The aging of larger numbers of Americans will require significant increases in the number of healthcare support workers. During the past years, foreign-born workers are playing a significant role in the direct care workforce in particular. Yet it is not always clear how foreign-born workers fill-in the current gaps. Using ACS (American Community Survey) and LTCFocus (Long-term Care: Facts on Care in the US) data from 2012 to 2016 and measuring quality by facility structures and residents’ health outcomes, this paper explores how shares of foreign-born workers in nursing-related occupations may contribute to the quality of nursing homes by applying a longitudinal model with a fixed effect for each nursing home. The result depends on different measures of quality and types of occupations, such as low-skilled occupations like Home Aides assistants and support workers and more professional occupations like registered nurses. I show that when using outcome measures of nursing home quality, such as long-stay residents with daily pain to measure quality, the estimators are generally insignificant, but in terms of Shares of Home Aides Supports occupations, they lead to an increase in quality. However, when using structural measures of nursing home quality, such as different staff ratios, some of the estimators are significant and although in a small attitude, leading to an increase in the quality. Overall, the effect of shares of foreign-born workers in Nursing-related occupations on nursing home quality remains a mixed picture. The result shows that increasing the shares of foreign-born workers itself may not lead to a better quality of nursing home, more effort shall be done to understand the mechanism behind this. Further studies shall focus on establishing better data and measurement.




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