that which makes us uniquely and proudly American. The United States deserves an immigration policy that reflects our highest values as a nation.

Today, our immigration system is under greater stress as a direct result of Trumps misguided policies, even as he has failed to invest in smarter border technology that would improve our cargo screening.

His obsession with building a wall does nothing to address security challenges while costing taxpayers billions of dollars. Most contraband comes in through our legal ports of entry. Its estimated that nearly half of the undocumented people living in the U.S. today have overstayed a visa, not crossed a border illegally. Families fleeing the violence in Central America are voluntarily presenting themselves to border patrol officials. And the real threats to our securitydrug cartels and human traffickerscan more easily evade enforcement efforts because Trump has misallocated resources into bullying legitimate asylum seekers. Trump fundamentally misunderstands how to keep America safe because he cares more about governing through fear and division than common sense solutions.

Trumps policies are also bad for our economy. For generations, immigrants have fortified our most valuable competitive advantageour spirit of innovation and entrepreneurship. Research suggests that the total annual contribution of foreign-born workers is roughly $2 trillion. Key sectors of the U.S. economy, from agriculture to technology, rely on immigration. Working-age immigrants keep our economy growing, our communities thriving, and country moving forward.

The challenges we face will not be solved by a constitutionally dubious national emergency to build a wall, by separating families, or by denying asylum to people fleeing persecution and violence. Addressing the Trump-created humanitarian crisis at our border, bringing our nation together, reasserting our core values, and reforming our immigration system will require real leadership and real solutions. Biden is prepared on day one to deliver both.

As president, Biden will forcefully pursue policies that safeguard our security, provide a fair and just system that helps to grow and enhance our economy, and secure our cherished values. He will:

Joe Biden understands the pain felt by every family across the U.S. that has had a loved one removed from the country, including under the Obama-Biden Administration, and he believes we must do better to uphold our laws humanely and preserve the dignity of immigrant families, refugees, and asylum-seekers.

The Obama-Biden Administration strongly supported the bipartisan comprehensive immigration solution that passed the Senate in 2013 and which would have put our countrys immigration policies on a much stronger footing. When the Republican House refused to even bring that bill to a vote, the Administration took action to fundamentally change the course of our nations immigration policies, offering relief and stability to hundreds of thousands of undocumented immigrants who contribute to our communities every single day.

As Vice President, Biden championed the creation and expansion of the Deferred Action for Childhood Arrivals (DACA) program; the Deferred Action for Parents of Americans (DAPA) program; the Central American Minors program, which allowed parents with legal status in the U.S. to apply to bring their children up from Central America to live with them; and the creation of a White House task force to support new Americans and help them integrate into their new homes and communities.

In a departure from their predecessors, the Obama-Biden administration took steps to prioritize enforcement resources on removing threats to national security and public safety, not families. It also issued guidance designed to end mass work-place raids and to prevent enforcement activities at sensitive locations such as schools, hospitals, and places of worship.

Critically, the Obama-Biden administration recognized that irregular migration from the Northern Triangle countries of Central America cannot be effectively addressed if solutions only focus on our southern border. The better answer lies in addressing the root causes that push desperate people to flee their homes in the first place: violence and insecurity, lack of economic opportunity, and corrupt governance. As Vice President, Biden spearheaded the administrations efforts in El Salvador, Guatemala, and Hondurasbringing high-level attention to these issues and securing bipartisan support for a $750 million aid package to help the Northern Triangle countries implement critical, concrete reforms. These efforts were beginning to deliver results and reduce migration rates until Trump froze the majority of the funding, began his campaign to terrorize immigrants and assault the dignity of the Latino community, and created the current humanitarian crisis at our border with his irresponsible and inhumane policies.

As president, Biden will finish the work of building a fair and humane immigration systemrestoring the progress Trump has cruelly undone and taking it further. He will secure our border, while ensuring the dignity of migrants and upholding their legal right to seek asylum. He will enforce our laws without targeting communities, violating due process, or tearing apart families. He will ensure our values are squarely at the center of our immigration and enforcement policies.

Take Urgent Action to Undo Trumps Damage and Reclaim Americas Values

The next president will need to take urgent action to end the Trump Administrations draconian policies, grounded in fear and racism rather than fact, work to heal the wounds inflicted on immigrant communities, and restore Americas moral leadership. As president, Biden will move immediately to ensure that the U.S. meets its responsibilities as both a nation of laws and a nation of immigrants.

In the first 100 days, a Biden Administration will:

Modernize Americas Immigration System

As president, Biden will commit significant political capital to finally deliver legislative immigration reform to ensure that the U.S. remains open and welcoming to people from every part of the worldand to bring hardworking people who have enriched our communities and our country, in some cases for decades, out of the shadows. This is not just of concern to Latino communities, this touches families of every heritage and background. There are approximately 1.7 million undocumented immigrants from Asia in the U.S., as well as hundreds of thousands from Europe, the Middle East, Africa, and the Caribbean. Biden will immediately begin working with Congress to modernize our system, with a priority on keeping families together by providing a roadmap to citizenship for nearly 11 million undocumented immigrants; growing our economy and expanding economic opportunity across the country by improving and increasing opportunities for legal immigration; and preserve the longstanding directive of our immigration system to reunite families and enhance our diversity.

Immigrants are essential to the strength of our country and the U.S. economy. When immigrants choose to come to the U.S., they bring their unique traditions and contributions to the rich cultural tapestry of our country. They are also a key driver of economic growth. The Congressional Budget Office found that the 2013 comprehensive immigration package would have, over time, increased the size of the economy by more than 5 percent. Currently, we are not taking advantage of Americas ability to attract the best and brightest workers in the world. A modern immigration system must allow our economy to grow, while protecting the rights, wages, and working conditions of all workers, and holding employers accountable if they dont play by the rules. Immigrant rights and worker rights are deeply connected. We must ensure that every worker is protected, can join a union, and can exercise their labor rightsregardless of immigration statusfor the safety of all workers.

Joe Biden will work with Congress to pass legislation that:

Welcome Immigrants in our Communities

Immigrants bring tremendous economic, cultural, and social value to their new communities. Even in cities hit hard by the loss of manufacturing jobs, immigrants are a key driver of entrepreneurship and population growth.

According to a 2017 report by the New American Economy, from 2000 to 2015, immigrants accounted for 49.7% of all population growth in the Great Lakes region over 1.5 million people which helped offset the impacts of population decline in cities like Syracuse and Akron. Immigrants are bringing new life to local economiesstarting businesses, paying taxes, and spending their dollars back into their new communities. The Center for American Progress has estimated that DACA recipients will contribute about $460.3 billion to the national GDP over the next decade. The U.S. needs to retain the talents and drive of American-raised Dreamers to secure those benefits for our own economic health.

Its time for the federal government to listen and learn from local municipalities across the country that have built vibrant and inclusive communities and economies by developing concrete policy and program recommendations at the grassroots level to provide opportunities for new immigrants.

As president, Biden will:

Reassert Americas Commitment to Asylum-Seekers and Refugees

The Trump Administrations policies have created a humanitarian disaster at our border and grossly mismanaged the unprecedented resources Congress has allocated for it. Trump has diverted money to terrorize immigrant families, even as CBP facilities at the border are overwhelmed. After almost three years, this Administration still doesnt have a coherent plan for the protection and processing of children and families. CBP officers in the field, who are neither trained nor equipped for this work, are shouldering outsized responsibility for managing this crisis. And through his Migrant Protection Protocol policies, Trump has effectively closed our country to asylum seekers, forcing them instead to choose between waiting in dangerous situations, vulnerable to exploitation by cartels and other bad actors, or taking a risk to try crossing between the ports of entry. In other words, Trumps policies are actually encouraging people to cross irregularly, rather than applying in a legal, safe, and orderly manner at the ports.

As president, Biden will:

Tackle the Root Causes of Migration

The worst place to deal with irregular migration is at our own border. Rather than working in a cooperative manner with countries in the region to manage the crisis, Trumps erratic, enforcement-only approach is making things worse. The best way to solve this challenge is to address the underlying violence, instability, and lack of opportunity that is compelling people to leave their homes in the Northern Triangle countries of El Salvador, Guatemala, and Honduras in the first place. As Vice President, Biden was the architect of a major program of U.S. assistance to advance reforms in Central America and address the key factors driving migration.

As president, Biden will pursue a comprehensive strategy to strengthen the security and prosperity of Central America in partnership with the people of the region that:

Implement Effective Border Screening

Like every nation, the U.S. has a right and a duty to secure our borders and protect our people against threats. But we know that immigrants and immigrant communities are not a threat to our security, and the government should never use xenophobia or fear tactics to scare voters for political gain. Its irresponsible and un-American. Building a wall from sea-to-shining-sea is not a serious policy solutionits a waste of money, and it diverts critical resources away from the real threats. Today, illicit drugs are most likely to be smuggled through one of the legal U.S. ports of entry. They are hidden among commercial cargo in semi-trucks or in a hidden compartment of a passenger vehicle. A wall is not a serious deterrent for sophisticated criminal organizations that employ border tunnels, semi-submersible vessels, and aerial technology to overcome physical barriers at the borderor even for individuals with a reciprocating saw. We need smart, sensible policies that will actually strengthen our ability to catch these real threats by improving screening procedures at our legal ports of entry and investing in new technology. The border between Mexico and the U.S. shouldnt be treated like a war zone; it should be a place where effective governance and cooperation between our two countries helps our communities thrive and grow togetherfacilitating commerce and connection, and fueling the exchange of cultures and ideas.

As president, Biden will:

Read Joes Plan to Build Security and Prosperity in Partnership with the People of Central America >>

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The Biden Plan for Securing Our Values as a Nation of Immigrants