Washington State Nursing Facility Characteristics, Foreign-born Employees and Quality Ratings: Does the proportion of foreign workers predict quality differences

The number of elderly people in the U.S. is projected to more than double over the next 30 years, leading to an increase in demand for long-term care. Washington State is following national industry trends, relying heavily on the foreign-born workforce to provide care for a growing number of disabled people in institutional settings. This descriptive, cross-sectional study relates Washington State nursing facility characteristics, including independent quality ratings, to the view of facility administrators as gathered in an on-line survey. We used independent sources to determine profit and chain status, size of facility as measured by number of beds, and geographic location. We then asked administrators to estimate the proportion and origins of their foreign-born employees, and to describe any problems associated with these employees. After controlling for other characteristics, the proportion of foreign-born employees was not a negative predictive factor in facility quality ratings. Administrators reported their main concerns to be issues related to communication and to discrimination by residents against foreign-born employees.