A direct care worker visa policy to support the aging US population

Health & Aging Health Access & Equity Health Care Industry Health Care Policy

健康与老龄化健康获取与公平医疗保健行业医疗保健政策

Over 20 million adults in the U.S. need long-term care or support in daily activities due to disabilities or other functional limitations associated with aging.

在美国，超过 2000 万成年人由于残疾或与衰老相关的其他功能限制而需要长期护理或日常活动支持。

Direct care workers—including home health aides, personal care aides, and nursing assistants—can provide these services in institutional settings or at home.

In recent years, and exacerbated by the pandemic, growth in these professions has been constrained by low recruitment and retention, largely reflecting poor job quality and low wages.

近年来，受疫情影响，这些职业的增长受到招聘和保留率低的限制，这在很大程度上反映了工作质量差和工资低。

The result has been understaffing in institutional settings and unmet need in the home health market.

其结果是机构环境中人员不足，家庭健康市场的需求未得到满足。

In the next decade, the gap between what the aging population in the U.S. needs and the capacity of the direct care workforce to deliver on those needs will grow.

The population 65 and older will grow from 65.6 million to 77.5 million, and the number of people 85 and older will grow from 6.8 million to 11.1 million.

65岁及以上人口将从6560万增加到7750万，85岁及以上人口将从680万增加到1110万。

As the population ages, the disabled population 65 and older is projected to grow by more than 6 million.

随着人口老龄化，65岁及以上的残疾人口预计将增长超过600万。

Reflecting that demand, about 1.28 million additional workers will be needed in the sector by 2036, an increase of about 35 percent versus today.

根据这一需求，到 2036 年，该行业将需要约 128 万名额外工人，比现在增加约 35%。

While improving working conditions, including compensation, can attract more people to the direct care workforce, this alone will not be sufficient to meet growing need.

虽然改善工作条件（包括薪酬）可以吸引更多人加入直接护理队伍，但仅此不足以满足不断增长的需求。

The solution to the emerging direct care workforce crisis should also include the targeted recruitment of immigrants to work in the U.S. in this industry.

解决新兴的直接护理劳动力危机还应包括有针对性地招募移民到美国从事该行业工作。

Immigrants are disproportionately represented in the direct care workforce, and the presence of immigrants has been shown to improve quality of care and reduce elderly mortality.

Tara Watson (Brookings Institution) proposes a temporary direct care worker visa, the H-1D, that offers a tailored and flexible way to address the looming workforce challenge and improve the quality of care available to older people needing support.

The H-1D visa would be a temporary employment-based visa for immigrants who have at least two years of experience in direct care to work in the United States in the direct care field.

H-1D 签证是一种临时就业签证，适用于在美国直接护理领域拥有至少两年直接护理经验的移民。

The visa would be additive to existing legal pathways and would be available to immigrants already living in the United States as well as to new immigrants.

Like the H-1B visa, the H-1D would be structured as a three-year initial visa with an option for renewal.

与 H-1B 签证一样，H-1D 的初始签证有效期为三年，并可选择续签。

It would be dual intent with the possibility of applying for legal permanent residence after six years and would include dependents.

这将是双重意图，六年后可以申请合法永久居留，并且包括家属。

The program includes safeguards to reduce the risk of exploitation and includes support for training and professional development for direct care workers.

Following an initial pilot, 65,000 visas would be made available each year, a level projected to meet about 35 percent of the needed growth in the direct care workforce over a decade.

初步试点后，每年将发放 65,000 个签证，预计这一水平可满足十年内直接护理劳动力所需增长的 35% 左右。

The program includes a commission to periodically review the numerical caps, allowing flexibility if the demographic or economic outlook changes.

The H-1D would generate a meaningful new labor pathway with strong worker protections and an above-market wage floor.

H-1D 将产生一条有意义的新劳工途径，为工人提供强有力的保护，并提供高于市场水平的工资底线。

It allows for the recruitment of additional direct care workers from abroad as well as the stabilization and regularization of workers already contributing to the U.S. direct care sector.

At the same time, the numeric cap is well below what would be necessary to fully address the direct care worker challenge through immigration alone, leaving room to grow the domestic workforce.

By expanding the direct care workforce, the H-1D would improve health and well-being for older adults.

通过扩大直接护理人员队伍，H-1D 将改善老年人的健康和福祉。

An adequate supply of direct care workers allows more older and disabled individuals to receive better care in both noninstitutional and institutional settings and to remain in a preferred setting for care.

Research finds that increased availability of direct care workers resulting from higher immigration reduces negative health outcomes, including nursing home falls and overall mortality rates among older adults.

Increased availability of professional care may also reduce burdens on family caregivers, allowing some to increase their own labor supply.

专业护理的增加也可能减轻家庭护理人员的负担，使一些人能够增加自己的劳动力供应。

Meanwhile, visa recipients and their families would benefit from the opportunity to live and work in the United States.

与此同时，签证获得者及其家人将受益于在美国生活和工作的机会。

Watson’s proposal focuses on direct care for older and disabled adults, given the predictable demographic transition that will generate sharp increases in demand for direct care over the next decade.

A similar model could be considered for other high-need occupations, and the success of this targeted program might help set the stage for broader immigration reforms.