Introduction
The United States will face major demographic changes in the next few decades. There are several reasons for this. U.S. population growth has been slowing for years, and in 2021, the population grew only by 392,665—or 0.1%, which is the lowest rate since the nation’s founding.1 Consequently, the number of residents in the country, though still growing, is doing so at a decreasing rate. It took, for example, from 1950 to 2020 (70 years) to go from 160 million to 330 million U.S. residents, but at the current rate it will take 80 years to add 100 million residents.2 This is largely because U.S. fertility rates fell by 4% in 2020, a record low for America;3 the number of authorized immigrants has settled to just over one million a year;4 and the number of unauthorized immigrants has decreased5—despite the ongoing asylum and humanitarian crises at the border in the last decade. At the same time, annual deaths in the U.S. have risen from 2.4 million in 2009 to nearly 2.9 million in 2019—and to roughly 3.4 million deaths in 2020, mainly due to the coronavirus pandemic.6 These demographic shifts will have important consequences for society and the economy. The U.S. will be older and more diverse but also unable to meet the workforce demands of a dynamic and competitive economy.
An Older and More Diverse Population
Indeed, as a result of these and other trends—which include slower population growth, lower fertility, longer life expectancy,7 higher death rates, and fewer migrants—America is rapidly aging.8 The Census Bureau projects that for the first time in U.S. history, Americans aged 65 and over will outnumber those under the age of 18 by 2034 (a year earlier than the previously projected 2035).9 And because, increasingly, migrants from Latin America and Asia are younger and their fertility rates higher than in previous years, the U.S. will become more ethnically diverse.10 Indeed, America is already more diverse than ever before. At present, 23% of older adults (65+ and above) in the U.S. are people of color—and by 2060 this rate will increase to 45%.11 This will have serious implications for the development of a workforce with linguistic and cultural skills that fit the needs of a growing, diverse population.12
A Workforce Under Stress
Simultaneously, the American workforce will be under enormous stress as demographic changes broaden their impact on the larger economy. First, the number of individuals not in the workforce is steadily increasing—a trend that is likely to continue in the next decades.13 Although more older Americans are working than in previous decades, their numbers will not keep up with the need for labor in key sectors of the economy—especially in the service industries.14 As a result, most analysts expect labor shortages to continue well after the pandemic is over, as more Americans choose to retire or not return to the labor market.15 Moreover, as the national workforce contracts, contributions to Social Security will likely slow, just as more Americans begin drawing from it, creating a fiscal problem for Congress and a potentially important political problem for the nation. Social Security remains a major source of income for most older Americans,16 yet the Social Security Trustees project that the Federal Old-Age and Survivors Insurance Trust Fund will be depleted by 2033.17 The limitations of the U.S. labor supply will make the American economy less dynamic and thus less competitive on a global scale.
This report examines two key issues posed by the U.S. demographic transition in the next decade(s)—the realities of an older population and the strains on the labor market—and explores how immigration can help maintain America’s vibrant, active society and strengthen its workforce and economy, resulting in greater global competitiveness.
Why Immigration Matters
In the next decade, net international migration to the U.S. will overtake native birth increases as the driver of population growth.18 According to the U.S. Census Bureau Vintage 2021 Population Estimates, we are beginning to see this trend. Between July 1, 2020, and July 1, 2021, the nation’s growth was due to net international migration (244,622) and natural increase (148,043).19 The data released shows this was the first time that net international migration exceeded a natural increase for a given year. Immigration will therefore play a fundamental role in the future of the U.S. demographics. Accordingly, the need for policies that take this into account and help shape immigration for future needs is now urgent. It is important to note that immigration is only part of the answer—and not the only solution—to the problems brought on by America’s shifting demographics. To best cope with the challenges that lie ahead, immigration should be viewed as the greatest opportunity to bolster overall growth and build a stronger, legal workforce, and keep America thriving in an increasingly competitive world economy. To accomplish this, the U.S. should establish or broaden legal immigration avenues to create a robust system that anticipates future needs. Determining the ideal level of immigrant inflows is challenging and often politicized and polarizing, but the United States must modernize an outdated immigration system that is incapable of adapting to the long-term problems ahead. Preparing for the coming changes goes beyond studying demographic trends; it requires innovative strategies and solid policy responses.
Revamping the immigration system can help address two major challenges stemming from America’s demographic shift: the growth of an aging population and the development of a dynamic labor force.
A Graying America: Who Will Care for Older Americans?
Figure 1 — Americans Aged 65 and Older, 1900–2060 (in millions)
Note Orange bars are projections.
Using data from the U.S. Census Bureau, Figure 1 shows that the number of Americans aged 65 and older is projected to nearly double from 54 million in 2019 to 95 million in 2060.20 The 85+ cohort is estimated to triple by 2060 in the same period.21 The driving force is the millions of baby boomers—Americans born between 1946 and 1964—who are retiring and aging into their 60s, 70s, and 80s. This trend also raises concerns about greater workforce demands on certain sectors like health care services, including home health care.22 People are generally living longer, but many also have chronic illnesses and medical conditions that require specialized care.23 With aging comes increased risks for age-related diseases and conditions, such as Alzheimer’s, Parkinson’s disease, and cognitive decline, as well as long-term services needs and help with daily life activities, such as transportation, housework, dressing, bathing, preparing meals, managing finances, and/or giving medicine, pills, or injections.24 Those living with Alzheimer’s disease, for example, are projected to double from 6 million today to over 13 million by 2060.25 Services for an aging population will continue to be in high demand; the U.S must improve access to care and ensure that its workforce is prepared and trained to meet the needs of older adults.26 The Bureau of Labor Statistics projects 3.3 million jobs will be added in the health care and social assistance sector through 2030.27 As of today, the education system does not appear poised to meet this demand.28 Some health care positions like home health aides require minimal education, and some professionals can be educated and trained quickly enough to meet upcoming demands. However, that it is not the case for physicians, who can require anywhere from 10 to 16 years of education.29 Against this backdrop, it is critical to consider migrants already trained in these professions who may aid in filling the gaps.
Already, the health care sector is populated by a large number of immigrants who have proven to be a valuable workforce. Their success shows that immigrants can be an important addition to the sector’s labor force. In 2018, 2.6 million immigrants worked in health care at every level, including as doctors, nurses, and pharmacists. Immigrants in fact comprise 28% of all physicians, 24% of all dentists, and 38% of all home health care aides in the U.S.30 Even so, there are significant shortages, which are likely to be exacerbated with the growth of an aging population that is already exiting the workforce—including those in the field of health and home care. Immigration can help solve this looming problem if more visa pathways are opened for health professionals.
Impending Labor Force Challenges
Even before the coronavirus pandemic there was a shortage of health care providers, from surgeons to home health aides.31 Another notable trend is the forthcoming retirement of many health care professionals. As of 2019, 20% of practicing physicians, nurses, and home health aides were between the ages of 55 and 65.32 According to projections by the Association of American Medical Colleges, the United States could see shortages of up to 124,000 physicians by 2034.33 The American Nurses Association reports that factors contributing to nursing shortages include retirement and high turnover rates; more concerning, nursing school enrollment is not growing at the pace needed to meet the projected demand for nursing services.34 In addition to recruiting and building that workforce, it is important to note that it also relies heavily on immigrant workers and will continue to do so in the next decades.35 The employment of home health and personal care aides is projected to grow 33% from 2020 to 2030, which is much faster than the average 8% growth rate for all occupations (Table 1).36 Currently, nearly 40% of home health aides in the U.S. are immigrants.37 Policymakers should make it a priority to look beyond the polarized immigration landscape and broaden immigration avenues and visa pathways to fill critical gaps and skills in the health care system and those employed in critical infrastructure sectors—the economic sectors needed, as determined by the U.S. Department of Homeland Security,38 to protect health and well-being.
Table 1 — Fastest-Growing Occupations in 2020 and Projections for 2030
Note Excludes occupations with above-average cyclical recovery.
Table 1 shows the top 10 fastest-growing occupations.39 Half are in the health care sector. New immigration pathways are a way policymakers can improve the outlook for the future and mitigate workforce shortages in the near- and long-term.40 If employment-based pathways are not reimagined, major challenges and barriers lie ahead for the direct care workforce—such as nursing assistants, home health aides, and personal care aides—as demand increases for these occupations.41 The direct care workforce—largely composed of immigrants, women, and people of color—is a crucial part of quality care for older Americans, and remains undervalued and underpaid (Table 1).42 In November 2021, Democrats in the House of Representatives passed the $1.75 trillion Build Back Better Act, which proposes a historic $150 billion investment over the next decade for in-home and community services through Medicaid.43 Filling those jobs, however, may be the greatest challenge ahead.
Beyond the challenges of recruiting, adequately training, retaining, and addressing high-turnover rates in this workforce, is the challenge of placing workers in rural, isolated, and medically underserved communities. A study by New American Economy highlights that immigrants may be well-positioned to fill health care roles in non-metro and rural areas, and concludes that the U.S. fails to consider a geographic focus for its immigration system.44 Other countries have begun to prepare for their upcoming labor force challenges, particularly in social care occupations.45 The Canadian government, for example, has implemented caregiver immigration pilot programs, allowing caregivers to live in Canada with their families as a pathway to permanent residence.46 Even Japan has implemented labor migration reforms to target labor market gaps.47 The U.S. is in need of more skilled employment-based visas and reforms that encompass occupations like direct health care workers, as well as other essential sectors such as construction, agriculture, and information technology. Immigrants are part of an essential American workforce that is required to meet the growing demand in the years ahead. Reforms are necessary.
Conclusion
The U.S. faces crucial challenges in the coming decades that will deeply impact the country’s demographic composition and economic performance. Their effects will touch everything from education, infrastructure, and retirement to health disparities, workforce needs, and labor shortages, to name a few. By many measures, the U.S. immigration system, which has the potential to ensure that none of these challenges poses a threat to the stability and competitiveness of America’s society or economy, is failing to adequately prepare the nation with the correct immigration levels and the high-skilled and productive workers that the U.S. economy needs to grow and stay competitive on a global scale.
It is well documented that immigration can indeed help with such issues. A National Immigration Forum study found that the U.S. needs an estimated 37% increase in annual immigration levels (or nearly 370,000 additional immigrants each year) to help maintain the current old-age dependency ratio (the ratio of older adults to working-age adults) by 2060.48 Another analysis by George Mason University estimates that if the U.S. doubles its annual immigration rate from slightly over 1 million to a little over 2 million, the U.S. gross domestic product could reach $47 trillion within the next three decades.49 A crucial point in this regard is to recognize that immigrants have long filled critical gaps in the labor force, often while they are marginalized and underpaid. Indeed, immigrants have exhibited a willingness to do essentially any job, even under difficult circumstances.
A key concern for policymakers and other stakeholders is, of course, how to best expand existing frameworks and develop new ones for visa pathways; address backlogs and delays in the immigration system; and build a sustainable, flexible, and modernized immigration system to best fit the needs of U.S. society and economy. In addition to immigrants who can fill health care-related jobs, this includes finding solutions for the 10.7 million undocumented immigrants currently residing in the United States, as well as preventing undocumented migration through a formal work visa system for industries that currently rely on less-skilled workers for whom there is no immigration pathway into the United States.
There is an urgent need for Congress to act, especially after the COVID-19 pandemic highlighted the many barriers, challenges, vulnerabilities, and inequities facing vulnerable populations such as the elderly and immigrants, and exposed key weaknesses in the U.S. labor market. It is also paramount for the United States to invest in its essential workforce now and for the future. The Build Back Better Act (H.R. 5376), currently awaiting an uncertain fate in the Senate, includes immigration provisions that provide a five-year parole status that could provide work authorization and protection from deportation for up to 6.5 million undocumented individuals.50 Building back a better America includes legal immigration pathways necessary to address workforce shortages and provide a safe and orderly way toward citizenship for those individuals and families who want to live, work, and contribute to society. Passing this law is a good beginning, although it is not enough. Focusing on the changing demographics is a way to understand the complex picture of America’s need for immigration reform. Failing to plan for our future immigration needs, including workforce shortages, only paints a grayer future for America.
Endnotes
1. U.S. Census Bureau, “New Vintage 2021 Population Estimates Available for the Nation, States and Puerto Rico,” December 21, 2021, https://www.census.gov/newsroom/press-releases/2021/2021-population-estimates.html; Macrotrends, “U.S. Population Growth Rate 1950-2021,” December 2, 2021, https://www.macrotrends.net/countries/USA/united-states/population-growth-rate.
2. Ibid.
3. Amanda Barroso, “With a potential ‘baby bust’ on the horizon, key facts about fertility in the U.S. before the pandemic,” Pew Research Center, May 7, 2021, https://www.pewresearch.org/fact-tank/2021/05/07/with-a-potential-baby-bust-on-the-horizon-key-facts-about-fertility-in-the-u-s-before-the-pandemic/.
4. Department of Homeland Security, “Yearbook of Immigration Statistics,” October 27, 2020, https://www.dhs.gov/immigration-statistics/yearbook.
5. Mark Hugo Lopez, Jeffrey S. Passel, and D’Vera Cohn, “Key Facts about the Changing U.S. Unauthorized Immigration Population,” Pew Research Center, April 13, 2021, https://www.pewresearch.org/fact-tank/2021/04/13/key-facts-about-the-changing-u-s-unauthorized-immigrant-population/.
6. Joseph Chamie, “One thing Americans can’t deny: The nation’s low life expectancy,” Hill, December 1, 2021, https://thehill.com/opinion/healthcare/583743-one-thing-americans-cant-deny-the-nations-low-life-expectancy; Farida B. Ahmad and Robert N. Anderson, “The Leading Causes of Death in the US for 2020,” JAMA Network, March 31, 2021, , https://jamanetwork.com/journals/jama/fullarticle/2778234; Population Reference Bureau, “Total Deaths,” 2019, https://www.prb.org/usdata/indicator/deaths/snapshot/.
7. Life expectancy is a complicated item in this list, however, as COVID-19 has caused close to one million deaths in the country. In addition, there were already some worrisome trends, such as a lower life expectancy for certain demographic groups, such as white men. This would indicate that demographic changes are likely to accelerate.
8. Jeff Desjardins, “Animation: U.S. Population Pyramid from 1980-2050,” Visual Capitalist, November 22, 2017, https://www.visualcapitalist.com/us-population-pyramid-1980-2050/.
9. Jonathan Vespa, “The Graying of America: More Older Adults Than Kids by 2035,” United States Census Bureau, March 13, 2018, https://www.census.gov/library/stories/2018/03/graying-america.html.
10. William H. Frey, “New 2020 census results show increased diversity countering decade-long decline in America’s white and youth populations,” Brookings Institute, August 13, 2021, https://www.brookings.edu/research/new-2020-census-results-show-increased-diversity-countering-decade-long-declines-in-americas-white-and-youth-populations/; Gretchen Livingston, “Hispanic women no longer account for the majority of immigrant births in the U.S.,” Pew Research Center, August 8, 2019, https://www.pewresearch.org/fact-tank/2019/08/08/hispanic-women-no-longer-account-for-the-majority-of-immigrant-births-in-the-u-s/.
11. Stephen Campbell, Angelina Del Rio Drake, Robert Espinoza, and Kezia Scales, “Caring for the Future: The Power and Potential of America’s Direct Care Workforce,” PHI National, http://phinational.org/wp-content/uploads/2021/01/Caring-for-the-Future-2021-PHI.pdf.
12. Jeanne Batalova, Michael Fix, and José Ramón Fernández-Peña, “The Integration of Immigrant Health Professionals Looking beyond the COVID-19 Crisis,” Migration Policy Institute, April 2021, https://www.migrationpolicy.org/research/integration-immigrant-health-professionals-beyond-covid-19.
13. William A. Galston, “How Covid Changed the American Workforce,” Wall Street Journal, December 14, 2021, https://www.wsj.com/articles/how-covid-changed-the-american-workforce-participation-remote-benefits-welfare-inflation-11639496874.
14. Josh Mitchell, Lauren Weber, and Sarah Chaney Cambon, “4.3 Million Workers Are Missing. Where Did They Go?,” Wall Street Journal, October 14, 2021, https://www.wsj.com/articles/labor-shortage-missing-workers-jobs-pay-raises-economy-11634224519.
15. Jan Hatzius, et al., “U.S. Daily: Why Isn’t Labor Force Participation Recovering? (Briggs),” Goldman Sachs, November 11, 2021, https://www.gspublishing.com/content/research/en/reports/2021/11/12/4f72d573-c573-4c4b-8812-1d32ce3b973e.html.
16. Social Security Administration, Fact Sheet Social Security Basic Facts, n.d, https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf.
17. Congressional Research Service, “Social Security: What Would Happen If the Trust Funds Ran Out?,” updated October 15, 2021, https://sgp.fas.org/crs/misc/RL33514.pdf.
18. Jonathan Vespa, Lauren Medina, and David M. Armstrong, “Demographic Turning Points for the United States: Population Projections for 2020 to 2060,” U.S. Census Bureau, Issued March 2018, revised February 2020, https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf.
19. Net international migration is the difference between the number of people moving into the country and out of the country; natural increase is the number of births that exceed the number of deaths. See U.S. Census Bureau, "Demographic Turning Points" and U.S. Census Bureau, New Vintage 2021 Population Estimates.
20. Ibid.; Administration for Community Living, “2020 Profile of Older Americans,” U.S. Department of Health and Human Services, May 2021, https://acl.gov/sites/default/files/Aging%20and%20 Disability%20in%20America/2020ProfileOlderAmericans.Final_.pdf.
21. Jonathan Vespa, “The Graying of America: More Older Adults Than Kids by 2035,” United States Census Bureau, March 13, 2018, https://www.census.gov/library/stories/2018/03/graying-america.html.
22. Ibid.
23. To be sure, life expectancy fell from age 78.8 in 2019 to 77.3 in 2020, a decline of 1.5 years—but that was largely due to the COVID-19 pandemic. Elizabeth Arias, Betzaida Tejada-Vera, Farida Ahmad, and Kenneth D. Kochanek, Provisional Life Expectancy Estimates for 2020, National Center for Health Statistics. July 2021, https://www.cdc.gov/nchs/data/vsrr/vsrr015-508.pdf.
24. Richard W. Johnson, “What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports?” U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, April 3, 2019, https://aspe.hhs.gov/reports/what-lifetime-risk-needing-receiving-long-term-services-supports; AARP and National Alliance for Caregiving, 2020 Report Caregiving in the U.S., May 2020, https://www.caregiving.org/wp-content/uploads/2020/06/AARP1316_RPT_CaregivingintheUS_WEB.pdf; Petra Maresova, et al., “Consequences of chronic diseases and other limitations associated with old age–a scoping review,” BMC Public Health 19, no. 1431 (2019), https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7762-5.
25. Alzheimer’s Association, “2021 Facts and Figures,” n.d, https://www.alz.org/alzheimers-dementia/facts-figures; Alzheimer’s Impact Movement, 2021 Alzheimer’s Disease Facts and Figures, March 2021, https://www.alz.org/aaic/downloads2021/2021_Alzheimers_Disease_ Facts_and_Figures.pdf
26. Patrick Boyle, “Aging patients and doctors drive nation’s physician shortage,” Association of American Medical Colleges, News & Insights, June 11, 2021, https://www.aamc.org/news-insights/aging-patients-and-doctors-drive-nation-s-physician-shortage; Terry Fulmer, et al., “Actualizing Better Health and Health Care For Older Adults,” Health Affairs, January 21, 2021, https://doi.org/10.1377/hlthaff.2020.01470; Patricia A. Grady, “Advancing the Health of Our Aging Population: A Lead Role for Nursing Science,” Nursing Outlook 59, no. 4 (July-August 2011): 207–209, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197709/.
27. U.S. Bureau of Labor Statistics, “Projections overview and highlights, 2020–30,” October 2021, https://www.bls.gov/opub/mlr/2021/article/projections-overview-and-highlights-2020-30.htm.
28. G. Richard Olds, “To get the doctors we need, expand their opportunities to train,” The Hill, August 19, 2021, https://thehill.com/changing-america/opinion/568604-to-get-the-doctors-we-need-expand-their-opportunities-to-train#:~:text=Medical%20schools%20 in%20the%20United,37%2C000%20 residencies%20offered%20that%20 year; Institute of Medicine, “Ensuring Quality Cancer Care Through the Oncology Workforce: Sustaining Research and Care in the 21st Century: Workshop Summary,” Washington, D.C.: The National Academies Press, 2009, https://www.ncbi.nlm.nih.gov/books/NBK215249/
29. Institute of Medicine, “Ensuring Quality Cancer Care.”
30. Jeanne Batalova, “Immigrant Health-Care Workers in the United States,” Migration Policy Institute, May 24, 2020, https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states-2018.
31. Kavitha Cardoza, “There's A Shortage Of Home Health Aides for the Elderly, and It's Getting Worse,” NPR, September 28, 2021, https://www.npr.org/2021/09/28/1031651663/shortage-home-health-aides-elderly.
32. Jeanne Batalova, Michael Fix, and José Ramón Fernández-Peña, “The Integration of Immigrant Health Professionals Looking beyond the COVID-19 Crisis,” Migration Policy Institute, April 2021.
33. Association of American Medical Colleges, “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034,” prepared for the AAMC by IHS Markit Ltd., June 2021, https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage.
34. American Association of Colleges of Nursing, “Nursing Shortage,” last update: September 2020, https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage.
35. Andrew Kreighbaum, “Hospitals, Foreign Health-Care Workers Press Congress for Action,” Bloomberg Law, November 19, 2021, https://news.bloomberglaw.com/daily-labor-report/hospitals-foreign-health-care-workers-press-congress-for-action; Julia Gelatt, Jeanne Batalova, and Randy Capps, “Navigating the Future of Work: The Role of Immigrant-Origin Workers in the Changing U.S. Economy,” Migration Policy Institute, October 2020, https://www.migrationpolicy.org/research/future-work-immigrant-origin-workers-us-economy; Stephen Campbell, et al., “Caring for the Future: The Power and Potential of America’s Direct Care Workforce,” PHI National, January 12, 2021.
36. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Home Health and Personal Care Aides, last modified September 8, 2021, https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm.
37. Jeanne Batalova, “Immigrant Health-Care Workers in the United States,” Migration Policy Institute, May 14, 2020, https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states-2018.
38. Cybersecurity & Infrastructure Security Agency of the U.S. Department of Homeland Security, “Advisory Memorandum on Identification of Essential Critical Infrastructure Workers During COVID-19 Response,” April 17, 2020, https://www.cisa.gov/sites/default/files/publications/Version_3.0_CISA_Guidance_on_ Essential_Critical_Infrastructure_Workers_4.pdf.
39. U.S. Bureau of Labor Statistics, “Fastest growing occupations,” last modified September 8, 2021, https://www.bls.gov/emp/tables/fastest-growing-occupations.htm.
40. Dan Kosten, “Home Health Care Workers: Immigrants Can Help Care for an Aging U.S. Population,” National Immigration Forum, May 28, 2021, https://immigrationforum.org/wp-content/uploads/2021/05/HealthCare.pdf.
41. Note: Direct care workers are known by a variety of job titles in the field. New American Economy, “A Helping Hand: How Immigrants Can Fill Home Health Aide Shortages in America’s Rural Communities,” October 2015, http://www.newamericaneconomy.org/wp-content/uploads/2015/10/Home-Health-Aides.pdf.
42. Ibid.; Campbell, et al., “Caring for the Future, PHI National.
43. Alessandra Malito, “Build Back Better—what’s in it for seniors?,” Market Watch, November 23, 2021, https://www.marketwatch.com/story/build-back-better-whats-in-it-for-seniors-11637696775; Alex Ruoff, “Democrats’ Slimmer Home Health Care Plan Hinges on State Uptake,” Bloomberg Law, November 1, 2021, https://news.bloomberglaw.com/health-law-and-business/democrats-slimmer-home-health-care-plan-hinges-on-state-uptake.
44. Ibid.; New American Economy, “A Helping Hand.”
45. Maria Vincenza Desiderio, Gov. UK, “International review: immigration routes for social care workers,” August 2021, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/1013142/IMMIGRATION_ROUTES_FOR_SOCIAL_CARE_WORKERS.pdf.
46. Government of Canada, Caregivers, last updated September 1, 2021, https://www.canada.ca/en/immigration-refugees-citizenship/services/immigrate-canada/ caregivers.html; Government of Canada, “Caregivers will now have access to new pathways to permanent residence,” news release, February 23, 2019, https://www.canada.ca/en/immigration-refugees-citizenship/news/2019/02/caregivers-will-now-have-access-to-new-pathways-to-permanent-residence.html.
47. Deborah J. Milly, “Japan’s Labor Migration Reforms: Breaking with the Past?,” Migration Policy Institute, February 20, 2020, https://www.migrationpolicy.org/article/japan-labor-migration-reforms-breaking-past.
48. Ali Noorani and Danilo Zak, “Room to Grow: Setting Immigration Levels in a Changing America,” National Immigration Forum, February 3, 2021, https://immigrationforum.org/wp-content/uploads/2021/02/Room-to-Grow.pdf.
49. FWD.US, “Increasing Future Immigration Grows the U.S.' Competitive Advantage,” April 7, 2021, https://www.fwd.us/news/future-immigration/.
50. H.R.5376—Build Back Better Act, https://www.congress.gov/bill/117th-congress/house-bill/5376/text?r=1&s=1; Congressional Budget Office, “Estimated Budgetary Effects of Title VI, Committee on the Judiciary, H.R. 5376, the Build Back Better Act,” November 18, 2021, https://www.cbo.gov/publication/57625; News release, “Representatives García, Ocasio-Cortez, Correa, Espaillat, & Meng Release Statement On Immigration Reform In Build Back Better,” November 22, 2021, https://chuygarcia.house.gov/media/press-releases/representatives-garc-ocasio-cortez-correa-espaillat-meng-release-statement; Robert Warren and Melissa Katsoris, “The House Version of the Build Back Better Act,” Center for Migration Studies, November 22, 2021, https://cmsny.org/house-version-build-back-better-act/.
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