In 1965, Charleston, West Virginia, was home to about 85,000 residents — now, that number has almost halved. The people who are left look a lot like the population in the rest of the state — namely white and older. And as they age, those older folks need someone to care for them. But across the United States, there’s a direct care worker shortage.

“The growth is going to be tremendous, I mean we’re going to need millions,” said Robyn Stone, co-director of LeadingAge — a non-profit aging research organization based in Washington, D.C. Millions is a slight exaggeration — but not by much. Data from the direct care worker advocacy organization PHI National projects that between 2018 and 2028, the direct care workforce will add 1.3 million jobs.

And in places like West Virginia, there aren’t enough people to fill them. West Virginia is one of a handful of states in which the population is actually going down due to people migrating out of the state. Recent data also shows there are more deaths than births.

“We know that in many rural communities there just are not enough bodies,” said Stone. “In fact we have anecdotes from our own association in some rural communities that nursing homes and other types of residential environments have actually had to stop admissions because they didn’t have a workforce to care for the people who needed the beds. We hear the same stories from people who are looking to hire home aides.”

Some experts like Sean O’Leary, senior policy analyst for the West Virginia Center on Budget and Policy, say immigration could help solve West Virginia’s population decline problem, which would help worker shortages like West Virginia is facing in the direct care workforce.

“[Immigrants are] 1.6 percent of our population, but since 2001 one in five new West Virginians has been an immigrant,” he said.

Immigrants play an important role in the U.S. economy — especially in lower-paying jobs like direct care workers. In California, for instance, which has the highest foreign-born population in the country, almost half of direct care worker jobs are filled by recent immigrants.

“A large proportion of this workforce in general are immigrants so — about 30 percent to a third of all the home care aids in this country are first-generation immigrants and about a quarter of certified nursing assistants are immigrants,” Stone said.

But in West Virginia, less than two percent of the population is foreign-born.

“We have the smallest share, but I would kind of argue that we have the most important share and it’s because of that population,” O’Leary said. “You know West Virginia is losing population, our state is shrinking, we’re likely to lose a congressional seat. The population that we do have is older, the population we do have is sick, the population we do have doesn’t work as much as we’d like to see in the economy. And all those things are made less of a factor by our immigration.”

West Virginia’s Immigrant Population

Edwiin Parra-Munoz moved to the United States on a green card from Mexico when he was 12. He’s now 29 and became a U.S. citizen on January 13.

Fifty-three percent of West Virginia’s immigrant population are naturalized citizens like Parra, according to a new report from the West Virginia Center on Budget and Policy. Nationwide, the number is around 44 percent. And more than half of immigrants work in health care or white-collar professions. Immigrants living in West Virginia are also more likely to have a college degree than native-born citizens.

Parra, for instance, will graduate with a masters in nurse anesthesia in May.

But immigration is a hot button topic in West Virginia.

In 2018 the Dominion Post polled West Virginians on immigration. About 60 percent of respondents agreed with the statement that “a growing number of newcomers from other countries threatens traditional American customs and values” and “immigrants today are a burden on our country because they take our jobs, housing and healthcare.”

At a 2018 rally in Huntington, West Virginia, President Donald Trump talked about immigration to a supportive audience.

“The new platform of the Democrat party is to abolish [U.S. Immigration and Customs Enforcement], a vote for any democrat in November is a vote to eliminate immigration enforcement, throw open our borders and set loose vicious predators and violent criminals,” he said. “They will be all over our communities, they will be preying on our communities.”

West Virginia Republican Delegate Carl Martin is one of three legislators who proposed a bill last session to help fund Trump’s border wall. But he said Trump’s stance on immigration has been misconstrued.

“Every time it’s — he talks about we want legal immigrants — we want them to come in the right way, but we want them here,” Martin said. When asked if he thought his constituents would echo that perspective he said, “100 percent, yeah, of course.”

Martin can’t speak to the state’s shortage in care workers, but he agreed immigration could help stem West Virginia’s population decline.

“It could,” he said. “We have to look at a lot of different avenues on maintaining our population and trying to increase our population…we have to do something. And we’ve been working on that.”

But, he said, he’s not sure if immigrants are interested in coming here.

“I don’t know how big of an impact immigration can make on our state. We have to figure out somehow how to get them to the Mountain State.”

Parra has been living in West Virginia for 17 years, but like many young people, he isn’t staying to work here. He just got a job at a hospital in Portsmouth, Ohio, which he said included help repaying loans.

But he loves West Virginia and considers Charleston home and hopes to return when his contract is up. He said people want to come to the United States for jobs — any jobs — but it’s really difficult to get here legally.

“Now the whole system it’s set up to make it very difficult — especially for people from Mexico…and it’s very hard for somebody with a very low economic status to be able to afford that. It’s just really incredibly hard to come the right way,” he said.

Regardless of whether or not immigration is part of the solution, West Virginia is facing a looming shortage of people to care for the aging population, and many experts warn something has to be done.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

This article was originally published by West Virginia Public Broadcasting.