Opinion— Fixing a Broken System: How Community-Based Intermediaries Can Transform the Care Workforce

By Dr. Esther Hio-Tong Castillo, originally published for Accesso Care. May 23, 2025.

Accesso Care Wellness & Success Day. Credit: Accesso Care

In long-term care, we’re facing a staffing crisis that isn’t just a numbers issue—it’s a systems issue.

Every week, I hear stories from immigrant women who are eager to work, to care, to contribute. They show up despite language barriers, cultural disconnects, and a system that often sees them as temporary labor rather than vital talent.

Here’s one number that says a lot: 1 in 4 Certified Nursing Assistants in the U.S. are immigrants, despite immigrants making up just 17% of the U.S. population. That’s not a coincidence—it’s a reflection of who we rely on to hold up our care systems, and who is too often left without the support they need to succeed.

“Immigrants do the work that holds this country together, often with the least recognition.”— Ai-jen Poo, National Domestic Workers Alliance

Meanwhile, nursing homes are desperately understaffed, relying on temp agencies or scrambling to cover shifts—an unsustainable cycle that puts both workers and residents at risk.

We don’t have a shortage of people willing to care. We have a shortage of bridges.

That’s where community-based intermediaries like Accesso Care come in.

What We Do

Accesso Care isn’t a temp agency. We work at the intersection of workforce development, immigrant support, and care system sustainability. We screen, train, and support immigrant workers to become Certified Nursing Assistants (CNAs), while helping care facilities build more consistent and culturally competent teams.

We also walk with people through the uncertainty: helping with legal documents, background checks, exam delays, transportation, and language support. We stay connected after placement—not just as case managers, but as a community. A WhatsApp message. A check-in call. A reminder that someone has your back.

Why It Might Work

Truthfully, we don’t know if it “works” yet.

We’re still building the plane as we fly it, often without a safety net. The emotional and logistical weight of holding workers, institutions, and broken systems together is real. And there are days we don’t feel very supported ourselves.

But here’s what we do know: when care workers are treated with dignity, when they feel heard and held, they stay. When nursing homes trust the people walking through their doors, the environment shifts. And when immigrant communities are seen not as problems to solve but as partners in care, something powerful starts to take root.

Stabilizing this workforce isn’t about quick fixes. It’s about investing in relationships, infrastructure, and trust.

The Bigger Picture

What if our city and state invested in connectors—trusted intermediaries that understand both sides: the community and the care facilities?

What if policymakers prioritized not only recruitment, but fair wages, adequate Medicaid reimbursement, and incentives for facilities that are doing the right thing?

What if the system wasn’t held together by the quiet exhaustion of immigrant women and women of color—but by infrastructure built to support them?

It matters who we build systems around. The caregiving crisis is not inevitable—it’s the result of policy choices. And it can be changed.

We’re not there yet. But we’re trying. And we know we’re not alone.