Migrant Care Labour and the COVID-19 Long-term Care Crisis: How Did We Get Here? (2020)

The COVID-19 pandemic has exacerbated and accentuated an ongoing crisis of care. Suddenly, the conditions of those working and living in these facilities have become a key concern for the public. LTC workers are predominantly women, and in Canada migrant and racialized minorities are overrepresented in the sector. In Canada, workers in this sector are low-paid, short-staffed and mostly part-time, who often piece together two or more jobs across many facilities. COVID-19, as with other epidemics, exposes how such working conditions undermine infection control protocols and make workers and residents vulnerable to infection.

This paper provides some context regarding the care crisis in LTC facilities, in particular its relationship with the type and skill mix of labour, including the degree to which immigrant workers are represented in this sector. It will highlight two of the contributing factors to this crisis:

1. the first is the gendered and racialized devaluing of migrant labour so essential to this sector;
2. the second is the role of the private sector and the unsustainable extraction of profits from this service and the labour that provides it.

A historic lack of investment in care, especially in areas of elder care, has resulted in long-term care (LTC) facilities being the epicentre of the pandemic in various nations. In France, one-third of all coronavirus deaths have been in care homes, and in Canada almost 80 percent. This is an international issue of concern, since in more than half of nations belonging to the Organisation for Economic Co-operation and Development (OECD), population ageing has exceeded growth in the number of LTC workers. In many higher-income nations, deaths linked to the COVID-19 global pandemic have been concentrated in residential care facilities, including LTC facilities that house the elderly or those needing assisted living.

Main points

• In Canada, there is an average of four LTC workers per 100 individuals over 65. Ontario faces especially dire working conditions in LTC facilities, with studies indicating insufficient training for caregivers, rigid hierarchies within facilities, understaffed homes and poor levels of care.⁵ In Ontario, the provincial government has failed to fund LTC appropriately.
• Despite the various approaches to funding LTC across the globe, approaches are generally unsustainable as the world population continues to age.
• PSWs are essential to most residential care facilities. Research has indicated that variation in PSW education and employment standards, has significant implications for patient safety and quality of care. PSWs in this sector are low-paid, short-staffed, mostly part-time and often piece together two or more jobs across many facilities.
• Internationally, the number of migrant care workers in LTC is increasing. A similar trend can be found in Canada, with research suggesting migrant workers represent up to 50 percent of LTC caregivers in certain provinces.
• Immigration and employment policies, combined with these structural forms of gendered and racial discrimination, create precarious employment conditions for immigrant workers in this sector.
• Employers can naturalize this labour market segmentation by reproducing ideas about certain racial and cultural backgrounds making migrant workers better at caring for older populations, and less likely to complain about strenuous or difficult work conditions.

Recommendations

• Workers’ compensation in LTC facilities must be better regulated, ensuring that workers make a living wage that is commensurate with the valuable, difficult and labour-intensive work they perform.
• LTC workers should be hired into permanent, full-time positions to allow workers access to employee rights and benefits, and to minimize the number of care workers employed at two or more LTC facilities.
• Care workers who enter the country as temporary migrants should be regularized, to allow them increased access to Canadian and provincial employee rights, and to minimize their vulnerabilities to employer exploitation.
• LTC should be deemed a medically necessary criteria under the Canada Health Act, in line with the recommendations proposed by the 2002 Commission on the Future of Health Care in Canada (Romanow Commission).