New study links more immigrants with lower elderly mortality

New research finds the addition of a thousand new immigrants in a metropolitan area reduces elderly mortality by about 10 deaths than would be typical.

Why? Because among the newcomers are foreign-born healthcare workers who are arriving amid a critical nationwide shortage, according to the study’s authors, who hail from Harvard Medical School, the Massachusetts Institute of Technology, and the University of Rochester.

David Grabowski, HMS professor of healthcare policy and a study author, said more immigration brings more physicians, nurses, and aides, but especially long-term care workers, both for private homes and nursing facilities.

The study indicates that adding 1,000 immigrants to what’s called a “metropolitan statistical area” — a city plus surrounding towns — means an additional 142 foreign-born healthcare workers of all kinds.

The study also indicates that foreign-born workers don’t displace those born here but add to a healthcare workforce that remains in short supply.

One sign of that, Grabowski said, is that increased immigration leads to a net increase in the long-term care workforce rather than competition for a static number of openings.

Plus, he said, the expanded pool of available workers does not depress wages as might be expected if many were vying for a limited number of jobs.

“This result is very supportive of the value that foreign-born workers add to the health of our population,” Grabowski said. “When you have an increase in immigration, you end up with more long-term care workers. It’s additive, not substitutive. It doesn’t crowd out anyone’s jobs, and it doesn’t appear to lower wages at all.”

The research, published as a National Bureau of Economic Research working paper in February, follows on earlier work by Grabowski that has its roots in the pandemic, a time when the importance of the long-term care workforce became apparent.

That research, Grabowski said, explored the makeup of that workforce and highlighted the importance of immigrants in a field that requires some skill but offers relatively low pay.

The current paper, which received support from the National Institute on Aging, highlighted the already crucial role of immigrants in the U.S. healthcare system.

About 18 percent of all healthcare workers are immigrants, the authors wrote, while roughly one in five nursing-home workers are immigrants and one in three home-care workers are immigrants.

“There’s shortages across the board, and I think there are opportunities for immigrants to contribute in all of these areas,” Grabowski said.

Prior research indicates that, as immigration increases, institutionalization of older adults falls, likely because more home-care workers become available.

The ability to age at home, Grabowski said, is a factor in the decline in mortality revealed in the current paper.

That’s because older adults tend to do better aging in a familiar environment, close to family and friends. More healthcare workers not only improve access to care but also quality of care, both at home and in nursing homes.

“There’s an argument that bad things happen oftentimes to older adults in nursing homes. When you’re in those congregate settings, you’re more likely to have an infection, more likely to have weight loss or hospitalizations,” Grabowski said. “When you’re in the home your mental health is better. It’s where everybody wants to be.”

Though the paper’s release comes at a time of heightened tension around immigration and America’s immigrant workforce, Grabowski said work on it began several years ago.

That doesn’t mean, however, that the research doesn’t have implications for current immigration policy, Grabowski said.

The paper indicates that a 25 percent increase in the flow of immigrants nationally would reduce elderly mortality by about 5,000.

However, if the political priority is to limit overall immigration, then it makes sense to consider special visas for foreign-born healthcare workers or those willing to enter the healthcare workforce, Grabowski said.

“I’m not really thinking of this as a current policy issue, but as a broader issue around how can nursing homes and home-care agencies solve this workforce shortage that became particularly acute during the pandemic,” Grabowski said. “Immigration could be one piece of a broader set of policies, including wages, benefits, and making this a better job.”

The nation’s demographic trends suggest that the worker shortage is only going to get worse, Grabowski said, with fewer younger workers providing care for more older adults.

“When you look at the demographics, it’s really alarming in terms of the number of older adults we’ll have relative to the number of middle-aged individuals,” Grabowski said. “We’re going to need help caring for all these older adults. I think technology can help a little at the margins, but it’s not going to replace the workers. Either we draw more native-born workers into this sector or we greatly increase our efforts to attract foreign-born individuals.”