Immigrants, refugees in Minnesota increasingly filling critical direct care jobs

A woman in scrubs stands and smiles for a photo
Rangineh Kalhor is a charge nurse at Aftenro senior care in Duluth. Kalhor has a degree in physics and math from Iran, but with limited English skills when she moved to Duluth in 2017, she started in housekeeping at Aftenro. She's since become a CNA and LPN, and next year is going to back to school to become a registered nurse.
Dan Kraker | MPR News

Updated: Aug. 7, 1:15 p.m. | Posted: Aug. 7, 4 a.m.

Six years ago, Rangineh Kalhor moved to Minnesota from Iran. She came to be near her daughter, who was pursuing an astrophysics degree at the University of Minnesota Duluth.

Kalhor herself has a joint degree in physics and math. She applied for graduate school at UMD. But she didn't get in.

“The problem was my English,” she explained. “Initially my English wasn't very good.”

Her daughter helped arrange a group on campus for her mom to practice English with other recent immigrants. One day, while walking to campus, Kalhor decided to stop into Aftenro, a senior living center across the street, to see if they were hiring.

And, to her surprise, she got a job. First in housekeeping. Then as a dietary aide. “It wasn't easy,” she recalled. “It was so hard.”

She had a really tough time saying names of different foods, such as “spaghetti.” She began taking the menu home every night, typed the words into Google Translate, and practiced pronouncing them, over and over.

Her English quickly improved. A year after she started, her employer paid for Kalhor to train as a certified nursing assistant. Then, she earned certification as a Trained Medical Assistant, with her training costs again paid by Aftenro.

But she wasn’t done. After some encouragement from a co-worker, last year she went back to school to become a licensed practical nurse. Now at 54, Kalhor is working as a charge nurse. She walks briskly up and down the hallway, helping residents, a ready smile always on her face.

“That’s the feedback I get from residents,” she said. “They told me, when we see you, your smile, and then your face is happy, it makes us happy too.”

Workers like Kalhor are increasingly the face of direct care around the state. According to data from the state Department of Employment and Economic Development, or DEED, foreign-born workers make up about 18 percent of the direct caregiver workforce even though they make up only 12 percent of the overall workforce.

They work as everything from home health aides to registered nurses.

The rate's even higher for personal care aides. They fill 27 percent of those jobs around the state.

“These are jobs that people who are just coming to this country who maybe don't have the language skills that they would need to do other kinds of service occupations, can find work in personal care service,” said Oriane Casale, assistant director in the labor market information office with DEED.

Two people write at a counter
Rangineh Kalhor, who's from Iran, and Festus Sili, from Kenya, count medications at Aftenro senior care in Duluth. Foreign-born Minnesotans account for 18 percent of the direct care workforce in the state.
Dan Kraker | MPR News

A huge need

Foreign-born workers, including recent immigrants and refugees, are an increasingly important recruitment target for state and local workforce agencies who are struggling to meet the insatiable demand for workers in what DEED refers to as the “caring careers.”

Direct care jobs make up 7.5 percent of the state's total workforce. Home health and personal care aides is the single largest occupation in the state with more than 100 thousand workers.

In Minnesota there are currently 45,000 vacancies in these jobs. For every 100 positions, there are 10 openings.

At Aftenro in Duluth, which provides 24-7 care for 54 senior residents, administrator Amy Porter said, like a lot of facilities, they've had to limit admissions because of staffing shortages that were exacerbated by the pandemic.

“We did have caregivers that dropped out. We're starting to see caregivers come back now,” she said, but added that others may not return.

It can be tough to recruit people when there are competing jobs that offer similar pay for much less demanding work, she acknowledged. “You're helping people with bathing, dressing, getting in and out of bed. So it is physically demanding.”

Employers have raised wages recently, due in part to a new union contract.

To try to reach new potential workers, state and local agencies have teamed up on a campaign they launched this summer called “Follow Your Heart to a Caring Career.”

As part of the effort, officials are specifically reaching out to foreign-born Minnesotans — or “New Americans” — in 10 different languages, including Spanish language radio ads, interviews on Somali TV and informational flyers geared toward Ukranian and Afghan refugees.

In addition to the ability to land a job with minimal experience and limited language skills, one of the selling points is the opportunity to receive additional training, often paid for by employers.

“It's a really exciting field, because of the stackable credentials that are available,” explained Betsy Hill, a workforce development technician for the city of Duluth, speaking at a recent job fair for direct care workers. “We're really seeing employers invest in training the employees that they have, and developing programs to move people from an entry level role onward.”

Covenant Ability Network, which provides care to people with intellectual disabilities in Duluth and the Twin Cities, was one of 14 employers with recruiters at the job fair.

Gallaya Karpeh, human resources manager for the nonprofit agency, said they employ several people from the Nigerian and Liberian communities in the Twin Cities who started in entry level care positions.

“And [they] worked their way up to a lead position or manager position. And it's just really rewarding when you're able to watch people grow in their careers.”

People sit around a table
Rangineh Kalhor, who came to Duluth in 2017 from Iran, oversees a shift change meeting at Aftenro senior care residence.
Dan Kraker | MPR News

Language barriers

Still, there are challenges to foreign-born workers entering the health care workforce, including limited English language proficiency for some would-be employees.

To help address that, Duluth Adult Education has developed an eight week English as a Second Language course specifically for health care workers.

Teacher Kristine Rikkola said the course covers basic medical terminology, human anatomy and most importantly, how to meet and greet patients. Rikkola is herself a former health care worker.

“So we talk about that in the class a lot, the meeting and greeting and what is appropriate or not appropriate,” said Rikkola. “Because let's face it, we have a lot of different cultures in those classrooms.”

She also has students role-play what they might encounter in a health care setting. “How do you verbalize what you need a patient to do? And what are some of those responses that you might get?”

Rikkola has had students from China, Russia, Afgahistan and Iran. Rangineh Kalhor was one of her first and she’s returned to speak to subsequent classes.

And Kalhor isn’t yet done with her education. Next spring, she plans to go back to school again, this time to become a registered nurse.

“I changed my career, I changed my life, I changed everything when I got here, and I'm so happy,” Kalhor said. “Because it’s my passion working with people, and then helping them.”

Correction (Aug. 7, 2023): This story has been updated with the correct spelling of Rangineh Kalhor’s last name.

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