This report, produced by authors at ODI and the Center for Global Development (CGD), analyses the intersection between the older persons’ care sector and migration. It looks at the experience of migrant workers and the patterns of mobility for older persons’ care between countries. It also provides three case studies – China, the United Kingdom (UK) and the United States (US) – to better understand how governments have sought to support older persons’ care systems and address workforce challenges. The report concludes with recommendations to policymakers in high-income, rapidly ageing countries that are struggling with these issues.
- Many high-income countries are facing a rapidly increasing demand for older persons’ care, alongside huge workforce shortages. Workforce shortages are directly linked to the sector’s low pay, poor working conditions and the undervalued nature of care work. These stem from the feminisation of care work, including paid employment, and the impact of more recent austerity, privatisation and marketisation trends.
- Migrants are essential to the delivery of older persons’ care in many high-income countries, often filling gaps left by inadequate formal care systems. They also help to make care affordable for those who would otherwise go without support. However, they are more likely than local workers to encounter low pay and poor working conditions, particularly if working in home care, and if undocumented.
- Few examples of labour migration pathways exist that bring in sufficient numbers of older persons’ care workers who are able to work under fair employment conditions. Where pathways have been used, careful design is required to guard against the exploitation of these workers and to ensure continuity of care.
- Countries need to make the sector more attractive to local workers. However, recruiting migrant workers appears to be the only way to provide safe and high-quality care for older people, both now and in the medium-term as countries age rapidly. Ensuring ethical and sustainable international recruitment should be an immediate policy priority.
Policy-makers in countries of destination should do the following:
• Make it easier for older persons’ care workers to migrate, through both general migration schemes and targeted pilots. These migration policies could provide either long- term temporary (e.g. three-year) visas – with a view to encourage circularity and skills-building – or a pathway to permanent residency and citizenship.
• Ensure migration pathways provide a tangible benefit to the country of origin. As the discussion on the WHO Code illustrates, the migration of older persons’ care workers should take place through a bilateral government-to- government agreement that prioritises ‘mutual benefit’. Financial and technical assistance can address immediate priorities and could, if well targeted, contribute to the establishment of sustainable and comprehensive long-term care systems in countries of origin.
• Ensure visas include family accompaniment. Migrant workers should not be expected to leave their families at home, especially if the visa is long-term temporary or permanent. Excluding family accompaniment merely contributes to the ‘care drain’.
• Ensure visas are not tied to one employer given the well-documented risks of exploitation and abuse of workers under tied arrangements. Instead, countries of destination could consider occupation-tied visas. For example, a new migrant must work in the care sector (as broadly defined) for the length of their visa (at least until they obtain permanent residency).
• Ensure that migrant care workers benefit from the same range of entitlements as non-migrant care workers. This must include those working in home-based care and as domestic workers who must also access full labour and social protections. Creating dedicated agencies to monitor home-based working conditions is likely to be necessary in many country contexts to deliver improvements in this area, particularly given that regulation and inspection currently focus mainly on care quality standards.
• Ensure that migrant workers in the older persons’ care sector have access to the same training and skills-upgrading opportunities. Countries should explore creating a continuum showing the level of skills required for different types of older persons’ care workers, and the training required for each level. Migrant and local workers should sit within this continuum and have the ability to move up if desired.
• Strengthen qualification recognition and ensure harmonisation with countries of origin. Recognised qualifications and career enhancement pathways are essential for the professionalisation and improvement of the older persons’ care workforce in high-income countries. These systems must also ensure that migrants can have their skills recognised. This will prevent ‘down-skilling’, or the fact that many qualified nurses are working as carers because they cannot get their nursing qualifications recognised. Harmonising these these qualification requirements with countries of origin, perhaps as part of a government-to-government migration agreement, will make it easier for graduates to pursue work in the older persons’ care sector at home and abroad.
• Gather, and publish regularly, data on the older persons’ care workforce that includes disaggregated information on the workforce (gender, age, country of nationality/birth, educational qualifications, skills/certifications), as well as on turnover, retention, vacancies, contract types, pay and conditions. These efforts could be led by a centralised workforce planning unit, perhaps within the Ministry of Health, with this data used to inform the balance between local and international recruitment strategies.
Chosen excerpts by Job Market Monitor. Read the whole story @ Migration and the future of care: supporting older people and care workers | ODI: Think change