Immigration Law
The staffing crisis in American nursing homes is not coming — it’s here. Nearly 95% of nursing homes report significant difficulty hiring new staff. More than 200,000 long-term care workers left the industry during the COVID-19 pandemic and never came back. And with the U.S. senior population growing faster than any domestic recruitment campaign can address, many facilities have been forced to turn away new residents altogether.
The EB-3 immigrant visa category offers a real solution — but not a fast one. For nursing home operators willing to think in years rather than weeks, it provides a pathway to a dedicated, permanent workforce. For international caregivers, it can be the clearest road to lawful permanent residence in the United States.
This guide covers how EB-3 sponsorship works in the long-term care context, what the process actually involves, where things tend to go wrong, and what both nursing home administrators and international caregivers need to understand before moving forward.
The EB-3 is an employment-based immigrant visa category that leads directly to a green card. It covers three types of workers: Skilled Workers (positions requiring at least two years of training or experience), Professionals (positions requiring a U.S. bachelor’s degree or equivalent), and “Other Workers” — a subcategory for roles requiring less than two years of training.
In nursing homes, most entry-level roles — certified nursing assistants (CNAs), home health aides, dietary aides — fall into the “Other Workers” (EW) subcategory. Licensed practical nurses (LPNs) typically qualify as Skilled Workers. Registered nurses (RNs) are often classified as Skilled Workers as well, though they have access to an accelerated pathway discussed below.
The EW subcategory is subject to an annual numerical limit of approximately 10,000 visas globally — including dependents of primary applicants. That cap, combined with historically high demand from the healthcare sector, creates the backlog that is the central planning challenge of any EB-3 sponsorship program. Understanding this going in is not a reason to avoid the process; it’s a reason to start it sooner.
For most caregiver positions, EB-3 sponsorship begins with the Permanent Labor Certification process — known as PERM. Administered by the U.S. Department of Labor (DOL), PERM requires the employer to demonstrate that there are no qualified, available U.S. workers for the offered position and that hiring a foreign worker will not undercut the wages or working conditions of domestic employees.
The first step is obtaining a Prevailing Wage Determination (PWD) from the DOL’s National Prevailing Wage Center. The employer submits Form ETA-9141 with details about the job and its location, and the DOL issues a wage figure based on occupational survey data. The offered wage in the final job offer must meet or exceed this figure. PWD requests currently take several months to adjudicate, so this step alone requires patience and early planning.
Once the PWD is in hand, the facility must conduct a good-faith test of the U.S. labor market. For Other Worker positions, the mandatory recruitment steps are:
After completing the recruitment, the employer prepares a detailed recruitment report describing every step taken, every applicant who applied, and the lawful, job-related reason for rejecting each one. Valid rejection reasons include failure to hold the required CNA certification, inability to pass a mandatory background check, or not meeting the specific training requirements defined in the PWD.
One important compliance note: an employer cannot reject a U.S. applicant who is “potentially qualified” through a reasonable period of on-the-job training. Failing to interview such a candidate — or rejecting them without a documented, job-related reason — is a frequent trigger for DOL audits. Approximately 30% of PERM applications are audited, which is why maintaining a meticulous recruitment file is not optional.
The Notice of Filing is the internal worksite posting, and it is one of the most technically demanding steps in the entire PERM process. It must be posted between 30 and 180 days before filing the PERM application, remain up for exactly 10 consecutive business days, and include specific regulatory language — including the correct contact information for the DOL Certifying Officer.
Errors here are treated as “non-curable defects” — meaning the DOL will deny the application outright with no opportunity to correct the mistake. An incorrect DOL address, missing language, or failure to document the exact start and end dates of the posting in the audit file are all enough to sink an otherwise compliant case.
The NOF should be posted in a conspicuous location where employees routinely review workplace notices — near wage and hour postings or occupational health and safety notices is typical. Keep a photograph of the posted notice with timestamps as part of your audit file.
Registered nurses and physical therapists occupy a special position in the EB-3 framework. The DOL has designated these occupations as “Schedule A” — meaning it has pre-certified that a nationwide shortage exists. As a result, employers sponsoring RNs do not need to complete the standard PERM labor market test or file Form ETA-9089 with the DOL at all.
This is a significant advantage. By bypassing the DOL certification step entirely, a facility can save 12 months or more on the total timeline — moving directly from the prevailing wage determination to the I-140 immigrant petition filing with USCIS.
Schedule A does not eliminate all requirements. The employer must still post an internal Notice of Filing for 10 consecutive business days and must document the nurse’s credentials carefully. Accepted proof of nursing qualifications includes a CGFNS (Commission on Graduates of Foreign Nursing Schools) certificate or a full, unrestricted, permanent license to practice nursing in the state of intended employment.
For nursing homes facing acute RN shortages, Schedule A is the most time-efficient pathway available within the EB-3 framework and should be the default strategy for any RN sponsorship.
After the PERM is certified (or bypassed via Schedule A), the employer files Form I-140 — the Immigrant Petition for Alien Worker — with USCIS. At this stage, the focus shifts from the labor market to the employer’s financial health.
USCIS requires the employer to demonstrate “ability to pay” (ATP) the proffered wage starting from the PERM priority date and continuing until the worker receives their green card. The standard ways to establish ATP are:
Smaller facilities — those with fewer than 100 employees — tend to face more scrutiny here. Where tax returns show low net income due to depreciation or other accounting factors, USCIS may look at the totality of circumstances: gross revenue, operational history, and the facility’s overall footprint. Having clean, well-organized financial documentation ready before filing is essential.
Current USCIS fees for the I-140 include a $715 base filing fee, a $600 Asylum Program Fee (reduced to $300 for employers with 25 or fewer employees, waived for nonprofits), and a $500 anti-fraud fee. Optional premium processing — which reduces the I-140 adjudication time from several months to 15 calendar days — costs an additional $2,805. For facilities trying to coordinate hiring timelines across departments, premium processing is often worth the investment.
Completing the PERM and I-140 does not produce a green card. It produces a priority date — essentially your place in line. Each month, the Department of State publishes its Visa Bulletin, which shows which priority dates are “current” and eligible for final visa issuance. When demand in a given category exceeds the annual supply of visas, earlier dates go current and later ones wait. When demand spikes, dates can actually move backward — a phenomenon known as retrogression.
For the EB-3 “Other Workers” category, wait times currently run 3 to 5 years for many countries of birth. For applicants born in India or China, the backlog extends significantly longer due to per-country annual caps.
There is also a technical limitation specific to the EW category. Under adjustments tied to the Nicaraguan Adjustment and Central American Relief Act (NACARA), up to 5,000 of the annual 10,000 EW visas can be redirected in certain fiscal years — effectively cutting the available supply in half. This is a real factor in how quickly the bulletin moves.
When I advise nursing home clients on this timeline, I’m honest that the Visa Bulletin can move faster or slower — there’s no guarantee. But the operators who get the most out of EB-3 sponsorship are the ones who stop treating it as a one-time transaction and start treating it as an annual program. If a facility initiates a new cohort of sponsorships every year, something powerful happens over time: within a few years, caregivers are arriving on a steady, predictable schedule. One group finishes the process just as the next enters its final phase. The pipeline becomes self-sustaining.
That framing changes the entire conversation. The question isn’t “can I get a caregiver in three months?” — the answer to that is no. The question is “what does my workforce look like in three years if I start today versus if I wait?”
If you’re a nursing home administrator trying to build this kind of pipeline, reach out to discuss a multi-year strategy.
This is one of the most misunderstood areas of the entire sponsorship process — for employers and workers alike.
The DOL is explicit: all costs associated with the PERM labor certification are the employer’s responsibility. That means attorney fees, recruitment costs, and administrative expenses related to PERM. The employer cannot seek, accept, or require reimbursement from the worker for any of these costs — not as direct payment, not as a payroll deduction, and not as a “clawback” clause in an employment contract. Violations can result in the facility being debarred from sponsoring future workers.
Once the PERM is filed and the process moves to the I-140 and green card stages, the legal framework becomes more flexible. Costs associated with the I-140 petition and subsequent adjustment of status or consular processing can, in certain circumstances, be shared or subject to repayment agreements. Many facilities use repayment contracts that require the employee to reimburse a portion of these costs if they voluntarily leave within a defined period — typically 24 to 36 months.
These agreements must comply with the Fair Labor Standards Act. Critically, any repayment deduction cannot bring the employee’s effective hourly wage below the applicable federal or state minimum wage. State laws — particularly in jurisdictions like New York and California — may impose additional restrictions on paycheck deductions.
My practice covers the immigration side of this process — PERM compliance, I-140 filing, and everything through final adjudication. For repayment agreements and employment contracts, I recommend consulting an employment attorney who knows the labor laws in your state.
If you’re an international caregiver and someone has offered to sponsor your EB-3 green card, that’s potentially a life-changing opportunity. It’s also an area where exploitation happens. Knowing the difference between a legitimate offer and a predatory one could protect your immigration future.
Legitimate EB-3 sponsorship looks like this:
Watch out for these red flags:
If you’ve received a sponsorship offer and want to understand whether the immigration structure is sound, I’m happy to review the immigration components with you. Consultations are available in English, Russian, and Romanian.
Not every nursing home is in the right position to pursue EB-3 sponsorship, and I think it’s important to be honest about that. This process requires upfront legal and filing costs, a multi-year organizational commitment, and the administrative capacity to manage a long-running compliance process.
That said, for facilities already spending heavily on agency and travel labor, the economics shift quickly. Agency and travel nurses can cost a facility as much as $70,000 more per year than a comparable full-time staff member. Each instance of nurse turnover that EB-3 sponsorship prevents saves an estimated $56,300 in immediate administrative and training costs alone. Redirecting even a portion of that agency spend into a sponsorship program can produce meaningful long-term returns.
The facilities I’ve seen get the most out of this process share one trait: they start early and stay consistent. They treat international recruitment not as a last resort but as one pillar of a broader workforce strategy.
If you’d like to explore whether EB-3 sponsorship makes sense for your facility, I encourage you to contact me at SG Legal Group. We can review your staffing situation, walk through the process timeline, and assess what a realistic multi-year program would look like for your organization.
Disclaimer
The information provided in this article is for general informational purposes only and does not constitute legal advice. Immigration laws and policies are subject to change, and individual circumstances vary. For advice specific to your situation, please consult with a qualified immigration attorney.
Oleg Gherasimov, Esq.
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