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The senior living industry potentially faces a workforce shortfall in the years ahead. For years, operators had hoped immigration would help close that gap – but that hope has faded in the last four months.
As demand for senior living rises, industry associations like Argentum, along with operators like Goodwin Living, have long advocated for immigration policies that would allow more people to gain U.S. residency or citizenship, in part so they could join the senior living workforce.
But the prospect of wide-scale immigration reform aiding the senior living workforce has dimmed since the election of U.S. President Donald Trump in November. The White House has taken a hard line on immigration and has paused immigration applications for some migrants previously allowed under the previous administration.
“I don’t get there’s any really strong appetite at this point for broad-based immigration reform,” Argentum CEO James Balda recently told me. “I just don’t see that being a priority anytime soon.”
For senior living operators, the immigration gridlock is coming at a bad time – right as the baby boomers begin to arrive at their doorsteps en masse. Depending on how the coming years go, current conditions could mean that senior living operators must compete more for a smaller pool of staffers, disrupting hiring budgets and potentially leaving demand on the table if they can’t grow fast enough.
All of this leaves me with a big question: Where will the senior living industry find enough workers to make up its shortage if it previously was banking on immigration? To that end, I don’t think operators have many good current solutions for staffing, other than getting more creative with hiring and offering better pay and benefits. And all of this tells me that the senior living industry’s staffing journey could get even harder before it gets easier.
In this week’s members-only SHN+ Update, I analyze current immigration rhetoric as it relates to the projected senior living workforce shortage and offer the following takeaways:
- What recent data tells us about what’s ahead of the senior living workforce
- Why the senior living workforce is “already in crisis”
- Inside the unknowns causing angst about the future
Rising demand coincides with workforce challenges
According to a projection from senior living industry association Argentum, the senior living industry must add 292,500 new jobs between 2021 and 2040 to keep up with demand. At the same time, operators must also contend with an additional 2.7 million job openings due to employees leaving their roles in that time span.
In total, the senior living industry will need to have filled more than three million job openings between 2021 and 2040 to keep up with the rate of demand, according to Argentum. And that is only for assisted living communities and continuing care retirement communities (CCRCs). Independent living and other senior living sectors are a whole other ball of yarn.
That shortfall isn’t only threatening senior living. The National Institutes of Health projects a deficit of 1.2 million registered nurses and 121,900 physicians by 2030, amid an aging workforce, lack of new employees, uneven distribution of resources across urban and rural areas and the workload and occupational stress.
Nearly 85% of U.S. population growth between 2020 and 2024 came from net immigration, according to the U.S. Census Bureau, but despite that growth, labor force participation remains nearly a full percentage point below pre-2019 levels.
Meanwhile, the industry is standing at the precipice of a years-long demand runway. Starting next year, the oldest baby boomers begin turning 80, just a few years shy of the average age of senior living residents.
Many operators have told us in the last few months they don’t think their workforces are in danger of deportation. Even so, the lack of new immigration at least could imperil whether they can successfully meet demand down the road.
If the senior living hiring pipeline stalls out, “the fallout hits every link in our operating chain,” NIC Senior Principal Omar Zahraoui told me.
“Fewer workers means fewer services, slower development and rising costs across the board,” he said.
A limited labor supply is already driving up the cost of providing senior living, with assisted living wages rising 10% year-over-year in 2024 for production and non-supervisory roles, according to Genworth and CareScout data. Any immigration policies that restrict access to a broader, global pool of workers will only accelerate that trend, Zahraoui told me.
And for some senior living operators, the immigration issue has already reached “crisis” levels.
Alexandria, Virginia-based senior living nonprofit Goodwin Living in 2018 launched a program to help noncitizen workers secure U.S. citizenship. Fast-forward to today, around 40% of Goodwin Living’s workforce come from outside the U.S. CEO Rob Liebreich told me.
Goodwin Living residents even tutored workers in the program to help them prepare for their upcoming U.S. citizenship tests.
Even with this effort to increase the company’s labor pool, Liebreich told me that he feels the senior living industry and other industries are “already in crisis” that could impact future ability to provide services.
“We’re in a battle for global workforce talent and we see that clearly we don’t have enough hands to support all the older adults that we need today,” Liebreich told me. “If we’re not winning today, we need to put some really strong resources toward winning tomorrow and advocate for legal pathways for people to engage in our society.”
Immigration difficulties are also impacting some current staff. The U.S. government has shortened long-term work permits of some of Goodwin’s staff, who have until April 24th to sort out the issue or leave the workforce.
“We’re struggling right now and it’s really hard for us because these are folks that have been extremely productive and loved by their residents and have been promoted in their roles,” Liebreich told me.
If the senior living industry is unable, or unwilling, to attempt to win the global workforce, the ramifications of that for the senior living industry will result in prices increasing for caregiving and senior living services, Liebreich added.
He noted that in 2024, Goodwin Living had 400 open positions, for which the organization received 11,000 applications. Obviously that’s a good thing for Goodwin and I think it’s a sign that good employers with creative benefits and programs will continue to attract new talent.
But to me it’s not a win if the industry separates into staffing haves and have-nots in the years to come. As Liebreich and Zahraoui noted, issues stemming from immigration could still cascade through the senior living operations chain.
‘Unknown causing a lot of angst’ but opportunity ahead
As myself and my colleagues have written about, starting late last year, uncertainty in many forms could hurt the senior living industry, and I believe that also applies to the workforce.
While these legal pathways exist for noncitizen workers, I believe the potential fear and uncertainty created by the Trump administration could dissuade workers from reaching out to employers with these legal pathways.
Ascension Living CEO Erin Shadbolt commented during a recent conference that the uncertainty created by political rhetoric and immigration could hurt the industry’s ability to source new workers.
“I think the unknown is causing a lot of angst, and we’re seeing that a little bit even with trends of the workforce,” Shadbolt said. “It’s a big unknown right now for us and I’m pretty worried about it.”
But amid the uncertainty, there could be opportunity, Monarch Healthcare Management Vice President of Innovation and Bench Strength Dan Strittmater recently told me. The Mankato, Minnesota-based long-term care and senior living provider uses recruiting focused on bringing in international workers from the Philippines, Kenya and Canada, along with sponsoring international students with F1 student visas to create career pathways.
“We’ve quadrupled the number of applicants from a year ago and we put a plan together with state innovation funding,” Strittmater told me. “We’re looking for opportunities wherever they are and if they’re coming from their country of origin with minimal experience, I do not think it would deter these folks.”
It’s important to note that colleges across the country have reported students have had F1 visas revoked. According to the nonpartisan Brookings Institution, higher deportation rates would have “adverse macroeconomic consequences,” disrupting labor markets and supply chains.
Still, putting the pieces together, I wonder what the coming years will bring for senior living operators and staffing. The good news is some technology, like fall-detection services or staffing management systems, help make current workers more efficient and able to handle larger workloads. But I think those can only go so far.
Senior living operators study available workers in their market study analyses for markets in which to open new communities. Too few workers in a market and that proposition becomes harder to achieve. I think that Goodwin’s Living’s case shows that senior living operators in or adjacent to major metro areas will still see a steady stream of new applicants for open roles. But I wonder about the fate of communities in some secondary and tertiary markets where new workers are harder to come by.
Of course, all of this could change in a matter of years with a new Congress or new president in the White House. But for now, I think the prospect of immigration solving senior living’s workforce worries is dimmer now than at any point in the last eight years.
