The need for additional nurses in nursing homes has led to more discussions about changing federal immigration law to bring new workers to the country. Mark Parkinson, president and CEO of the American Health Care Association, calls for increasing immigration, describing a “mature immigration policy” that “not only would solve our labor problems, we would also reduce our labor costs.”
The nursing home industry has supported increasing immigration as a solution to staffing shortages for many years. On April 19, 2022, the Brookings Institution hosted a webinar entitled “Who will care for aging baby boomers? Immigrants” that presented various views on immigration as one solution to nursing homes’ labor shortages. Delia Furtado, University of Connecticut, Department of Economics, presented findings from her research indicating that immigration improves quality of care in nursing homes – 4% decrease in falls, 33% decrease in restraints, and 20% decrease in pressure ulcers, among other positive effects. She also suggested that hiring immigrants is a less costly way to increase staffing levels than enacting minimum staffing standards or increasing worker wages. Howard Gleckman, Urban Institute, pointed out that 27-28% of aides are immigrants, many workers receive poverty-level wages and are otherwise taken advantage of, and low-paid immigrant workers could drive down workers’ benefits and wages.
Gleckman’s concerns about the exploitation of immigrant workers were vividly exposed more than 15 years ago. In November 2005, 22 Filipino nurses recruited in the Philippines came to New York to work for facilities affiliated with SentosaCare, then a network of 24 facilities with more than 5,000 residents and 5,000 employees. Ten of the nurses left their jobs at Avalon Gardens Rehabilitation and Health Care Center in April 2006, saying that they had poor working conditions and were paid less than they had been promised. In March 2007, the Suffolk County District Attorney indicted the nurses and criminally charged them with endangering the welfare of five chronically ill children on ventilators and one terminally ill man.
In January 2009, a New York State Court four-judge Appellate Division overruled a lower court judge and “unanimously issued a writ of prohibition halting the prosecutions[,] a rare judicial maneuver used when a prosecutor oversteps his powers.” The Appellate Division ruled that the prosecution “violated the 13th Amendment prohibition against ‘involuntary servitude by seeking to impose criminal sanctions upon the nurses for resigning their positions.’” The nurses had not left the facility in mid-shift and no patient was left without care.
Meanwhile, since 2006, SentosaCare had sued at least 30 nurses to enforce a provision in their employment contracts that required the nurses to pay a penalty of $25,000 if they left their employment before the end of the contract term.
In March 2017, Rose Ann Paguirigan, one of the nurses, sued Prompt Nursing Employment Agency, LLC d/b/a Sentosa Services, et al, on behalf of a class of more than 200 Filippino nurses, charging defendants with violating the Trafficking Victims Protection Act (TVPA), 18 U.S.C. §1589, by recruiting more than 350 nurses in the Philippines “to work for the defendants in this District under contracts of indentured servitude.” Federal District Court Judge Nina Gershon denied defendants’ motion to dismiss, certified the class, granted summary judgment to plaintiff class on liability, granted summary judgment on compensatory damages, and, on April 7, 2022, approved a Settlement Agreement requiring defendants to pay the nurses $3,211,305.06 and attorneys’ fees not exceeding $656,432.43.
Changes to federal immigration law could benefit the country in many ways, including nursing home staffing, so long as immigrants and other workers are protected from exploitation. However, addressing the decades-long nurse staffing shortage in nursing homes requires a broader and more comprehensive set of strategies, which must focus on mandating minimum staffing levels, assuring that workers are appropriately trained and treated well, and paying all workers a living wage and benefits.
April 28, 2022 – T. Edelman
 James Berklan, “Parkinson offers ‘obvious solution’ to staffing problems, occupancy outlook and financing answers,” McKnight’s Long-Term Care News (Mar. 30, 2022), https://www.mcknights.com/news/parkinson-offers-obvious-solution-to-staffing-occupancy-and-financing/; Alex Zorn, “‘We’ve Got a Real Problem Here’: Parkinson Warns SNF Operators Could Fact Medicare Funding Cuts,” Skilled Nursing News (Mar. 31, 2022), https://skillednursingnews.com/2022/03/weve-got-a-real-problem-here-parkinson-warns-snf-operators-could-face-medicare-funding-cuts/
 See AHCA’s long-time support for immigration: AHCA, “Immigration Reform Will Help Ease Long Term Care Workforce Shortage” (undated), https://www.ahcancal.org/Advocacy/IssueBriefs/Immigration%20Issue%20Brief.pdf; Elizabeth Newman, “AHCA makes push for immigration reform,” McKnight’s Long-Term Care News (Apr. 1, 2013), https://www.mcknights.com/news/ahca-makes-push-for-immigration-reform/ (citing AHCA study reporting 60,000 vacant direct care staff as of 2010). See also AHCA’s other solutions for the workforce crisis: “U.S. Long Term Care Communities Ready to Support Ukrainian, Other Refugees” (Press Release, Mar. 17, 2022), https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/U-S–Long-Term-Care-Communities-Ready-to-Support-Ukrainian,-Other-Refugees.aspx
 https://www.brookings.edu/events/who-will-care-for-aging-baby-boomers-immigrants/. The video of the webinar is available at https://www.youtube.com/watch?v=OoPcQQSFunc
 Delia Furtado and Francesc Ortega, “Does Immigration Improve Quality of Care in Nursing Homes?” Institute of Labor Economics, Discussion Paper Series, IZA DP No. 13552 (Jul. 2020), https://ftp.iza.org/dp13552.pdf
 Joseph Berger, “Filipino Nurses, Healers in Trouble,” The New York Times (Jan. 27, 2008), https://www.nytimes.com/2008/01/27/nyregion/nyregionspecial2/27Rnurses.htm
 Joseph Berger, “Suffolk Can’t Prosecute Nurses, Court Rules,” The New York Times (Jan. 23, 2009), https://www.nytimes.com/2009/01/25/nyregion/long-island/25nursesli.html?searchResultPosition=2
 “New York’s largest for-profit SNF operator kept nurses in ‘indentured servitude,’ lawsuit claims,” McKnight’s Long-Term Care News (Mar. 14, 2017), https://www.mcknights.com/news/new-yorks-largest-for-profit-snf-operator-kept-nurses-in-indentured-servitude-lawsuit-claims/
 Paguirigan v. Prompt Nursing Employment Agency LLC d/b/a Sentosa Services, Case 1:17-cv-01302-NH-JO (E.D.N.Y., filed Mar. 7, 2017), https://www.courthousenews.com/wp-content/uploads/2017/03/slave-nurse.pdf
 286 F.Supp.3d 430 (E.D.N.Y. 2017)
 2018 WL 4347799 (E.D.N.Y., Sep. 12, 2018)
 2019 WL 4647648 (E.D.N.Y. Sep. 24, 2019), aff’d in part, appeal dismissed in part, 827 F.App’x 116 (2d Cir. 2020)
 2021 WL 2206738 (E.D.N.Y. Jun. 1, 2021)
 Order Granting Joint Motion for Final Approval of Class Action Settlement, Unopposed Motion for An Award of Attorneys’ Fees and Costs, and Joint Motion to Vacate (Doc. # 185), Case No. 1:17-cv-01302-NG-CLP (E.D.N.Y. Apr. 7, 2022).