After a year of back-breaking work with too many patients and frequent double shifts, Baslio—one of the thousands of Filipina nurses or aides providing care to U.S. seniors--eventually moved to Maple Hill, a small group home in Maryland. There, she not only earns enough to help her family back home, but she grew to care for the seniors “in memory of my grandma, it’s like taking care of my family.”
“You have to have the right kind of heart and a lot of patience for this job. It’s not easy but if you love your job it’s easier,” Baslio said.
For decades the United States has turned to Filipina nurses, such as Baslio, and those from other countries, especially China, the Caribbean and India, to fill its growing shortage of nurses and nurses’ aides. American long-term care companies actively recruit nurses from the Philippines because of its U.S. style health care education programs.
Yet, despite the American nursing shortage, so many Filipino health care workers—even those with promised jobs—are caught in an effective freeze on U.S. work visas -- there is a seven year waiting period for admittance to the U.S.
According to Philippine Embassy Labor Attaché Luzviminda Padilla, “There is still a shortage of health care professionals, but whether or not these shortages will be filled by Filipinos, we cannot tell because currently we are experiencing difficulty in obtaining releases of visas for Filipino nurses and other caregivers.”
Aging Boomers Will Need Care
The U.S. nursing shortage is only expected to worsen as the huge boomer generation ages. The 78 million boomers start going on Medicare in 2011, as the first of them turn 65. And modern gains in longevity have given many of them very elderly parents. The U.S. Bureau of Labor Statistics projects that the country will need more than one million new and replacement nurses by 2016.
A 2004 report by the Immigration Policy Center titled “National Health Worker Shortage and the Potential of Immigration Policy,” found that 1.1 million immigrants account for 13 percent of heath care providers in the United States.
Philippine Health Education U.S. Style
History has it that foreign-born and foreign-educated health professionals have played an important role in providing care to the United States. In the mid-1940s, the U.S. sponsored nurse training in the Philippines comparable to the work culture and training in America, which includes the study of the English language.
“Education is big business in the Philippines. To meet the demand for nurses in other countries, many nursing schools were established,” said Aurora Soriano-Cudal, age 77, who was a health educator and senior health education adviser of the Philippines Bureau of Disease Control before moving to San Diego in 1994.
Cudal, who was also department chair of social and preventive medicine at the Manila Central University College of Medicine, added, “The nursing curricula are designed to meet the needs of nurse importing-countries, especially the United States; much to the disadvantage of the healthcare system in the Philippines. Nursing graduates are often perceived as nurses who can work better in the U.S.A. than in their own countries.”
A columnist for San Diego’s Filipino Press for 15 years, Cudal went on, “The whole educational system in the Philippines was established by early American educators or by Filipinos trained in the United States. Most of the deans of the colleges of nursing obtained post-graduate degrees in top nursing schools in the United States.”
Cudal, whose seven children are health care professionals in the U.S. and the Philippines, added, “My mother was one of the first nurses in the Philippines graduated from a mission school of nursing established by American missionaries with nursing degrees.”
--Maricar C. P. Hampton
The study stressed, “Foreign-born professionals play a crucial role in filling severe shortages within the two largest health care occupations: physicians and nurses.” The center reported that in the U.S., 25.2 percent of all physicians; 17 percent of nursing, psychiatric and home health aides; and 11.5 percent of registered nurses come from other countries.
“In long-term care, in many nursing homes, particularly in the West Coast, the vast majority of the director of nursing and the licensed practical nurses, who are working on the frontline as supervisors are from the Philippines,” said Robyn I. Stone, executive director of the Institute for the Future of Aging Services at the American Association of Homes and Services for Aging in Washington, D.C.
Stone continued, “Filipino nurses have been a very important part of the management structure and frontline-supervisor structure in many nursing homes, as well as other settings.”
Stone, a former head of the U.S. Administration on Aging in the Clinton administration, said she is especially concerned about the alarming lack of nurses: “It’s just going to get worse, partly because it is really difficult to attract nurses into the long-term care.” In a recent speech on health care, President Barack Obama called for more nurses to care for the aging population. But not many nurses are educated in geriatric care.
Overall, the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) officials states that “to meet the projected growth in demand for RN services, the U.S. must graduate approximately 90 percent more nurses from U.S. nursing programs.”
Nurses' Union Opposes More Immigration
To solve this problem the American Nurses Association (ANA) and other groups are pushing for an increase in health care training in the United States. But because this long-range plan will not remedy the crisis at hand, some nursing home facilities and hospitals have been recruiting nurses from other countries to bridge the gap. This idea, however, is unpopular with some groups.
Cheryl Peterson, who directs nursing practice and policy at ANA, noted, “We certainly understand, that we don’t have sufficient supply of registered nurses who have specific education around geriatrics beyond what is included in our basic nursing education.”
However, she said, ANA opposes increasing the immigration of foreign-educated nurses as the solution, calling it a “band aid approach” to the problem.
Peterson went on, “If we allow for a large number of foreign-educated nurses to come to the U.S., and we make it easier for hospitals to get the providers that they need, they are not likely to address the issue of why we can’t have a sufficient supply in the U.S.”
Before increasing immigration, she said, U.S. health care providers should take steps to attract “the 500,000 plus licensed nurses that we know we have, who are not working in nursing,” by improving the work environment and the wages.
ANA further justifies its resistance to nurse immigration claiming it doesn’t want to aggravate the global nursing shortage by recruiting nurses from other countries. Peterson asserted that U.S. health care providers “are not solely recruiting the new-graduate nurses, but we are actually recruiting the experienced nurses from the Filipino hospitals.” She said that this could be exacerbating the Philippines’ own shortage of nurses.
U.S. politics also plays a role in the long backlog of approvals for U.S. work visas. Peterson explained, “There is just a lot of anxiety around broadening immigration,” Peterson said. Some members of Congress have resisted efforts to move forward on nursing immigration “because they really want to force a broader debate about immigration reform.” They see the needs for more nurses here and want “to use that as a leverage to kind of force a bigger conversation,” Peterson said.
Representatives of the Philippines Nurses Association of America did not respond to several interview requests for this article, and the group includes no discussion of this issue on their website.
Seven-Year Visa Backlog
However, Virginia immigration lawyer Arnedo Valera declared, “There are just no visas available.” He continued, “The problem is, it’s really frozen. Maybe we can say it’s subject to quota, but in reality nurses cannot come to the U.S., because the immigrant visas are frozen.”
Valera said that the State Department’s backlog is processing the appropriate visas for health care workers from the Philippines and other countries in only up to February 2003 for people arriving this month. “So we are talking of a seven-year backlog, and that still doesn’t move,” he said.
According to the U.S. State Department website, The Immigration and Naturalization Act provides a yearly minimum of 140,000 employment-based immigrant visas, which are divided into five preference categories.
One category is the Employment Third Preference, or EB-3 visas, which includes healthcare workers. The State Department defines this group as follows: “Skilled Workers, Professionals Holding Baccalaureate Degrees and Other Workers receive 28.6 percent of the yearly worldwide limit, plus any unused Employment First and Second Preference visas.”
Stone of the American Association of Homes and Services for Aging, observed that nursing needs are greater in long-term care than in hospitals, which usually pay more and are more desirable clinical working environments.
“The long-term care sector is already struggling, and we are going to see that more as we have more and more elders, particularly those 85 and over who are going to require a lot of services in nursing homes and community-based settings,” she said.
She said a large proportion of frontline caregivers and supervisors are from other countries. “They are an important part of our sector, so you know I think immigration policy is really going to bump up against that.” Stone added, “I know that the Filipino nurse in long-term care has been a major source of labor.”