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Immigration, the Long-Term Care Workforce, and Elder Outcomes in the US
David C Grabowski1, Jonathan Gruber2, Brian E McGarry3
1Harvard Medical School.
American Journal of Health Economics
|June 22, 2026
Summary
Increased immigration boosts nursing home staffing and improves patient care quality, particularly with full-time workers. Hispanic immigrants showed the strongest positive impact on the nursing workforce and care outcomes.
Area of Science:
- Health Services Research
- Sociology
- Economics
Background:
- The U.S. nursing home industry is experiencing critical labor shortages, exacerbated by the COVID-19 pandemic.
- Nursing homes heavily depend on immigrant labor to meet staffing needs.
- Policy discussions often propose increasing immigration to alleviate these shortages.
Purpose of the Study:
- To assess the impact of increased immigration on nursing home staffing levels and care quality.
- To examine heterogeneity in treatment effects and explore underlying mechanisms.
- To extend previous research using detailed nursing home and patient-level data.
Main Methods:
- Utilized nursing home- and patient-level data.
- Employed shift-share analyses to evaluate immigration's effects.
- Investigated heterogeneity in observed treatment effects and potential causal pathways.
Main Results:
- Increased immigration significantly enhances direct care staffing ratios in nursing homes, especially for full-time positions.
- Immigration robustly improves a variety of patient outcomes.
- The most substantial positive effects were observed with increases in Hispanic immigrant populations.
Conclusions:
- Immigration positively influences both the supply and quality of the nursing home workforce.
- Immigration plays a crucial role in addressing persistent staffing and quality challenges within the nursing home sector.
- Findings support immigration as a viable strategy for improving elder care.
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