As noted in section IV on the recruitment process, employers highlighted several benefits of hiring immigrant care workers which helped encourage them to recruit and retain these workers. Some of these advantages include how immigrant care workers have a good work ethic, are committed to caring for older people, are loyal, have the right skills and are willing to learn from others (see Table IV.13 p. 72). By way of contrast, the employers we interviewed and surveyed did note that there are also some challenges associated with employing immigrant care workers. One of the most important challenges was that of language barriers (see Figure V.1). They explain that immigrant care workers who do not speak English often struggle in communicating with staff, residents and clients’ families and how not speaking English can cost immigrant care workers their jobs.

Interviewer: What are some of the challenges in employing immigrant health workers?
Employer: Probably English as a second language because, um, sometimes for the elders it can be frustrating, um, trying to understand what it is they’re actually trying to say. (BC Employer 5)

Employer: Sometimes language cause I’ve heard families say that they didn’t understand someone. So you may have someone who their English is not their main language and then language does play a part in the communication.

Interviewer: So do residents complain about their language?Employer: Families complain. And the residents may do sometimes. Yeah, say they didn’t understand what the person said to them. (Ontario Employer 4)

We can’t hire somebody without English. They have to speak English. (QUÉBEC Employer 2)

A few employers find it particularly challenging when care workers speak their native language to one another in the presence of residents. They explain that this can be troubling and disrespectful for residents and has been an issue in the past.

Sometimes there’s been speaking their own language because English is the language of the building and so, um, sometimes like a Filipino group will be talking ## you know, for elders to understand that and they’ve already got a dementia so we don’t need to, you know... So we have had some discussion around that with them. (BC Employer 5)

Similarly, one immigrant care worker noted the difficulties with the same issue on his part:

They [co-workers from his own country] tend to forget that it’s a workplace and it’s not right to speak in our language when there are other people out there that don’t speak. ... I understand you ... speak in your own language if you’re by yourself outside of work but not when you’re at work. Those are problems that I encounter in the workplace at times. (BC Care Worker 6)

A number of employers also noted the difficulty they have in ensuring all staff can meet written language requirements.

Um, part of their job does require them to fill out a flow sheet or a documentation sheet so part of the interview, sometimes if I feel that language is a barrier, um, I would have them read something or fill out a paperwork. Um, you know, you don’t want to put someone on the spot by asking them if they can do or if they can read, but somehow finding that perhaps that’s maybe an issue for that person. (Ontario Employer 1)

A few employers find that immigrant care workers require additional job training when they enter the workplace, but for the most part it appears thatthis training is conducted in-house, and further that it is culturally specific rather than technical or medical in nature.

…some people do require a little bit of extra training depending on, you know, their background. I wouldn’t say that just because somebody is an immigrant that they need extra training but, you know, there are cases where things were done differently from wherever they came and it’s a matter of spending a little extra time. (Ontario Employer 5)

Another challenge to employing immigrant care workers is that employers feel they may be hiring workers that are often over-qualified for the available positions and it is difficult to grasp their real accreditation levels. Employers note that it is also a challenge for some employers to recognize degrees/certifications from certain countries.

For instance we’ll recognize a Bachelor of Nursing from the Philippines as qualifications. ... as well from Hong Kong and Europe and Thailand. But we won’t recognize a registered nurse from China (BC Employer 1).

The fact that employers often hire overqualified immigrant healthcare workers and that the degrees from some countries are not recognized in Canada was also described as challenging in interviews with the workers. That this topic was recurring in the interviews is not surprising given the fact that around 60% of our sample has prior education in nursing and other health related occupations. Commenting on the frustration he feels with regard to inability to use the MD skills he obtained in his home country, one physician from Columbia, working as Personal Support Worker (PSW) notes:

Obviously the employers recognize that I am a medical doctor and I have... I am over qualified for the job. It’s how I feel, yes, that I am using for that kind of particular job I am using 5% of my capacity. You see. It’s how I feel. (Ontario Care Worker A7)

Similarly, elaborating on barriers to using her skills, a nurse from Zimbabwe, currently employed as PSW in a long-term care facility says:

I’m not registered. I cannot use my skills as a nurse because I am not registered in Canada. I didn’t train in Canada so they don’t allow me to practice my nursing. (Ontario Care Worker J1)

Some employers have had cases where the residents in their facilities did not accept immigrant care workers due to their accents, the colour of their skin, etc., however, this was not a reoccurring theme throughout the interviews. A few employers mention that they have to speak to immigrant care workers about being culturally sensitive towards residents and staff. Some employers find that immigrant care workers may be misinterpreted because of their cultural backgrounds/differences, and that this can pose a challenge. Often these cultural differences may lead residents to question the skills of their immigrant carers.

I think sometimes people can misunderstand that. So like lots of times we’ll sit down with them and talk about it and people may not have meant what... how it sounded. You know, sometimes it could be blunt but that’s not how they meant it. So you’ll talk to staff about, um, how it came across and usually meet with the two staff members and sit down with them and discuss it. But yeah, that certainly has occurred (BC Employer 5).

Given Oakville's existing demographic makeup, there may be some reticence on the part of our users (older adult clients) to accept foreign born nurses as they may question the quality of care. We've seen, however, that this reticence often dissipates rather quickly as our nurses and (immigrant care workers) interact with the clients. (Employer, online survey)

While a few employers noted the fact that immigrant care workers are sometimes hesitant to approach management over issues, this does not appear to be a significant challenge in employing immigrant care workers. Immigrant care workers’ lack of decision-making skills or their low education level was not seen as challenges for employers. High turnover rates do not appear to be a huge challenge for employers. A few employers, however, do note the challenge that immigrants can pose when requesting extended vacation time to visit family overseas.