Who will provide long-term care to you or your loved ones? If you live in developed countries like the US or the UK, the answer may surprise you according to a new report issued by the AARP Public Policy Institute>.

The difficulty in attracting and retaining healthcare workers, particularly in long-term care settings, has dramatically increased in recent years. As a result, healthcare employers in the US and other developed countries are hiring a growing number of workers from developing nations to address their critical staffing needs and to meet future demand.

The AARP report “We Shall Travel On: Quality of Care, Economic Development, and the International Migration of Long-Term Care Workers,” cites US Department of Health and Human Services (2003) projections that the number of workers needed to provide such services (including nurses, aides, and personal care workers in institutional and home-based settings) will grow from 1.9 million to 2.7 million, a 45 percent increase between 2000 and 2010. Looking further into the future, the demand for long-term care workers may increase to between 3.8 million and 4.6 million by 2050-a 100 percent to 140 percent increase over 2000 levels.

While demand skyrockets, the US population age 15-64 is only projected to increase by 27.2 percent between 2005 and 2050. The pool from which such workers have traditionally been drawn-largely women between age 25 and 50 without post-secondary education-continues to shrink. Unless more can be done to attract and retain native-born workers, reliance on migrant workers will grow.

The AARP report examines the size, scope and demographics of migrating long-term care workers. The report also looks at the social factors behind the flight of workers, and examines related policy considerations such as immigration, long-term care financing, and worker recruitment, education and credentialing.

AARP Director of Policy and Strategy John Rother explains, “Under a cover of little public awareness, an increasing number of long-term care workers in the US and other nations are immigrants from developing nations. This trend has repercussions around the world.”

The report notes that in the Philippines alone, 70 percent of nurse graduates have “traveled on” to other countries in recent years. The Philippines example shows how large the scope of worker migration is for just one nation. Similar situations are playing out in India, China, sub-Saharan Africa, Mexico, the Caribbean, Eastern Europe and the Pacific Islands.

A big question for some is competency. The migration trend impacts the quality of nursing education in both positive and negative ways. Some nurses are taught to international standards so that graduating nurses can be licensed in other countries. But in some countries such as the Philippines and India, the quality of new nursing schools to meet increasing demands is uneven.

For unlicensed, low-skilled aides, the issues are different. They rarely immigrate to pursue careers in health or long-term care, but often find such jobs and training after immigrating. Many in this group are domestic service workers who constitute a large segment of caregivers in developed countries.

“The most intimate care to frail older persons in developed countries is increasingly likely to be provided by young women whose native tongue, race and culture are different from those they serve,” report co-author Don Redfoot said.

Redfoot, a senior advisor for AARP’s Public Policy Institute, explains the impact migration has on developed countries that are losing working-age people. “Demographic trends are increasing the need for caregivers in countries all over the globe. In the two countries with the oldest populations, Italy and Japan, the number of people age 80 and above is projected to more than triple by the year 2050 while the number of working age people (15-64) is projected to decline by 38 percent during that period.”

“As long-term care needs continue to grow, meeting this demand will require more engagement across international borders,” Redfoot said.

Also of great concern is the impact of countries losing educated and skilled workers. The “brain drain” worker migration causes depends on the country. The report found that in sub-Sahara Africa, many countries have fewer than 20 nurses for each 100,000 in population. In Norway or Finland, there are more than 50 times as many nurses per population.

“Migration raises complex immigration issues in the post 9/11 world and complex national security issues as well,” Redfoot said. Most developed countries have been reluctant to open their doors to more immigration, especially low-skilled workers. In Japan, the country with the greatest need for long-term care workers, there are also some of the most stringent immigration laws,” he explained.

To that end, the AARP Global Aging Program brought world experts together this week at an International Forum on worker migration. They examined an array of policy options, programs and international arrangements that can make migration work better for both developed and developing countries.

AARP International Affairs Director Ladan Manteghi said, “The quality of long-term care received by older persons in developed countries will depend on the quality of engagement with less developed countries which are likely to supply the workers. But importing workers from abroad is not a complete solution. We must do a better job attracting, educating and retaining US workers. AARP is facilitating a dialogue to help policy makers, practitioners and the public better understand the complex economic and cultural issues surrounding the migration and employment of long-term care workers.”