Angelite Nurses

This is the second of two articles by Maricar Hampton resulting from her 2010 New America Media Fellowship, supported by The Atlantic Philanthropies. You can read part one here.

Nurse Edel Pimentel believes that Filipino health care providers will be especially able to deal with the demands of the 78 million aging boomers in the United States -- plus their elderly parents -- once they enter a healthcare facility, because Filipinos are “natural caregivers.”

In the Philippines, she said, “We tend to take care of our loved ones ourselves until they die. We don’t put them in nursing homes; we just don’t have that,” said Pimentel.

The role of foreign-born health care workers is especially important now because the United States is facing severe shortages of nurses and other eldercare workers. One in six nursing aides and one in nine nurses in the United States are foreign born, according to a 2004 study by the Immigration Policy Center in Washington, D.C.

The Philippines has been especially important, because its health care education programs have long been patterned after that in the U.S. Also, American long-term care providers actively recruit health care personnel there, even though immigration concerns in the United States have slowed State Department approvals of work visas to a seven-year backlog.

A report by the Philippine Embassy on Filipino medical staff for the year 2008-2009, shows that a total of 1,887 nurses, 1,450 physical therapists and 229 occupational therapists in the Philippines have been recruited by, or have job orders to work for, different hospitals and nursing home facilities all over the United States. However the embassy is not sure whether these people made it to America or are still waiting back home.

Immigrants Fill U.S. Eldercare Shortages
Pimentel was only 23 when she was recruited away from her job as a hospital nurse in the Philippines by Potomac Valley Nursing and Wellness Center to come to its nursing facility in Maryland.
Like many of her colleagues, she initially found it difficult to adjust to her new circumstances. “When I came here it was a struggle; it was depressing being in a nursing home and working with them,” said Pimentel. Over the past 16 years, though, she became a nursing supervisor and data coordinator, and came to love her job.

Today, Pimentel is fortunate to be among the thousands of Filipino nurses and aides, who find satisfaction in providing long-term care to millions of older Americans. Many others who venture abroad as caregivers tell awful stories of abuse, harassment and broken dreams.

Even in non-abusive situations, long-term care staff can find themselves stuck on double shifts and assigned to too many facility residents. Despite doing the most difficult tasks direct-care nurses’ aides typically get paid hourly wages of $10 an hour or less, frequently without benefits.

Immigrants in nursing are particularly needed in geriatric care, because the fragmented U.S. system of long-term care attracts few health care providers, according to 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, a former head of the U.S. Administration on Aging, noted, “We have a coalition here in Washington called the Eldercare Workforce Alliance, a group of various associations that are all focused on really trying to get a better geriatric training, education and support for nursing and other health care professions.”

But until the United States  finds ways to fill the shortages, Stone said, immigrants skilled in health care will continue to be vital in both institutional and home or community-based care, she said.

Not only registered nurses such as Pimentel, but nursing caregivers in long-term care, also known as direct care workers, have always played a key role in American eldercare. In nursing facilities, homecare or community-based programs, such as assisted living, direct caregivers provide most of the hands-on care.

In many states on the East and West coasts, caregivers are predominantly from other nations. A 2008 article in the Gerontologist, a journal of the Gerontological Society of America, Globalization, reported that the Philippines has become a major source of long--term care workforce for the U.S., Canada, and European countries and others. Many others come from Africa, the Caribbean and other developing regions.

Grueling Tasks
Direct-care workers in long-term care often perform grueling tasks, such as bathing and feeding frail elders, helping them use the bathroom, cooking, cleaning and serving meals. In addition, they administer basic first aid and, in some cases, are licensed to dispense medications and participate in the care planning process for residents.

For Ted Melon, a caregiver at Maple Ridge, in Rockville, Md., providing real care to seniors greatly depends on resident-staff relationship.

“It’s all about interpersonal relationships with the residents,” he said. Mallon takes time to talk with residents, because “that personal touch” enables him to note subtle changes in a resident’s character that might tip him off to emerging issues in their care.

Direct-care workers, such as Melon, are the lowest paid employees in long-term care. Few work in settings that involve them on the caregiving team, or provide them longer-term career development.

That’s why turnover among direct care workers ranges from 40 to 75 percent annually nationwide, according to the 2009 Direct Support Professionals Wage Study, conducted by ANCOR, a trade group for direct-care providers. A 2001 report by the U.S. Government Accountability Office found that turnover has been as high as 100 percent in a year in some facilities.

Direct caregivers typically need one or more other jobs simply to make ends meet. Such is the case with Melon, who does private-duty caregiving on weeknights, and works in a group home on the weekends.

“I used to work in the mortgage industry. But with the real estate market going down, I had to look for an alternative source of income, which is in healthcare. But even then I still have to have two jobs,” Melon said.

Edita Baua, a patient-care unit manager , is one of Edel Pimentel’s nursing co-workers at Potomac Valley Nursing and Wellness Center in Maryland. “I came here as a tourist and wasn’t planning on staying for good,” she said. When a friend persuaded her to remain, she applied at Potomac Valley, where an administrator welcomed her and said the organization would sponsor Baua to become a legal U.S. resident.

Tess Orlina, director of nursing at Potomac Valley added, “We directly recruit our staff from the Philippines or sponsor them. Our administrator goes to the Philippines and directly interviews nurses from there.”

Currently, Potomac Valley has petitioned the U.S. State Department for three nurses to receive American work visas. But the visas are yet to be approved because of the virtual “freeze” on them, Orlina said.

Pimentel remains hopeful. For Filipino caregivers, she said, the U.S. provides “fertile ground. There are a lot of opportunities for you to move up in this profession. A lot of Filipino nurses thrive and do well because it’s innate in us to be hard working, patient and caring which, in this job, is very much needed.”

As for those nurses trying to emigrate here, she, Pimentel said, “Yes, there is a big need for nurses in this country, but it is limited because of the government restriction. But I hope the U.S. will give them the opportunity to come here too and fill the shortage.”