NEW YORK - As the death toll from the COVID-19 pandemic continues to rise, a new initiative is helping Mexican immigrants living in the United States deal with issues of end-of-life planning.

Hispanic Americans are 18% of the U.S. population, but account for 25% of COVID deaths, adding extra urgency to things like advance directives for end-of-life care.

Patricia A. González-Portillo is National Latino Communications and Constituency Director with the organization Compassion & Choices. She says the collaboration with a national health outreach program from the Mexican Consulate should help reduce disparities in end-of-life planning and health care that negatively impact the immigrant community.

"We can catch this horrible virus that can kill us," says González-Portillo. "Are we going to wait 'til that happens before we have the conversation with our family about what I want in case I die from this illness?"

Compassion & Choices has assembled a free, bilingual COVID-19 toolkit, which is available online at 'CompassionandChoices.org.'

Maria Otero, Compassion & Choice's national constituency manager, points out there are Hispanic cultural values - such as the importance of family involvement and the influence of religion - that affect behavior at the end of life. And there are cultural barriers, too.

"There's not a word in Spanish about advance directives. We don't have a word for 'hospice,'" says Otero. "So, often we are perceived like we are not very assertive to what we want at the end of life."

She adds that the pandemic represents an opportunity to start important conversations among families about a topic that most people prefer to avoid.

Because COVID-19 is so contagious, currently incurable and the symptoms can advance quickly, González-Portillo stresses that everyone should complete an advance directive.

"That clearly details what the person wishes for at the end of life," says González-Portillo. "So that family members are not left with this task of guessing, 'What would my brother want?'"

She says without an advance directive, hospitals often are forced to make decisions about medical interventions and treatment that may not be what the patient would want.

Minnesota has joined several states in raising the age limit for young immigrants who have escaped trauma to receive legal protections in the United States.

This week, Gov, Tim Walz signed a bill increasing the age limit from 18 to 21 to seek Special Immigrant Juvenile Status, aligning Minnesota law with federal statute. The process allows young people who left their home country unaccompanied, fleeing an abusive situation, to secure judicial guardianship at the state level. They then apply for the federal SIJ status, with a path toward citizenship.

State Rep. Sandra Feist, DFL-New Brighton, led the efforts through the House.

"It confronts this issue on a regular basis with young people who realize that their immigration is an issue later in their teens and then, are up against that deadline of their 18th birthday," she said.

When the state age cutoff is below the federal threshold, the teen faces deportation. Feist, who also is an immigration attorney, said that puts them back into a traumatic situation. She added that this affects roughly 70 people a year in the state. The bill had broad bipartisan support, although the federal component is under scrutiny over case backlogs.

Despite those issues, Minnesota advocates have said relief at the state level still is important. Veena Iyer, executive director of the Immigrant Law Center of Minnesota, said not only is there more stability for these youth, it benefits their communities as well.

"We're talking about folks who have come here as young people," she said, "many of whom end up finishing high school getting their GED in the United States - and then are such an important part of the labor force."

She said that's especially helpful for rural Minnesota, where there are challenges in finding skilled labor. Immigration experts who track these policies say nearly a dozen other states have taken similar action.

An all-volunteer vaccine clinic run by a farmworkers' union says it's expecting an increase in demand from seasonal migrant workers who want to be vaccinated against the coronavirus.

President of the Farm Labor Organizing Committee (FLOC), Baldemar Velasquez said the mobile clinic has provided shots to thousands in North Carolina's low-income immigrant community.

But he pointed out that migrant workers can be especially vulnerable because they travel, live and work in crowded conditions.

"And now," said Velasquez, "we'll convert over to reaching the migrant population when they start coming in for the planting and cultivating and then finally, the harvesting. And that's when we'll get the mobile clinic out to a couple of the big farms."

According to the Environmental Working Group, North Carolina counties with the highest concentrations of farmworkers also have the highest rates of documented COVID-19 cases.

And Purdue University research shows as of last December, more than one million agricultural workers have tested positive for COVID-19.

Velasquez said he's worried about emerging subvariants and how they might impact nationwide vaccine supplies. He added that clinic volunteers already faced an uphill battle getting the vaccine.

"I know from past experiences that when there's initiatives like that," said Velasquez, "not only in the health departments, but in other federal and state agencies - the migrant workers and the immigrant population are the last ones in line. They're the last ones to be reached."

At the University of Toledo College of Medicine, Clinical Professor of Medicine Dr. Richard Paat heads mobile vaccination clinic efforts. He said his staff, primarily medical students, travels to church and work sites in order to reach people who would otherwise have limited access to vaccines.

"By going there to the sites, we became accessible to the population that did not have access to transportation," said Paat. "And again, working with known leaders like Baldemar and Father Molina, there was an instant acceptance of our teams."

Research shows a high percentage of Hispanic or Latino individuals are willing to be vaccinated, and optimistic about the vaccine's ability to prevent illness, especially among young adults.

As the country reels with the highest levels of inflation seen since the 1980s, experts say without adding more workers, wage increases could drive prices - and inflation - even higher in Ohio and across the U.S.

While many future jobs will be taken by youths aging into the workforce, research suggests many positions will still go unfilled unless the Buckeye State, and the U.S. as a whole, gains more workers by 2030.

Andrew Lim is the director of research for the nonprofit American Immigration Council. Through analysis of Bureau of Labor Statistics and other data, his organization found immigration policy in Canada and other countries may be the golden ticket.

"The government, in coordination with the provinces in Canada, say, 'What are the jobs that are most in demand? Where do you need these workers?'" said Lim. "And we don't have that in the U.S. We have an immigration system that largely has not been reformed for now three decades. And so it's really not as responsive as other countries have been able to become."

Of the more than 165 million jobs expected to exist in 2030, almost half will be left open by retirees, career changers, or workers who've left the labor market entirely, according to American Immigration Council findings.

Lim said Ohio mirrors much of what's going on nationally, with the added problem that some of the state's major cities have been shrinking since as far back as the 1970s.

Lim added that while COVID restrictions may be mostly a thing of the past, the pandemic's effects on the economy and worker shortage will remain into the future.

"You have this great resignation where people are really looking for better conditions, but also better wages," said Lim. "And this is putting a lot of pressure on employers because now the competition for workers is really, really tight. And there are limits to what employers are able to do without passing those elevated costs up to consumers."

Lim said unlike other parts of the country, Ohio is dealing with more than the effects of the past two years.

"Even before the pandemic," said Lim, "there was a lot of planning that was being done by chambers of commerce, city councils, by regional associations about how do you make Ohio metros attractive, not just to immigrants but to people in general. And so, a stable population at the very least is really important."

Data shows occupations that grew the most between 2019 and 2021 had a large share of immigrants, including health care, transportation, food preparation, construction, and manufacturing.

Reporting by Ohio News Connection in association with Media in the Public Interest and funded in part by the George Gund Foundation.