A New Visa Proposal Wants to Give Nursing Homes a Workforce Pipeline They’ve Never Had

Washington, District of Columbia — The people who bathe, feed and lift America’s aging parents are in short supply, and the gap is about to get much worse. A new proposal out of the Brookings Institution argues that Washington could close part of it with a tool this field has never been offered: its own visa.

Economist Tara Watson, writing for Brookings’ Hamilton Project, has proposed the H-1D — a temporary, employment-based visa designed specifically for direct care workers. Home health aides, personal care aides and nursing assistants would qualify, as long as they bring at least two years of experience in the field. It’s an occupation the current immigration system largely ignores, even though immigrants already make up a disproportionate share of the direct care workforce.

The design borrows from the H-1B visa familiar to the tech industry. Workers would get an initial three-year stay with a renewal option, dependents could come along, and after six years they could apply for permanent residence. The proposal also builds in worker protections: an above-market wage floor, safeguards against exploitation, and support for training and professional development.

The math behind the idea

Demand is coming whether operators are ready or not. More than 20 million adults already need help with daily activities. The population 65 and older is projected to grow from 65.6 million to 77.5 million within a decade, and the 85-plus group — the one most likely to need a nursing home — will jump from 6.8 million to 11.1 million.

That trajectory points to roughly 1.28 million additional direct care workers needed by 2036, a 35% jump from today. Higher pay would help, Watson writes, but it won’t close the gap on its own.

Under the proposal, an initial pilot would give way to 65,000 visas a year, enough to cover about 35% of the needed growth over ten years. A standing commission would revisit the cap if demographics or the economy shift. Immigrants already working in direct care could use the program to steady their status, alongside new arrivals recruited from abroad.

Why operators should pay attention

The stakes show up at the bedside. Research cited in the report links a larger direct care workforce to fewer falls in nursing homes and lower mortality among older adults. The timing is pointed, too — federal jobs data released last month showed how badly nursing home hiring has stalled nationwide. And operators would welcome the help; after a year of tightened enforcement, many say they can’t replace the workers they’re losing.

Nothing happens without Congress, and immigration expansions rarely move quickly. But the proposal hands the sector something it hasn’t had before: a specific, numbered starting point. Watson argues a similar model could eventually serve other high-need occupations, and that a targeted program like this one could set the stage for broader immigration reform.