Working paper 03 — Data collected, analysis under way
Immigrant Labor Supply and the Capital Margin of U.S. Nursing Homes
When immigrant caregivers become scarce, do nursing homes buy machines to replace them — or machines to help the workers who remain?
Austin Tucker · Harvard University · 2026
HCRIS
facility capex data
Bartik IV
identification
SNFs
U.S. skilled nursing
01 — Why it matters
The U.S. long-term care workforce is disproportionately foreign-born, and immigration policy swings its supply. Economists usually study the labor response to these shocks. But there's a capital margin too: facilities can respond by substituting equipment for people, or by investing in technology that makes remaining workers more productive. Which one happens shapes both care quality and what restrictive immigration policy actually costs.
02 — How I answer it
A shift-share (Bartik) instrument — national immigration flows interacted with pre-period settlement patterns — isolates plausibly exogenous variation in local immigrant labor supply, linked to facility-level capital expenditure from Medicare cost reports (HCRIS).
03 — What I find
Analysis beginning — data collection complete.
04 — What it means for policy
If capital substitutes for scarce caregivers, immigration restrictions accelerate automation of intimate care work; if capital complements labor, restrictions simply make care scarcer and more expensive. The answer determines who bears the cost.