A crisis in Iowa health care looms before us. Today, there are estimates of a shortage of thousands of workers in the primary caregiver sector – a sector that includes nursing assistants and home health aides. In layman’s terms, we lack the employees who provide basic care for daily living to the elderly and the infirm.

Nursing homes across the state offer hundreds of dollars in sign-on bonuses for people willing to bathe, feed, dress and nurture the most vulnerable of our people.

The bad news is two-fold. First, we have a shortage of employees that current recruitment strategies do not seem to remedy. Second, we have a shortage of employees at a time when our elderly population is lower than it will be in the future.

Remember the baby boomers? They were born demanding from society. Demanding new elementary schools and more teachers. Demanding more dormitory space in college. For a short time, they shifted from demanding to protesting, but yuppie-hood pretty much placed them back on the demand side of the equation.

I ask you to picture this same generation 10, 15, 20 years from today. They will be demanding more space and more care in the current nursing home system. Contrast this with our current generation of octogenarians – the widely dubbed “greatest generation.” Current nursing home residents have lived through a world war or two, as well as the Great Depression.

As a five-year veteran of the nursing assistant ranks, I can vouch for a general attitude evident in the hundreds of elderly for whom I had the privilege to provide care. Even in situations of pain and suffering, our current generation of nursing home residents is generally retiring, flexible, and most important, not demanding.

Hundreds of times when we were desperately short-staffed, I would dash into a resident’s room to perform some small care. “It’s all right, honey,” she would invariably say. “I know you girls are short three today and the nurse you’re working with is no good. You can help me later.”

One particular case in was a woman who had been able to perform her own cares up until a few weeks before I met her. While she was a resident in our facility, I had not been assigned to her hallway and instead had been generally left to fend for myself with 20 patients depending on me for care. One day when I happened into her room, we went through the usual “don’t do anything special for me, honey” routine before I successfully convinced her to get up and get washed.

Having never met this woman, I was in no way prepared for what I found. Her dentures had been cementing food particles to the roof of her mouth since roughly the Truman administration. I hid from my assigned post for close to half an hour, probably doing the first washing, hair care, and freshening she had received in weeks, all the while giving the woman a lesson in assertiveness.

I reminded her she was paying good money to be there, but unfortunately she was not getting the care she deserved. I told her it was all right to be pushy and demanding, in fact, I had her practice reading me the riot act just so she could get into her zone. I heard later she had become a real handful. That made me happy.

I wouldn’t tell you these sad little stories if I did not believe there was a relatively simple way to alleviate the shortage of staff in Iowa’s nursing homes. I believe that the answer lies with our immigrant population.

Nursing homes already recruit and provide the 75-hour training for the paltry staff they have; certainly immigrants could be heavily recruited and trained in the same way.

In lieu of a sign-on bonus, nursing homes (or the companies that manage them) could even provide sponsorship for qualified immigrants to get their work documents in order.

Many of the new immigrants in Iowa come from cultures where families provide care for the elderly, and I would venture to say that among our immigrant population in Iowa we could find hundreds of capable people who have spent their lives caring for their parents and children.

Why we would let such a resource slip unnoticed into the clutches of factory farms is beyond me.

While the candidates received their training, they would also be learning the relevant English to perform their jobs. Working primarily with English-speaking patients and co-workers would also accelerate the acquisition of English skills.

I do not believe that the nursing home industry should become the major source of employment for our immigrants, nor do I believe that immigrants are well suited to the work of a nursing assistant.

However, I do know that with our current shortage of primary-care givers in the state, substandard care and conditions in our nursing homes will persist, making them anything but home for a burgeoning elderly population.

Rachel Faber Machacha is a graduate student in international development studies from Emmetsburg.