Migrant Workers Providing LongTerm Care to Older Persons: Canadian Policy and Experience

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Migrant Workers Providing Long-Term Care to Older
Persons Canadian Policy and Experience

• Gloria M. Gutman, PhD Reshmi Chowdhury, M.A.
• Gerontology Research Centre
• Simon Fraser University
• Vancouver, Canada
• Paper presented in the symposium Migrant long
  term care work as a rising challenge for elder
  care research, policy and practice (II)
  international developments, 19th World Congress
  of Gerontology, Paris, France, July 5-9, 2009

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Table 1Total Population and Population 65,
Canada, 2001, 2011, 2021
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Table 2 Elderly Population by Living Arrangement
and Age, Canada, 2001()
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Migrant workers are a significant component of
the Long Term Care workforce in some parts of
Canada

• Reasons
• As in other developed countries, as opportunities
  have opened for women to enter the labour force
  at higher status positions, increasingly home
  based care has been provided by non-family
  members.
• Immigrants are often the only ones willing to
  provide the 24 hour live-in help needed to
  replace traditional family caregivers.
• At the upper skills level, pay differentials and
  working conditions, as well as the glamour
  factor may influence Canadian born health care
  workers to select acute or critical care over
  long-term care.

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The LTC Labour Market in the USA

• Redfoot and Houser (2005) suggest that the LTC
  labour market is comprised of three relatively
  distinct groups of immigrant direct service
  providers, each with its own dynamics
• registered nurses, who must become credentialed
  in the receiving country if they are to practice
  their profession
• unlicensed low-skill aides and others who seldom
  immigrate to pursue a career in the health care
  sector but find jobs there after immigrating
• domestic service workers, many of whom operate
  in the grey economy.

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The Live-in Caregiver Program Makes the Situation
Somewhat Different in Canada

• Established in 1992 by Citizenship and
  Immigration Canada, the Live-in Caregiver Program
  (LCP) allows Canadians to employ qualified
  foreign workers in their private residence when
  there are not enough Canadian citizens and
  permanent residents to fill the available
  positions for child care, care of the sick or
  elderly or persons with disabilities
• LCP participants are initially granted temporary
  resident status and a work permit
• After two years they are eligible to apply for
  permanent resident status
• Source http//www.cic.gc.ca

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Worker Eligibility Criteria

• A job confirmation letter from Human Resources
  and Skills Development Canada (HRSDC)
• Employer must apply to HRSDC to have job offer
  reviewed to ensure duties, working conditions,
  pay, etc. meet provincial labour standardsand
  that job cant be filled by Canadians.
• A written contract from the future employer
  outlining duties, hours of work, salary and
  benefits
• Successful completion of the equivalent of
  Canadian secondary (i.e. high) school
• At least 6 months training, or at least one year
  of full-time experience (including 6 months with
  one employer) in past 3 years in a
  field/occupation similar to what they will do as
  a live-in caregiver.
• Ability to speak, read and understand English or
  French
• A work permit before entering Canada

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Employers Must Agree that LCP will

• Work for them in a private home
• Live with the employer
• Have a private, furnished room in the employers
  house with a door that locks
• Be employed on a full-time basis
• Meet CIC requirements for language, education and
  work skills

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Employers must understand and agree that a
Live-in Caregiver cannot

• Work for more than one employer at a time
• Work for a health agency or labour contractor, or
  in a day care or foster care.
• If the employer agrees to these conditions,
  he/she can apply to Service Canada for a labour
  market opinion. The opinion assesses the impact
  of hiring the live-in caregiver on Canadian jobs.

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Geographic Distribution

• Table 3 shows the distribution of the total
  population and the population aged 65 across
  Canadas 10 provinces and 3 territories.

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Total Pop. Pop. 65, Canada, Provinces and
Territories, 2001
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Geographic Distribution of LCP Workers

• The vast majority (88.6) are in English-speaking
  Canada -- in Ontario (47), and the two western
  provinces of BC (23.8) and Alberta (17.8)
• An additional 9.6 chose to become permanent
  residents of Quebec where the official language
  is French

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Table 4Permanent Residents under LPC by
Destination, 2003-2007
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Sex of LCP Participants

• The vast majority of migrant carers are female.
  In the 17 years since establishment of the LCP,
  116,075 females and 4809 males have participated
  in it.
• The proportion of males has increased in recent
  years

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Number of Female and Male Live-in Caregiver
Immigrants to Canada by Year, 1992-2008
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Table 5 Sex of LCP Participants by Period of
Entry to Canada
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Table 6 Age Distribution of LCP Workers 1992-2008
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Race and Countries of Origin of LCP participants

• Redfoot and Houser (2005) note that at all levels
  of LTC, a system is evolving in more developed
  countries where much of long-term care is
  provided by women of color from other countries
  (p.9).
• The vast majority of LCP participants are from
  the Phillipines

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Figure-1 Top 19 Countries of Origin of Live-in
Caregivers, 1992-2008
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Top 18 Countries of Origin of Live-in caregivers,
1992-2008excluding Philippines
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Job Mobility

• Redfoot and Houser note that LTC labour markets
  are not distinct from health and other services.
  
• Registered nurses are not credentialed for LTC
  only, so movement among nursing home, home
  health, and hospital care is quite common (p.7).
  
• Redfoot and Houser also comment on the high
  turnover rate of unskilled workers in both
  institutional and home care settings, who often
  move to and from jobs in a variety of service
  sectors.

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Horror Stories Other Countries
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Canadian Studies

• Bourgeault, L., Atanackovic, J., Parpia, R.,
  Winkup, J. LeBrun, J. (2009). The role of
  immigrant care workers in an aging society The
  Canadian context and experience
• Pratt, G. (2003). From migrant to immigrant
  Domestic workers settle in Vancouver, Canada.
• Pratt, G. (2008). Deskilling across the
  generations Reunification among transnational
  Filipino families in Vancouver.
• Spitzer, D.L. Bitar, S. with Kalbach, M.,
  Bernardino, C and Pereira, I.I. (2002). In the
  shadows Live-in caregivers in Alberta
• Spitzer, D (2006). The land of milk and honey or
  dreams deferred? An examination of foreign
  domestic care-workers in Canada.
• Spitzer, D.L. (2008). Live-in caregivers in rural
  and small city Alberta.

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Table 7 Studies of LCP Workers
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Case Study 1- 41 year old female from
Philippines (Gutman Chowdhury, in progress)

• Education College diploma in midwifery
• Marital status 4 sons living in Philippines
  husband works in Qatar. She Worked in Hong Kong
  for 7 years as a domestic worker before coming to
  Canada.
• She was hired to take of an 86 year old lady with
  Parkinson disease. She was laid off after 5
  months as the employer wanted someone who could
  drive.
• Her second job was to take care of 2 children .
  As they demanded 24 hours service from her and
  she was not given liberty to handle the children,
  she quit.
• Her third and current client is a 91 years old
  lady with Alzheimer. She has looked after her for
  17 months. This client will be admitted to a
  nursing home next week so her job as a caregiver
  will end. She has already applied for an open
  work permit visa, as her tenure for an LCP visa
  is complete.

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Case Study 1 contd

• While in Hong Kong, her family was still in
  financial crisis, as her earnings were limited
  and she could not send much money home. Now she
  can save some money. Her familys economic
  condition has improved. She provides for her
  childrens education and living costs. A nanny
  takes care of her 4 boys.
• She is planning to work in a nursing home or
  hospital. She is interested in studying to become
  a care aide.

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Case Study 2 47 year old male from the
Philippines (Gutman Chowdhury, in progress)

• Education BSc in Civil Engineering
• Marital status Divorced
• Work experience in the Philippines College
  teacher for 6 years. In 2002-2007 worked in Hong
  Kong as a Domestic Worker took care of a 91 year
  old male.
• Reason for leaving the Philippines was financial.
  The salary was insufficient to support his
  family (two children, wife, two younger brothers,
  sister, father).
• In Philippines he heard that receiving American
  citizenship is a very hard process and that it
  takes more than 6 years to come to Canada as an
  skilled immigrant and is expensive to apply for
  immigration and to come to Canada under a
  business visa. While in Hong Kong, he learned
  that it takes only 6 months to process paperwork
  to come to Canada under LCP.

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Case Study 2 contd

• He says the 86 year old lady he cares for in
  Vancouver and her daughter who is his employer
  treat him like a family member.
• I do not mind being a caregiver, because loving
  and dedicating yourself for taking care of
  somebody else is a good thing.
• Here at my employers place, I am allowed to have
  my own computer Im allowed to have my own
  space. The situation here is much different than
  the one I was in Hong Kong. While I was in Hong
  Kong, I did not have the freedom to choose on how
  to take care of the client. The employer is
  telling you what to do...you do this, you do
  that. But here, Im given the chance to do it
  myself. I take my decision on how to take care of
  my client on my own initiative and own
  knowledge.  
• While finishing the LCP, he plans to upgrade his
  education in Engineering. He also intends to
  sponsor his children and his sibling to come to
  Canada. He says he gave his family financial and
  moral support. His family gave him the moral
  foundation and the ability to handle things
  right.
•  

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Case Study 3 57 year old female from the
Philippines (Gutman Chowdhury, in progress)

• Education BSc in Medical Technology
• Married with 2 daughters one immigrated to
  Canada before her - the other lives in the
  Philippines.
• In the Philippines, worked as a medical
  technologist for 5 years owned a credit card
  agency for 15 years.
• First client was a 2 year old child second
  client was a 10 year old third client was a 65
  year old female with arthritis current client is
  a 56 year old female who had a stroke and is
  confined to a wheelchair.
• She stated that in the beginning it is always
  like being a family member but gradually it turns
  into an employer-employee relationship.
• Now that she has gained experience she is
  interested in pursing a career in elder care.
• LCP program is a good opportunity for people in
  developing countries, where the economic
  condition is not favourable. LCP is a less
  expensive way to come to Canada than coming as a
  skilled immigrant

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Changes to the LCP

• In 2006, the maximum duration of the work permit
  for live-in caregivers was extended from one year
  to three years and three months

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Additional Changes Workers Association is
Lobbying for

• That workers have 4 years to complete authorized
  work where there is a good reason it could not be
  completed in initial 3 years
• That caregivers be exempt from the medical
  examination that they must currently undergo when
  applying to be a permanent resident
• That LCP workers be allowed to change employers
  without obtaining a new work permit
• The LCP workers be given permanent residence
  status as soon as they arrive in Canada on the
  understanding that they would lose their pr
  status if they did not accumulate 24 months as a
  caregiver in their first 3 years.
• That LCP caregivers unable to quality for
  provincial health coverage be given federal
  coverage,
• That LCP workers be permitted to study without
  having to obtain a separate study permit.
• Source Okun-Nachoff (2009)

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References

• Bourgeault, L., Atanackovic, J., Parpia, R.,
  Winkup, J. LeBrun, J. (2009). The role of
  immigrant care workers in an aging society The
  Canadian context and experience. Poster presented
  at the annual meeting of the Canadian Assn. for
  Health Services and Policy Research, May 11-14,
  Calgary , AB.
• Gutman, G. Chowdhury, R. (in progress). Migrant
  workers in long-term care Pilot study of workers
  who entered Canada under the Live-in Caregiver
  Program
• Okun-Nachoff, D. (2009). Update on policy reform
  Live-in Caregiver Program. Nannies Voice
  (Newsletter of West Coast Domestic Workers
  Association, June, p.2
• Pratt, G. in collaboration with The Philippine
  Women Centre (2008, September). Deskilling across
  the generations Reunification among
  transnational Filipino families in Vancouver.
  Vancouver Centre of Excellence on Research on
  Immigration and Integration in the Metropolis
  (RIIM). Working Paper No. 08-06. 
• Pratt, G. in collaboration with The Philippine
  Women Centre (2003, November). From migrant to
  immigrant Domestic workers settle in Vancouver,
  Canada. Vancouver Centre of Excellence on
  Research on Immigration and Integration in the
  Metropolis (RIIM). Working Paper No. 03-18.
• Redfoot, D. Houser, A. N. (2005, October). We
  Shall Travel On Quality of Care, Economic
  Development, and the International Migration of
  Long-Term Care Workers. Washington, DC AARP
  Public Policy Institute, Paper No. 2005-14.
• Spitzer, D (2006). The land of milk and honey or
  dreams deferred? An examination of foreign
  domestic care-workers in Canada. Paper presented
  June 9, 2006. National University of Singapore.
• Spitzer, D.L. (2008). Live-in caregivers in rural
  and small city Alberta. Edmonton The Prairie
  Metropolis Centre.
• Spitzer, D.L. Torres, S. (2008). Gender-based
  barriers to settlement and integration for
  live-in-caregivers A review of the literature.
  Toronto The Ontario Metropolis Centre.
• Spitzer, D.L. Bitar, S. with Kalbach, M.,
  Bernardino, C and Pereira, I.I. (2002). In the
  shadows Live-in caregivers in Alberta. Report
  prepared for Changing TogetherA Centre for
  Immigrant Women.
•