When Juanita Webb moved into Providence Mount St. Vincent nursing home in West Seattle, she was surprised to find that half the staff were immigrants, hailing from some two dozen nations.

The diversity didn't upset her, but — like the rest of the nursing-home experience — it took a little getting used to.

The former church secretary and bookkeeper had never needed help with such intimate tasks as brushing her teeth, bathing and getting dressed. And, in all her years living in Seattle, "I never had any association with any foreigners, even Europeans. ... I've just been with Americans."

At age 83, Webb is among millions of frail older and disabled people in the U.S. and worldwide — and about 80,000 in Washington — who find themselves in later life receiving the most personal kind of help from nurses, aides, housekeepers and others who often look different from them and weren't raised speaking English.

It's a reality not just for American-born residents like Webb, but for residents who are immigrants themselves, and perhaps already struggling to be understood.

That's not to say such diversity necessarily results in a gulf between resident and caregiver. In fact, many in the long-term-care community say diversity enriches a nursing home's culture and often leads to bonds between people who otherwise might not have met.

Still, "You talk to residents. They'll tell you about the difficulty of language barriers, especially if they have a hearing impairment," said Louise Ryan, assistant state long-term-care ombudsman. "And the feelings of being left out or ignored when two caregivers are speaking another language and, at the same time, providing care."

The impact of a global work force on the long-term-care industry has become part of the nation's debate on immigration, especially given a continuing shortage of workers and a glut of baby boomers who will need a hand in old age.

"We are dependent on a culturally diverse work force to do our work right now," said Charlene Boyd, administrator at Providence Mount St. Vincent. 

"They will continue to be important and we embrace that."

A changing work force

Immigrant labor is in high demand in the U.S. and other countries with rapidly aging populations and too few younger workers to fill long-term-care jobs, according to a 2005 report by AARP, an advocacy group for older Americans.

In King County over the past 15 or so years, immigrants have been reshaping the face of the long-term-care industry, with some Seattle nursing homes now reporting that half their staff is foreign born.

The county's 900-plus adult-family homes are owned predominantly by immigrants who typically hire other immigrants as workers. And many of the companies that provide in-home care to clients also are owned by immigrants.

"Without foreign labor, long-term care could close its doors in King County. I'm very serious about it," said Josh Gortler, chief executive officer at the Caroline Kline Galland Home, a Jewish nursing home in Seward Park with independent and assisted living on First Hill.

Most immigrants who work in licensed long-term care — at least in this state — are here legally, in large part due to heavy regulation and government oversight of the field, according to state regulators and industry and union officials.

But it's also likely that certain kinds of jobs or operators in long-term care — such as the private home-care market — are dependent on illegal immigrants, said David Rolf, president of Service Employees International Union 775, which represents 28,000 long-term caregivers in Washington.

The immigration debate

Martha Martinez, a member of that union, makes $12.58 an hour as an aide at Seattle's Horizon House.

She crossed the California border illegally 20 years ago, received amnesty in the mid-1980s and recently became a U.S. citizen. She and her husband have raised four children in the U.S., the oldest a graduate of the University of Washington.

"I never see American people doing the kind of work I'm doing," she said. "They don't want to do what I'm doing."

Local 775 accepts any long-term-care worker as a member regardless of their immigration status. Martinez maintains that union membership helps protect illegal immigrants from being taken advantage of on the job.

As the immigration debate has unfolded, the nation's long-term-care industry has asked Congress to strike a balance between maintaining secure borders and serving the needs of the rapidly aging population. The industry supports the proposed guest-worker program to help fill caregiver vacancies.

"Quite frankly ... rather than kicking people out and battening down the hatches, they need to be thinking about opening up and allowing more folks to come to this country," said Peter Nazzal, director of long-term care for Catholic Community Services.

Some providers have become assertive in recruiting and hiring workers.
Both Providence and Kline Galland advertise jobs in local ethnic media and cultivate close relationships with various ethnic communities, where job opportunities can be spread via word of mouth.

Providence's human-resources director has started traveling to the Philippines every two years to recruit nurses, a profession that's critically understaffed in the U.S.

"A great opportunity"

Cristine Palacios chose to leave her husband and 7-year-old daughter behind in the Philippines when she took a job recently as a nurse at Providence.

Her mission is to earn enough money to bring the whole family to Seattle and enroll her daughter in a good school in hopes that she, too, will one day work as a professional.

Palacios earns $23.55 an hour, compared with the approximately $120 a month she could make as a nurse back home. But the sacrifice is high. Her daughter keeps asking on the phone: "Where are you, Mom? I miss you."
"I guess I have to harden my heart," said Palacios, 39.

Once an immigrant is hired, nursing homes such as Providence and Kline Galland say, they try to create a respectful workplace where employees can be themselves.

"We are a Jewish facility, but we have no problem hiring Muslims," said Gortler at Kline Galland. "We let them practice their religion ... I think it's wonderful ... We may learn it's a great opportunity, a teaching laboratory."
Challenges, joys

At Providence and Kline Galland, employees who understand English but can't speak it well enough are offered jobs in positions that don't require contact with residents, such as laundry, housekeeping or kitchen services. To move up, they can take classes in English and American culture.

In one English class at Providence, a Filipino employee practices his English by haltingly describing his work. "I use the vacuum cleaner and I use shampooer. Also, the scrubber ... "

The teacher interrupts: "And remember the word floor — the 'f' sound."
Another student takes a turn.

"I am a host. I serve food to residents for lunch and dinner ... After resident eats, I wash dishes."

Staff at all levels are encouraged to teach residents about their cultures through conversation, potlucks and fashion shows. The flags of their countries fly outside in good weather.

"What we try to do is make it a fun and engaging work environment," said Steve Ricard, director of human resources for Providence Senior and Community Services.

Even so, hostilities occasionally flare.

A resident may say something derogatory or refuse help from an aide of another race. Workers from countries in conflict with each other may argue.
Though rare, "it can be a challenging situation," Ricard said.

Providence resident Juanita Webb has seen a few residents have trouble adjusting to a foreign-born employee, which she chalks up to poor health or lack of communication.

She's made close friendships with aides from Ethiopia, Ghana and the Philippines and is fascinated by their foods, ways of worship, tight-knit support systems, shared care of children and high work ethic.

"I just think it enriches our life because they give as much to us or more than we give to them," Webb said.

After an aide from Ethiopia gave birth following a difficult pregnancy, it was such a joyous occasion that, while still on maternity leave, the woman and her husband brought the newborn for Webb to hold.

"I was so touched," Webb said.

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