As noted at the outset, our long-term goal in conducting this research is to inform future immigration, integration and employment policies and practices in health and social care to: 1) improve the standard of care for older adults, and 2) to improve the working and living conditions of the migrant workers who care for them. Our shorter-term goal is to provide authoritative new data and analysis which is widely acknowledged by academics, policy makers and other stakeholders as making a substantive and original contribution to knowledge and debate. In this section, we begin to map out the key conclusions and policy implications of our findings in three key areas – demand for immigrant care workers in this sector; implications for care policy within the older adult care sector; and broader immigration and integration policies.

Current and anticipated future demand for migrant care workers and influences on demand

All of our data sources – surveys and interviews with employers, workers, and older adults, and the commissioned demographic projections report – all point to the great and growing need for care workers in the elder care sector. This will not be news to policy makers. It is also not particularly newsworthy to report on the labour challenges in this sector. It is difficult to recruit workers to work in home and long term care; the facts of high turnover and burnout are well established. Instead of addressing the quality of work in this sector, the seemingly easier solution seems to have been to backfill these less-than-attractive positions with new Canadians. Immigrant care workers are not immune to the challenges of working in this sector faced by Canadian born and educated workers – indeed, we find that it can be more challenging for a range of reasons.

Implications for care policy, employment rights and regulation of the care sector

Many of the findings presented in this report indicate the need for employment and hiring policies and practices in Canadian home and long-term sectors for older adults to change in a way that helps to ensure that:

1. they address the need for Canadian cultural competency and experience that does not result in discriminatory hiring practices of immigrant care workers. So, educational programs about relevant Canadian cultural issues with a particular focus on the care of older adults should be made available to immigrant care workers working in Canadian care settings for older adults;
2. culturally appropriate and care specific language classes are introduced as a part of the job training for immigrant care workers, so that communication challenges between workers, employers, residents and families is avoided;
3. the shortages of staff, supplies and other resources in nursing homes and in home care services should be resolved so that working conditions in these settings, the relations between care workers and older adults and the care of older adults can be improved and a greater quality of care can be provided.
4. immigrant care workers are better informed about their rights as workers if faced with discriminatory working conditions. By extension, more anti-racist education campaigns should be introduced targeting care-settings and care services for older adults and workshops that educate Canadian-born as well as immigrant care workers about diversity in the workplace are organized in the facilities/services, so that working relations can be improved; and
5. the credentials of internationally educated health professionals or areas of remediation are more quickly recognized.

Implications for immigration policy and the integration of migrant care workers

The results of our study indicate that there is an important role that immigration policy can play in the more effective employment and integration of immigrant care workers in the older adult care sector. More broadly, there is a need for organizations serving immigrants to take a greater role in facilitating the process of integration of the immigrant care workers into the Canadian society. This could be achieved through campaigns that would inform this immigrant group on vast array of services that are offered by these organizations, including legal advice, bereavement support, family counselling and support, mental health counselling, housing support, to mention just few of these, in addition to the technical services that are already used.

Some of the immigration policy implications of our study address in particular the Live-in Caregiver Program. Although the LCP is effective in bringing immigrant care workers into the country, there are inherent challenges in this program that many have addressed in the literature and by those we interviewed in this study. As we noted above, there is a need for the training required for applicants to this program to be more clearly linked to cultural competency in the provision of older adult care as well as to employment standards to address the present mismatch between educational requirements and training of LCP and the context of care they will be providing. The requirements and training should be shifted to ensure that applicants gain useful knowledge, for instance of how to deal with problems of old age, how to be culturally sensitive to the client needs, how to identify and deal with different forms of abuse (both themselves and of their client) and whom to contact in the case they experience it, and how to cope with the death of a client rather than learning how to perform simple or outdated housekeeping tasks.

One policy shift that could address some of the negative features of the living/working conditions of immigrant care workers in the LCP would be to separate the care and immigration sponsorship relationship – with the latter being mediated by an agency at arm’s length from both client/family and worker. Such an agency could also assist in finding alternative placements so that the 24 month working requirement of the programme could be satisfied within the 36 months in the case of shifting employment (as a result of problematic working conditions for the worker or problematic care for the client). Also, the agency could be responsible for ensuring that workers are not overworked or subject to any kind of abuse and in turn could ensure clients also were not abused. This would help to address the vulnerable situation of LCP workers and their clients. Establishing such an arm’s length agency would also increase the accessibility of older adults to LCP workers beyond those who know of the programme and have family members who can apply for care workers on their behalf. This would aid vulnerable older adults in particular. Such an agency could also ensure that a client who does not know any of two Canadian official languages is matched with a caregiver who is fluent in the client’s native language. In this way, the Live-in Caregiver Program would better cater to the needs of Canadian multicultural clientele.

In sum, it should be clear from this examination that there is a need for immigrant care workers in Canada but that some key issues need to be addressed to better meet their needs and the needs of the older adult recipients of their care. Some of the changes deemed necessary are related to the immigration status of the care worker but others are more general concerns with the lack of status and attention that older adult care has garnered in the Canadian context. Indeed, the relative invisibility of the conditions of older adult care is mirrored in the invisibility of the work and living conditions of their immigrant care workers.