Immigration bill could improve--or worsen--labor shortage.

An immigration proposal by President Bush and resultant legislation promises aid to medical care facilities suffering from a severe workforce shortage.

Some believe that the president's proposal will start a much needed public discourse on immigration reform; others see the proposal as an additional stress factor to an already overstretched system of both patients and workers.

The nation's hospitals need an additional 126,000 nurses and 90 percent of long term care organizations are short on nurses, according to a Health Worker Shortages & the Potential of Immigration Policy, a report by the Immigration Policy Center in Washington, D.C.

Under Bush's proposal, some 8 million illegal immigrants will be allowed to obtain legal status as temporary workers. These workers can receive a three-year visa, renewable once, but are expected to return to their countries once their visas expire. Employers would first have to demonstrate that they were hiring those workers for jobs that they could not find U.S. citizens to fill, Bush said.

Senate Minority Leader Tom Daschle, D-S.D., and Sen. Chuck Nagel, R-Neb., have unveiled the Immigration Reform Bill of 2004, a bipartisan bill based on Bush's proposal. The bill, S. 2010, is under consideration by the Senate Committee on the Judiciary.

Many long term care advocates hope the final bill will help fill gaps in the workforce shortage. But they are also concerned about the effect an influx of workers may have on efforts to improve wages and working conditions.

"We see staffing issues, particularly wages and benefits, and quality of care as intertwined," said Pat McGinnis, executive director of California Advocates for Nursing Home Reform in San Francisco. "Something like [Bush's proposal] could provide a staffing pool for [certified nursing assistants (CNAs)] and increase staff in nursing homes. On the other hand, it could be very detrimental to efforts to increase staff wages and improve working conditions."

One of the most contentious issues surrounding the role of immigration in the U.S. workforce is whether immigrant workers lower the wages of U.S. workers by increasing the overall sup ply of potential employees. Long term care advocates fear that if nursing homes begin paying lower wages due to an employer-dominated market, efforts to professionalize the industry will be thwarted.

"When you have an influx of labor, you can get away with paying cheaper wages," McGinnis said. "If nursing homes are not willing to pay prevailing wages, if they're not willing to give employees incentives for advancement ... the quality of long term care will not advance."

Proponents of Bush's bill argue that the plan could open the medical industry's borders to much-needed unskilled workers, such as foodservice and housekeeping workers, as well as CNAs.

However, many long term care advocates believe that this proposal does not address the bigger problem inherent a U.S. nursing homes: An underpaid and undertrained workforce. More than 70 percent of hands-on care in nursing homes is provided by CNAs, who are also the lowest paid employees, McGinnis said. In California, where the staff turnover rate is 80 percent, CNAs earn $9 an hour.

According to Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform in Washington, D.C., Bush's proposal--if passed as is--would be a step backward for nursing home reform. "It would allow nursing homes to hire people who were accustomed to working at jobs with low wages and no benefits, and who are pretty much captive to their jobs," Wells said. "We have to improve these jobs in ways that attract Americans or people from other countries to them."

Others see the bill as only a temporary solution to the industry's labor shortage. According to Jeff Smokier, deputy director of communications for the American Health Care Association in Washington, D.C., there are 96,000 vacant nursing positions in the long term care industry, including 52,000 vacant CNA positions. What's needed, Smokier said, is federal funding for the creation, improvement, retention and training of career-ladder jobs.

"Any debate, conversation or discussion on immigration reform must include consideration of the long term value of moving forward with a temporary program that matches foreign workers with willing U.S. employers unable to find American citizens to fill key jobs," Smokier. "What we are lobbying for is a new, separate visa class for long term healthcare workers."

Benjamin Johnson, director of the Immigration Policy Center, said the long term care industry clearly does not want to continue to experience massive workforce shortages, especially when there are well-trained, well-qualified foreign-born people who are available and willing to work.

But combine the phenomenal growth of the health care industry during the past decade with the slow process of passing legislation, and it appears the workforce shortage will continue to plague long term care facilities for some time, Johnson said.

"Immigration policy is a train moving at 50 mph, while the health care industry is a train moving at 100 mph," he said. "They won't catch up to each other."

Gina Bernacchi is a business writer with the Denver News Bureau.