By Geralyn Magan
In this article from Generations, Robyn Stone identifies several trends that raise concerns about the future supply of direct care workers needed to provide hands-on care for older people around the world.
Recruiting foreign-born or migrant workers could represent one solution to the projected shortage of direct care workers needed to provide long-term services and supports (LTSS) in the coming decades, according to a new article by Robyn Stone, executive director of the LeadingAge Center for Applied Research.
The article, entitled “The Migrant Direct Care Workforce: An International Perspective,” appears in the Spring 2016 issue of Generations.
Stone identifies several trends – including increased demand for LTSS and projected decreases in the availability of family caregivers – that raise concerns about the future supply of direct care workers needed to provide hands-on care for older people around the world.
“Policy makers, providers, and consumers are already struggling to recruit a quality, competent direct care workforce to meet current demand for LTSS,” writes Stone. “The confluence of trends … suggests that the availability of direct care workers is likely to become more challenging in the future.”
A number of developed countries are working to reduce the care gap by recruiting foreign-born and migrant workers, writes Stone. For instance, approximately 1 in 5 direct care workers in the U.S., and 1 in 4 direct care workers in Canada and Australia, are foreign born.
Migrant Workers and Immigration Policy
Most developed countries use “managed migration schemes” to recruit foreign nurses and other professional staff to work in health care settings, writes Stone. These managed schemes feature formal structures to control the nature and scope of migration flows between source and destination countries.
However, most migrant direct care workers enter host countries through “unmanaged migration” routes, reports Stone. For example, these workers enter Europe’s LTSS sector, through overstaying, fraudulent entry, or illegal border crossing. Direct care workers typically enter the United States through family reunification, as refugees, through a green-card lottery, or for unauthorized work.
An estimated 79% of the foreign-born direct care workers entering the U.S. are legal, Stone points out. The vast majority of these migrant workers remain in the United States permanently and many become naturalized citizens.
Benefits and Challenges
The most compelling opportunities offered by migrant LTSS workers are financial, writes Stone.
Migrant workers who move to other countries often earn more money than they could at home – and they often send a portion of those earning to families left behind. This arrangement benefits families while bolstering the larger economy of the countries of origin, writes Stone.
Hiring of migrant workers can also keep LTSS staffing costs relatively low in destination countries, like the U.S. These lower costs are particularly appealing to families hiring workers on the private market, LTSS organizations with tight budgets, or policy makers struggling with the costs of their public LTSS programs.
Challenges associated with migration include the potential for financial, emotional, and physical exploitation of direct care workers. In addition, writes Stone, policy makers in destination countries must address issues related to the qualifications and training standards for migrant workers; language and cultural differences between migrant workers and their care recipients; and the likelihood that migration of workers to other countries can create significant care gaps in their countries of origin.
Conclusion
Stone concludes her article by outlining 5 steps that countries around the world should take to support the migrant direct care workforce:
- Develop guidelines to support a quality and ethical process for the international transfer of human capital in the LTSS sector. The Organisation for Economic Co-operation and Development has developed guidelines outlining policies and procedures needed to protect workers, consumers, and employers.
- Invest in initial and ongoing training to ensure that foreign-born direct care workers have the skills and knowledge needed to do a quality job.
- Develop cultural competence on the part of the workers, employers, and consumers.
- Avoid financial exploitation of foreign-born workers by developing policies focusing on fair compensation and benefits.
- Use immigration policy to address the care demands of the aging population and the development of a viable eldercare workforce.
“Using migrant labor as a solution to the world’s eldercare workforce challenges must be considered from the perspective of fair trade, human rights, quality health and social care, and overall economic development,” concludes Stone.