title: Foreign-born care givers in Washington State nursing homes: characteristics, associations with quality of care, and views of administrators.
abstract: 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.
  
  
  CONCLUSIONS
  The proportion of foreign-born employees in nursing facilities may be associated with improved performance.
authors.affiliation: University of Washington, Seattle, USA acker.katie@gmail.com.
authors.forename: Katherine
authors.initials: K
authors.lastname: Acker
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Pletz
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Katz
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Hagopian
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000706:statistics & numerical data*; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D005551:Foreign Professional Personnel / Q000706:statistics & numerical data*; D006269:Health Facilities, Proprietary / Q000706:statistics & numerical data; D006270:Health Facility Administrators / Q000523:psychology*; D006801:Humans; D007802:Language; D009096:Multi-Institutional Systems / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data*; D010067:Ownership / Q000706:statistics & numerical data; D011287:Prejudice; D011369:Professional-Patient Relations; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012067:Religion; D014861:Washington
keywords: foreign-born; nursing homes; policy; quality of care; workforce