COVER SERIES

There Is a Cure for the

ELDERCARE STAFFING CRISIS

Why visa-based international hiring should be part of your staffing strategy

By John Dorer

For providers in home health and non-medical homecare, the staffing crisis is no longer some obscure entity that is looming on the horizon. The crisis is here, and it’s being felt hard across the industry. Those on the ground doing the work know it all too well. They’re faced with burnout, understaffing and unpredictable schedules as operators deal with limited capacity while meeting rising demand.

An aging population means more older adults are seeking care at home, making this issue all the more urgent. The pressure it has placed on home-based care providers isn’t just a matter of better recruiting. This is a deep workforce problem—one that reflects back to a labor pool that has been unable to keep pace with the growth in demand.

Immigrants have been a critical part of caregiving for years, and a recent study from the Massachusetts Institute of Technology (MIT) demonstrates this. While the research focused on nursing homes, the results ring true across the homecare sector, too. In metro areas with higher rates of immigration, facilities experienced more registered nurse and certified nursing assistant hours, along with better patient outcomes and fewer hospitalizations. The broader lesson here is hard to miss. When more caregivers are available, care systems function better and when the labor supply is short, strain builds quickly.

That point matters because the same demographic forces pushing against nursing homes are also pressing on agencies trying to staff aides, caregivers and home health workers in the community. The setting may be different, but the labor challenge is not.

Local Labor Is Not Enough on Its Own

Recruiting new caregivers has become exceedingly difficult in market after market. While the work is essential and meaningful, it’s also very demanding, requiring reliability, patience and a willingness to do work that is physically and emotionally taxing. Providers are doing their level best to hire more workers, but today those workers have more options and are quicker to leave if a role feels unstable, unsupported or too difficult compared to the pay level.

That’s why this crisis transcends simple hiring tactics. Providers can do things like improving the recruiting process, tightening up onboarding, strengthening leadership and building better retention practices, and they should. But in many places, this won’t be enough to overcome the core challenges facing the industry.

The shortage of caregivers has real business consequences. An agency may be limited in the number of clients it can take on. At the same time, schedulers are forced to work around gaps that are never truly closed, resulting in more strain on the caregivers that remain.

International Caregivers Are Already Part of the Answer

In eldercare, it’s the international workers who help to hold things together, given the short supply of domestic help.

The MIT study reinforces a point that many providers already understand through their own experience in this environment: When immigration rises, care capacity improves and the situation for all caregivers and clients gets better. More workers are available. More care can be delivered. Better continuity becomes possible. For home-based care providers, this should restart the conversation about solutions to this crisis. International caregivers shouldn’t be looked at as peripheral to the staffing discussion.

This does not mean domestic recruiting becomes less important. It means that a workforce strategy built around only one source of labor is increasingly fragile.

Why Lawful Workforce Pathways Matter

Lawful immigration pathways like the EB-3 visa need to be a central part of this discussion.

When piecing together a more durable staffing model, the question is not just whether international caregivers are available. It’s whether there is a lawful, workable way to bring them into the workforce. The EB-3 visa is one of the clearest examples of this. It enables United States employers to sponsor foreign workers for permanent, full-time roles when qualified domestic workers can’t be found.

In home-based care, these legal pathways for foreign labor matter immensely because the staffing shortage is no longer a temporary disruption. It’s protracted, structural and increasingly has an effect on whether providers grow, stabilize schedules and keep pace with the growing demand for care.

A broad staffing strategy is the best way forward, including stronger domestic recruiting, better retention efforts, clearer pathways for advancement and lawful immigration tools. The goal is not to replace one pipeline with another—it’s to build multiple streams at once so the provider isn’t overly dependent on a single source of labor.

In an industry where the demand for care is only going to grow larger, this approach is critical because it is a long-term strategy for a long-term problem.

Staffing Strategy That Matches the Moment

The home-based care sector is already doing difficult work in one of the tightest labor environments in the sector. What is needed now is a staffing strategy that matches that reality. That means recognizing that the eldercare crisis is not coming—we are currently in the midst of it.

Looking at local labor alone may not be enough in every market. And it means treating international caregivers and lawful workforce pathways as part of a serious long-term staffing discussion, not as a side issue.

John Dorer is CEO of EB3.Work, a workforce solutions company that helps U.S. employers address labor shortages through lawful and compliant staffing strategies. Visit eb3.work.