Foreign-born care givers in Washington State nursing homes: characteristics, associations with quality of care, and views of administrators

Objective: Following national trends, Washington State relies heavily on foreign-born workers to provide long-term care. Our study assesses state nursing facility characteristics, quality ratings, and the views of facility administrators about the implications of an increasing number of foreign-born employees. Methods: We used independently available data to supplement a survey of nursing home administrators. Results: Nearly half of the administrators reported difficulty hiring U.S.-born job applicants. Three in four administrators reported problems related to language differences, and just more than a third reported challenges related to cultural and/or religious differences. Nonetheless, the proportion of foreign-born employees was positively associated with independent facility quality ratings. Almost half of the administrators reported discrimination by patients/clients toward their foreign-born workers. Quality ratings were negatively associated with for-profit, chain, or multi-ownership status. Discussion: The proportion of foreign-born employees in nursing facilities may be associated with improved performance.