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Recent immigrants and workers in foreign countries are two groups frequently identified as potential sources of new workers for nursing positions in long-term care (LTC). Recruiting workers directly from other countries, either permanently or temporarily, is difficult because of restrictive visa classifications; is unlikely to impact significantly the worker shortage; and may have risks that outweigh the potential rewards. On the other hand, with targeted recruitment and retention efforts, the nation's rapidly growing immigrant population (the so-called "New Americans") can become an even more important source of labor for frontline LTC workers. To be successful employees in LTC, however, New Americans will have to overcome a variety of cultural and language barriers. Equally important, the institutions and agencies that comprise the LTC system must exhibit a higher level of sensitivity to cultural differences. Efforts to recruit, train, and retain New Americans for positions in LTC present win-win opportunities and should be expanded.

Although the nearly one in seven Americans who have disabilities share many characteristics, the attitudes toward and the programs, care models, expenditures, and goals for people with disabilities differ substantially across age groups in ways that suggest ageism. Expenditures per recipient are substantially higher for younger individuals with disabilities, largely as a result of more effective advocacy. Programs that are rejected by younger people with disabilities are considered mainstream for older adults. As demographic, social, and economic circumstances change, preserving the programmatic separation will become more problematic. Increased competition for finite resources may motivate a closer examination of commonalities across disabilities in an effort to achieve greater equity.

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