Immigrant nurses are already a key demographic in long-term care, and are likely to become more vital in the future. But allegations of coercive labor practices by some providers and staffing agencies could put a chilling effect on their participation in the sector.

Jo-Ann Heram S. Esturas, a registered nurse and Filipino immigrant, sued her former employer Nov. 20 — claiming she had been trapped into untenable working conditions and subpar pay. The terms of her recruitment allegedly threatened having to pay $25,000 to Glen Island Center in New Rochelle, NY, if she breached her three-year contract, as well as the loss of her residency status without work. 

The case is among the latest examples of immigrants being recruited to bolster the staff of US nursing homes, then allegedly finding themselves locked into years-long contracts and working conditions they found to be unbearable or dangerous. 

Some staffing agencies also have tried to make employees pay for the agencies’ legal fees if they are found to be in breach of their contract — a “loser-pays” practice that the US Department of Labor has argued is coercive and likely to dissuade immigrants from pursuing legal action to protect themselves from violations of immigration law. 

In a civil suit against one such agency, the DOL asserted that recruiting immigrant workers with contracts threatening to force repayment of wages and then pile on additional legal fees amounted to attempts to “use workers as insurance policies to unconditionally guarantee future profit streams.”

Increasingly vital workers

The long-term care sector has increasingly come to rely on foreign-born care workers in the midst of staffing shortages and increased staffing mandates. About 20% of direct care workers in nursing homes are immigrants in 2023, with research showing that the increase over time has improved overall care quality without impacting nurse skill levels or the cost of care. 

Immigration could become an even more important source of workers for the sector if a proposed federal nursing home staffing mandate goes into effect. 

However, exploitative labor practices have been a steep obstacle for some immigrant workers. 

Esturas’ complaint describes her recruitment as a “take-it-or-leave-it” offer that left her trapped once she arrived in the US and discovered her job involved overwhelming workloads and pay that never matched the DOL prevailing wage she had reportedly been promised.

The complaint alleges that Esturas and other staff commonly had no time to help residents with requests, assist them and manage their pain after falls or bring them their medication on time. 

Esturas resigned on the same day she sued her former employer, claiming that she was afraid she could lose her license or even be responsible for the death of a patient if circumstances continued unchanged. 

Immigrants are often recruited with the promise of higher wages than they can find in their countries of origin. But with cases like Esturas’ circulating, the question arises of how attractive these jobs will continue to be for foreign-born workers. 

Esturas is not alone — more than 40 other Filipino nurses filed a similar complaint against the same nursing home on Oct. 12 for alleged violations going back as far as 2013. 
Glen Island Center did not respond to a McKnight’s request for comment to the allegations by time of publication.