Empowering the Workforce: Why valuing immigrant CNAs is the key to solving the national staffing crisis.
Why the Immigrant Workforce Can Solve the Staffing Crisis in Skilled Nursing Facilities
Introduction
Skilled Nursing Facilities (SNFs) in the United States are confronting a severe staffing crisis that has intensified over recent years. In 2024, approximately two-thirds of nursing home providers expressed significant concern about potential closures due to workforce shortages. This alarming trend is underscored by an 82% turnover rate among skilled nursing staff.
The demand for Certified Nursing Assistants (CNAs) in the United States is increasing, primarily due to the aging baby boomer population. Projections indicate a 5% growth in employment for nursing assistants from 2021 to 2031. Conversely, the supply of native-born CNAs has been declining since the mid-2010s. Between 2018 and 2022, the overall nursing assistant workforce decreased by 7.74%. During the first two years of the COVID-19 pandemic, the proportion of immigrant CNAs in nursing homes increased, compensating for the simultaneous reduction in native-born staff. The reliance on immigrant CNAs varies by state, with over 70% in Hawaii and over 60% in California.
Overall, the integration of immigrant workers into the skilled nursing workforce is not only beneficial but crucial for mitigating the current staffing crisis in SNFs. Immigrant workers’ significant contributions help bridge the gap between the growing demand for care and the decreasing supply of native-born CNAs, ensuring the delivery of quality care to the nation's most vulnerable populations.
Why Higher Wages Alone Are Not Enough
The staffing crisis in skilled nursing facilities is influenced by low wages for CNAs. Recent data indicates that the average hourly wage for CNAs ranges between $17 and $25, depending on the state. In Philadelphia, CNAs earn an average hourly wage of approximately $20, with entry-level positions starting around $13.75 per hour and experienced workers earning up to $29.83 per hour. Studies have shown that increasing wages can be a solution to high turnover rates. However, high wages alone does not fully address the multifaceted challenges faced by CNA professionals. Several additional barriers contribute to workforce attrition:
Emotional and mental health challenges: CNAs often endure physically and emotionally demanding work environments, leading to high levels of stress and burnout. The aftermath of the COVID-19 pandemic continues to take a toll on CNAs, as many still face high levels of stress and burnout. While the pandemic intensified workloads and emotional strain, its long-term effects persist, contributing to ongoing turnover rates. Studies indicate that burnout remains prevalent among healthcare workers, with many CNAs struggling to recover from the heightened demands of the crisis. Post-pandemic, nursing assistants continue to report lower levels of compassion satisfaction and elevated stress, making retention and mental health support critical priorities for the industry.
Family responsibilities: About 25% to 30% of CNAs balance demanding work schedules with significant caregiving roles at home. The lack of supportive workplace policies, such as flexible scheduling or childcare assistance, can create additional stress, making it challenging to maintain employment. A study found that a majority (62.9%) of women who were caregivers for children reported spending 41 or more hours per week on caregiving.
High retirement rates: High retirement rates among experienced CNAs significantly contribute to the staffing crisis in skilled nursing facilities. The average age of CNAs is approximately 40 years, with 53% being 40 years or older. This aging workforce indicates that a substantial portion of CNAs are approaching retirement age, leading to increased attrition. The U.S. Bureau of Labor Statistics projects about 216,200 annual openings for nursing assistants and orderlies from 2023 to 2033, largely due to the need to replace workers exiting the labor force, including retirees. As these experienced professionals retire, their departure exacerbates existing staffing shortages, underscoring the necessity for effective recruitment and retention strategies to sustain the skilled nursing workforce.
How Immigrant CNAs Can Help Alleviate the Crisis
Given the declining supply of native-born CNAs, immigrant workforce can be part of the solution in sustaining the workforce. Their contributions offer numerous benefits to SNFs, including:
Cultural competency and multilingual support: A diverse workforce improves patient care by bridging cultural and language barriers, particularly in facilities serving immigrant communities.
Younger workforce for the CNA industry: Immigrant CNAs tend to be younger, as many are willing to take on the demanding roles in skilled nursing facilities. With 62% of nonelderly adult children of immigrants under age 35, the immigrant workforce skews younger. This helps offset the retirement rates of experienced professionals and ensures a steady pipeline of workers committed to long-term careers in healthcare.
Higher retention rate: Research indicates that immigrant CNAs are more likely to remain in their roles long-term. According to Robin Wolzenberg, vice president of clinical and regulatory services for LeadingAge Wisconsin, immigrant nursing assistants have retention rates between 80% to 90%—nearly double that of domestic workers. This is largely due to their strong commitment to stable employment and the economic necessity of maintaining a consistent income. Many immigrant CNAs view their roles as long-term career opportunities rather than temporary jobs, further contributing to workforce stability.
Conclusion
Expanding immigrant CNA workforce is an innovative solution to the staffing crisis in skilled nursing facilities. Their presence helps bridge the gap between increasing demand and a declining native-born workforce, ensuring the delivery of quality care to vulnerable populations. However, addressing the staffing crisis requires a multi-faceted approach that goes beyond wage increases. By investing in workplace support programs, fostering an inclusive environment, and implementing immigration-friendly policies, healthcare institutions and policymakers can create long-term solutions that strengthen the CNA workforce and improve patient care.
