New Rules

Are you up-to-date on the new rules? All RNs have a decade to get their B.S. in Nursing if they don’t have one yet. Many are going back to school now!

Multiple Positions to be filled

We are currently accepting applicants for multiple positions in Westchester
– Food Service Manager
– Director of Social Service & Marketing
– MDS Coordinator
– Finance Controller
– Admissions Coordinator

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Meridian’s Open House Event

Meridian's Open House Event

Refreshments will be served

Non-Immigrant Visa Options for Nurses –

In this post, other avenues for sponsorship are explored.

NIV Options for Nurses — Atty. Rio Guerrero

Since the H-1C nonimmigrant visa program sunset on December 20, 2009, visas for hundreds of nurses have expired or will soon expire, leaving H-1C-authorized healthcare employers struggling to provide much-needed professional nursing care with a dwindling nursing staff. Although H.R. 1933, which is currently pending before the U.S. Senate Judiciary Committee, would reauthorize the H-1C nonimmigrant visa program, the sunset of this program casts light upon the dearth of nonimmigrant visa options available for foreign nurses and its negative impact upon nurse staffing nationwide. What are the alternatives for healthcare facilities in the United States?

Currently Available Nonimmigrant Visa Options for Nurses

Registered nurses are included in the list of professions eligible for TN status pursuant to Appendix 1603.D.1 to Annex 1603 of NAFTA.
It is difficult to accurately measure the precise number of Canadian and Mexican citizens currently employed as professional nurses in TN status, however, TN status is generally believed to be the most frequently utilized nonimmigrant option among foreign nurses employed in the United States. The primary advantage of TN status is the ease of entry. Registered nurses applying for admission in TN status may be employed in positions covering a wide scope of expertise – from entry-level RN placements to more senior administrative positions. However, the stark disadvantage of TN status is that the pool of potential foreign nurses is restricted to Canadian and Mexican citizens.

H-1B Specialty Occupation Workers
It is well-settled that certain specialty occupations in the nursing industry may qualify for H-1B  nonimmigrant status. Specifically, a narrow group of nurses holding a baccalaureate or higher degree (or equivalency) in nursing that includes advanced practice nurses (such as Clinical Nurse Specialists (CNS), Nurse Practitioners (NP), Certified Registered Nurse Anesthetists (CRNA), and Certified Nurse-Midwives (CNM)), nurse managers, and nursing administrators, may qualify for H-1B status. According to USCIS data, the issuance of H-1B visas for specialty occupation nurses varies greatly from year to year. In recent history, the greatest number of H-1B nurse visas issued in any given fiscal year was only 136. Unlike TN status, the H-1B visa for specialty occupation nurses is available to qualified nurses from all foreign countries. However, the limited scope of eligible specialty occupations greatly narrows the potential use of the H-1B to fill U.S. nursing job vacancies. For instance, many RNs may not qualify for an H-1B because employers and state licensing boards do not usually require a BSN to perform services as a registered nurse.

Return of the H-1C?
The H-1C nonimmigrant classification enables foreign nurses to perform services as a registered
nurse in a U.S. health professional shortage area as determined by the U.S. Department of Labor
(DOL). To qualify for an H-1C visa, both the employer and employee must meet certain
eligibility criteria. The U.S. employer must:
-Be a “subsection (d)” hospital under the Social Security Act;
-Be located in a “Health Professional Shortage Area;”
– Have at least 190 acute care beds;
-Have a Medicare population of no less than 35%;
– Have a Medicaid population of no less than 28%; and
-Be certified by DOL.

The employee must:
-Hold a full and unrestricted nursing license in the country where their nursing education was obtained, or have received a nursing education in the U.S.;
-Have passed the examination administered by the Commission on Graduates for Foreign Nursing Schools (CGFNS), or have a full and unrestricted license to practice as a registered nurse in the state where the employee will work, or have a full and unrestricted registered nurse’s license in any state and have received temporary authorization to practice as a registered nurse in the state where the employee will work; and
-Have been fully qualified and eligible under the laws of the state of intended employment to practice as a registered nurse immediately upon admission to the U.S.

According to recent information provided by the U.S. Senate Judiciary Committee, H.R. 1933 remains on the Committee’s agenda, but is not yet scheduled for a Senate vote. As drafted, this legislation reauthorizes the availability of 300 H-1C visas (a departure from the 500 originally authorized under NRDAA) for an initial validity period of three years, with the opportunity to renew H-1C status for an additional three years. New aspects of H.R. 1933 include the three-year extension and H-1C portability between any of the eligible hospitals under INA §214(n). Whether H.R. 1933 becomes law remains to be determined, but it would no doubt assist authorized healthcare facilities to meet their nursing staff needs given that most H-1C visas have already expired.

Click here to view complete text for “Non-Immigrant Visa Options for Nurses”.

H1-B Nurses to US – from

via LinkedIn

Nursing is fast becoming another “profession-in-transition” in U.S. immigration law parlance. It is not unlike the transition that the physical therapy industry experienced this past decade – when a master’s degree officially became the minimum education standard for entry into the profession.But, again like the physical therapy industry, the initial years of this transition will require compelling arguments from the petitioning employer to convince U.S.

A recent New York State bill sponsored by Democratic Assemblyman Joseph Morelle, Republican Senator James Alesi and other legislators seeks to further professionalize nursing in the state. Specifically, registered nurses would have to earn a baccalaureate degree in nursing (BSN) within ten years to continue working in the state. It does not require nurses who seek to enter the profession to hold a BSN now in order to obtain licensure, however they will have to obtain a BSN within 10 years once licensed.

The bill is a result of the national movement to increase the minimum education standards for nurses. The U.S. nursing community appears split on this issue. While many nurses are lobbying against the bill’s passage, a great many others in the nursing community champion the overall increase in minimum education standards.

The “bachelor’s of science degree in nursing within ten years” movement – known as the “BSN in 10” initiative is supported by health care organizations and nursing associations. It seeks to resolve a significant concern in the industry. Specifically, while the U.S. baby-boomer population ages and creates an explosion in the demand for elder care providers, there are not enough qualified nurses to meet that demand.

Presently, most registered nurses (RNs) hold only an associate’s degree. Incredibly, there is no state that actually requires a BSN as a minimum education level to enter the profession. But any nurse or other health care professional familiar with this occupation will quickly attest to the need for specialized knowledge and skills to perform many of the complex duties demanded in the profession today.

There is no debate regarding the rampant shortage of qualified nurses in the U.S. to care for the existing and growing population. This problem has persisted for decades. Unfortunately, the U.S. labor market has been unable to resolve this problem. Workers and students have recognized the career opportunities in nursing and are entering this profession. But even with this influx of U.S. workers, nearly all in the industry agree that a severe nursing shortage will persist unless more foreign nurses are authorized to work in the U.S. because attrition and a high burn out rate are inherent in the profession.

Foreign nurses are permitted to reside and practice their profession in the U.S. through a limited number of temporary work visas and permanent immigrant visas (m/c/k/a “green cards”) whose availability remains scarce. But if this bill succeeds, there will be a surge in the number of foreign nurses entering the New York State nursing profession, because many of them already have their BSNs or the equivalent. At present, there are thousands of overseas nurses desirous of coming to the U.S. to practice their profession. However, the lack of a BSN minimum education requirement and the current U.S. immigration law prohibits all but a select few foreign nurses to achieve from achieving this goal.

The BSN minimum education requirement and the resulting customs and practices of certain employers in New York State should allow a greater number of foreign nurses holding a BSN in nursing or foreign degree/work experience equivalency to secure H-1B temporary work visas through a petitioning employer. This would be a welcome result for the New York State healthcare system and the countless foreign nurses and their families who wish to immigrate to the U.S.

Citizenship and Immigration Services (USCIS) that a BSN is, in fact, required for the nursing position sought to be filled by the foreign nurse. Such arguments must be artfully crafted and carefully articulated by the lawyers building the case. But if presented properly, ultimately, USCIS must follow the industry and the employer’s standards, allowing foreign nurses to more easily immigrate to and work in New York state and the U.S.

Please feel free to ask any questions, comment, or request more information in the Comments Box below. Also, please forward this blog article to anyone who may be interested.

Rio M. Guerrero, Esq.

Home care aides | Inquirer Opinion

Home care aides | Inquirer Opinion.

Last month US President Barack Obama ordered the labor department to look into the salaries of home careaides or people who help to care for the elderly and the infirm. At present, employers of home care aides are exempted from paying the workers a minimum wage and overtime pay.

I’m writing about this issue for two reasons. First many Filipinos in the United States (and other countries) work as home care aides and, secondly, here in the Philippines we have our own growing senior citizenpopulation, many of whom need home care aides.

Obama’s order comes after a long drawn-out battle waged by home care aides to improve their pay. In 2002, an elderly home care aide, Evelyn Cook, filed a lawsuit to overturn the exemption of home care aides from the minimum wage and overtime pay. The courts ruled against her and she died in 2009 at the age of 74, still earning $7 an hour and no overtime pay, although she often worked 24-hour shifts.

That $7 hourly wage should be put in context.  Based on a 40-hour week, that’s about $1,020 a month or $12,240 a year. In 2010, the poverty threshold for a single elderly person was $10,458. It’s hard to imagine how Cook managed when she was younger, raising five children as a single mother. No wonder Cook was reported to have worked on multiple jobs, and 24-hour shifts.

The reason home care aides are exempted from the minimum wage and overtime pay is that they are classified, together with babysitters, as providing “companion services.”  They are not seen as health professionals or even semi-professionals and are therefore given the bare minimum.

But with the graying of America’s populations, it is becoming clear that these home care aides are more than companions. They are supposed to help the elderly with six ADL or activities of daily living: bathing, dressing, transferring, using the toilet, eating and walking. Then there are six more IADL or instrumental activities of daily living: light housework, preparing meals, taking meals, shopping for groceries and clothes, using phones and managing money. Just looking at those 12 activities shows there’s a world of a difference between babysitters and home care aides.

If the home care aides are granted minimum wage and overtime pay, it will be a boon not just for them but also for the patients. Their low salaries translate into poor quality of care because of low motivation, overwork (from taking on extra jobs) and rapid turnover as the aides look for better-paying jobs.

Filipino elderly

Let’s look at the situation in the Philippines. For a population of about 95 million, with 4 percent over the age of 65, we would have 3.8 million senior citizens, certainly not a small number. Not all would require home care aides.  One US study estimated about 6 percent of those aged 65 would need home care aides but the figure jumps to 20 percent among those aged 85 or older. We need to do our own study for the Philippines but I am certain our figures will be similar, which means thousands of elderly needing assistance for daily living.

Notice how the term caregiver, referring to hired assistants, is now falling from disuse. The reason is that technically, a caregiver is anyone who provides care for a patient and in many cases in the Philippines, this is a relative. There is a gender bias here, with women relatives more likely to be asked to give up their careers and personal lives to provide this home care.

Relatives are not necessarily the best persons to provide intensive care for the elderly. Besides not being properly trained for their responsibilities, they have ambivalent feelings toward the patient, feeling obligated and yet harboring some resentment at having to give up so much of their own lives. Not surprisingly, relatives “volunteered” into this role burn out more easily.

The term “home care aide” is used to refer to someone from outside the family, but who is not a professional like a nurse or midwife. At the same time, home care aides should, ideally, be provided some formal training. In Canada, they also have to have an equivalent to two years of college.

It is important, certainly, for family members to provide care for their elderly but, when possible, someone from outside should be hired. Patients in critical condition, for example someone who just had a stroke, will need a special nurse.  Later, as the patient recovers, a midwife can come in. And for the elderly who basically need assisted living, for example those with Alzheimer’s and other dementia conditions, a well-trained home care aide can do very well.

Such services are not cheap. Special nurses are paid P1,800 for a 12-hour shift. Midwives go for about P500 to P700 per shift. Home care aides (or “caregivers” in the Philippine setting) vary tremendously but a good one, with proper six-month training, gets about P500 per shift. There are “colorum” special nurses, midwives and home care aides who will go for lower pay, but all I can say is you get what you pay for—with great risks, including abuse of the patient.

For economic reasons, many households end up getting a helper, sometimes with very little formal education, to take up the tasks of home care aides. They’re paid a pittance, P3,000 a month if they’re lucky. I once met one who was unpaid and only offered free board and lodging for her family.  She was literally on 24-hour call, the Lola calling her and her husband (who had outside work as a driver) in the middle of the night several times for food or toilet assistance.

We need studies to project our needs in this area and legislation not just on the salaries and work benefits for the aides, but also on their training and certification. We should avoid the disaster that came with those diploma mill caregiver institutions that sprouted on every corner, drawing Filipinos hoping they could work overseas. The diploma mills have closed down while thousands of their graduates are jobless, which is just as well since many were so badly trained they would have contributed to early deaths of their wards.  I speak here from experience, having interviewed some of these graduates, who couldn’t even understand medication doses, or do a blood pressure measurement.

The bottom line is that relatives must be part of the caring team with health care aides. My mother has a midwife and a trained caregiver rotating for day and night shifts, but I still turn down invitations for dinners (including the Inquirer’s anniversary party) or prolonged out of town trips because I consider it to be important to get an update from her carers, and, more importantly, to be at her side at the end of the day, even if for short moments.

I know, too, I am still fortunate, being able to be in the Philippines and with her. Too many Filipinos have to work overseas, ironically providing care for other nations’ children and elderly, while leaving their own behind, home and alone.

* * *

Immigration Counsel and HR Departments

The genesis of much of the successful work produced by our law firm originates from a company’s human resources (HR) director or department. A company’s HR department may have a prospective employee, or a current employee, for whom an immigration matter has arisen that must be resolved in order to begin or continue lawful employment. Typically, an HR associate or director asks us what information we need to build a winning case before U.S. Citizenship and Immigration Services (USCIS).

A client’s HR department will call or email our firm asking whether a prospective (or current) employee possesses the correct work authorization documentation. Do they have the correct non-immigrant visa status in place? There is an alphabet soup of visa options – such as H, E, L, O, P, TN, etc. – available to foreign nationals seeking authorization to work in the U.S. Or, do they have a currently valid employment authorization document (EAD)? An EAD is commonly issued to persons who are in the process of applying for U.S. lawful permanent resident status, more commonly known as “green card” status. There are other situations whereby a foreign national may obtain an EAD.

When initially analyzing any potential employment-based visa matter, immigration attorneys consider three vital components:

The Employer

At a minimum, USCIS is typically concerned with two issues regarding a prospective sponsoring employer:

  • the legitimacy of the employer’s business operations; and
  • its ability to pay whatever the minimum wage or salary may be required for a particular position.

The Position

USCIS is also focused upon the position offered:

  • Is this a specialty occupation job or a professional job?
  • Considering the particular industry at issue, what is the minimum education and work experience required?
  • Are there other specific requirements for this position such as licenses, languages, credentialing, security clearances or certifications?
  • Does this position customarily exist for similar employers in this industry?

The Employee

  • If there is a minimum of education and/or work experience required for the position, has the individual met it/them?
  • Has the individual met any licensure, language, etc. minimum requirements?
  • Is the individual in the country legally, and if yes:
    Is their immigration status adequate for the position, or can it be changed easily to a visa status that will authorize employment for this position?
  • Will they have to travel outside of the country in order to make any necessary visa status change?
  • Does the individual have any derogatory immigration or criminal history?
  • Does the individual have any immediate family who wish to accompany him/her in the U.S.?

Generally, these three components are the focus of our initial analysis and a helpful starting point for our HR colleagues. Every case is unique, no matter how it may appear similar to another. From the outset, it is important for HR and immigration counsel to work together – asking the right questions and procuring the vital documentation to properly analyze a matter and develop a winning strategy.

Immigration Counsel and HR Departments | Guerrero Yee LLP – The Immigration Specialists | Share on LinkedIn.

Rehabilitation Professionals Apply Now

Getting Informed is the Best Route to America

Much has been said about the US economic downturn and how a lot of first world countries have overtaken America in most aspects, but still the nation has built itself as a symbol of democracy and land of opportunity that many smaller nations look up to for economic growth. In US Consulates in most countries, people come in droves daily to try their luck with the Consuls. A lot of foreign nationals go through a lot of trouble just to get to America. Whether America delivers the dream to the people or not, is another story. Still the greencard and the US visa remain one of the world’s most sought after commodities.

There are many paths to working and finally settling in US such as an employee-sponsored work visa or greencard. But the reality is the requirements are so stringent and costs are high making it almost impossible especially with the ever changing and unpredictable Immigration laws. Sadly, as if this isn’t bad enough, some erratic agencies and individuals take advantage of the ignorance of the prospective immigrants.

The best route is being informed and prepared. Online information is readily available just make sure to visit the official sites.




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Becoming an Army Nurse Can be Rewarding

Considering an Army post as RN can indeed be very rewarding. Here’s an excerpt from an email a nurse in London sent me recently:

I have an Aunt who migrated from the Philippines when she was 21. Her first stop was as staff nurse at Mt. Sinai Hospital as a L & D nurse and later got offered to teach nursing courses at nearby Hunter College. She did both, teaching and nursing until one time, she got invited to a recruitment event that needed professional nurses to join their team of army nurse educators. Initially she said, she went there out of curiosity,  but after she learned more about the program, she came home a new person.

Forty years forward,  she retired as a Colonel who despite being civilian now still enjoys recognition in several organizations and worldwide events she attends without costing her anything. She has a centrally located apartment in Manhattan, 2 houses located in New Jersey and Seattle and a mansion in the Philippines. She travels 4 times a year paying almost nothing for airfare, gets discounts in a lot of stores, and gets superior medical and dental care in recognized hospitals in New York. The children’s tuition are fully paid off and the husband enjoys same healthcare benefits she has. Add to her list the sizable pension she receives … What a life!

Listed below are the benefits of enlisting in the Army as a healthcare professional. (

Health care professionals who serve as Officers in the U.S. Army Medical Department (AMEDD) enjoy a wide range of opportunities and financial incentives. There are benefits, tangible and intangible, available to Officers who choose to serve full-time in the Army. These benefits are also conferred upon those who choose to serve when needed and maintain careers in their communities as part of the Army Reserve.

Active Army professionals are members of a multidisciplinary team focused on providing the best health care possible. Here, there aren’t any concerns about running a practice, hiring employees, processing insurance, purchasing equipment, stocking supplies or paying malpractice insurance.

You’ll also have opportunities to develop even more specialized skills than those you already have. From continuing education courses and seminars to clinical research and teaching, you’ll be able to enhance your level of expertise.

Plus, the U.S. Army offers scholarships and student loan repayment assistance to students and recent graduates in many health care fields.

You have many career options. Learn more about the benefits that come with serving your country.

via Benefits |