Although in general, immigrant care workers think that their contracts are fair with regard to duration and employment conditions, the interviews reveal some issues concerning working conditions in the sector more broadly. Regardless of the type of care setting in which they work, immigrant care workers reveal that they are working more than one job due to a lack of full time work provided by employers. In particular, this problem is the most severe in the case of the immigrant care workers employed through agencies. These immigrant care workers complain about the lack of shifts (they work on average 3-4 working days in a week), frequency of night shifts and low pay rates provided by agencies (which, according to the respondents, is often four to five dollars below the pay rate given to those directly employed by the employer):

I don’t think it’s fair because you work yet they [agencies] don’t give you a permanent job. It’s always part time. There are no permanent jobs, you know. (Ontario Care Worker J1, employed through agency)

If the agency gets more shifts from the different hospitals then I’ll have 40 hours all the time. But sometimes I don’t get full time, the 40 hours, because if they don’t get any shifts from the hospital then they won’t give me any shifts. (Ontario Care Worker A12)

According to the immigrant care workers, working on call (a common experience of those employed through agencies) has a disruptive impact on their lives since it hinders them from planning ahead.

You don’t even know what you are doing because you don’t like plan anything because you don’t know whether you still go to job tomorrow or you are not. ... So you remain on the same place and you won’t do anything constructive because it’s blocking all. You don’t know what you are doing. You just say ‘Oh I will see tomorrow what my tomorrow will be. What’s going to be?’ Tonight ‘What’s going to be tomorrow morning? What’s going to be?’ Or sometimes they’ll phone me. Like today they phoned me to tell ‘Can you go now to work? I said ‘No, I’ve got an appointment.’ You know, it’s hard. (Ontario Care Worker J1, employed through agency)

One of the advantages to being on call and working for an agency, noted by some immigrant care workers, is being exposed to different hospital and nursing home settings. One immigrant care worker is using this time to evaluate workplaces, determine where she will eventually apply to work on a more permanent basis, and what settings she will avoid in future.

Intervieweuse : Et donc vous êtes responsable de combien de personnes?
Travailleur: Là-bas, il y a 64 personnes.Intervieweuse: Et donc vous faites ça pour toutes les 64 personnes, les médicaments, vérifier leur glycémie.
Travailleur: Oui, quelques-unes n’ont pas besoin.
Intervieweuse: Oui, c'est sûr que ce n'est pas tout le monde.
Travailleur: Oui, mais c'est une institution privée de personnes autonomes, c'est plus calme, non. Comme travail. On peut voir…On peut connaître plus de personnes aussi parce qu'on peut parler… Et puis un peu moins à l'hôpital parce qu'il n'y a pas de temps. Donc c’est… c’est, mais bon.

Interviewer : And so you are responsible for how many people?
Care worker: There are 64 people there.Interviewer: And so you do all of that for all the 64 people, the medications, checking their glycemia?Care worker: Yes, there are some who don’t need it.Interviewer: Yes, for sure, it’s not everyone.
Care worker: Yes, but a private institution with autonomous people is calmer, isn’t it? In terms of work. We can see... we can get to know the people better as well because we can talk...A little less at the hospital because there’s less time. So it’s.... so it’s, oh well. (QUÉBEC Care Worker 6)

Beyond the issue of being on call, immigrant homecare workers report that they are often expected or asked by the employers or their families to do additional work such as housekeeping not included in their job contracts. Commenting on the extra workload that her employer imposes on her, one immigrant care worker says:

Yeah. Um, my employer, this is the live-in caregiver ... she gave me a cell phone which I thought okay, that’s good, but then she had a colostomy and she would call me even on my day off. Because what happens with the elderly is they become so dependent on you that they don’t trust anybody else. They only want you, you, and only you. Even the family member doesn’t matter. They get so attached. And the problem is with our culture we feel it’s so rude, you know, to say something that this is not my duty. You end up doing it and doing it and doing it until you just want to burst. (BC Care Worker 11)

This type of situation is especially true for immigrant workers who migrated under the Live-In Caregiver programme. Although the work contract stipulates that they are to work 40 hours a week, the very nature of the contract dictates that they work much more than that. Because they are caregivers living with their employer, they are often expected to be available at all hours of the day and night.

Because sometimes they become dizzy, like she wanted to get out of the bed alone, so because I have my own room and she has her own bed, but we put the monitor.

Interviewer: Like a baby monitor.Care Worker: Yes. So, every time she moves you have to -- it’s incredible hours still, because every time you hear even when you’re sleeping -- every time, even when you’re sleeping and then you hear something –Interviewer: You have to be alert.Care Worker: Yes, you have to be alert, yes. It means it’s still 24 hours.Interviewer: Absolutely.
Care Worker: Because the monitor, you can’t sleep and you’re going to be awakened because of the monitor and yet it’s really very -- you have a lot of stress too, because ...it’s a big responsibility.” (QUÉBEC Care worker 12)

The burden of extra work put on workers’ shoulders by employers is identified also in long-term care settings. In fact, the interviews reveal that housekeeping duties which are not included in their job contracts are often assigned.

Some of the interviewees, however, reveal that compared to the work in long-term care settings for the elderly, the work in a home care setting is less stressful and more meaningful.

There’s a relationship [in home care setting]. I mean the relationship is more, uh, one-on-one so it’s better….Well, um, like when you have more clients to attend to, the lesser interaction, the lesser things that you can understand them. And plus the pressure of the co-workers. (BC Care Worker 10)

On the other hand, others argue that work in private homes puts more stress and responsibility on them due to the lack of team work that characterizes such settings and unpredictability awaiting them behind the doors.

Care Worker: Hospital and homecare, the hospital is easier I think.Interviewer: Why is that?Care worker: Because they have the teams really to help you out and then you’re not alone; it’s a team and every day you can see people around, not --Interviewer: Yes.
Care Worker: -- like in the house, where you’re alone. (QUÉBEC Care Worker 13)

For me, if you work at home you are alone. You don’t have the... if I needed to do anything I wouldn’t have the help of the co-worker, so if there was something going on I couldn’t ask a co-worker’s opinion which in the hospital in my setting I can always do so. And then in the hospital generally you know what you’re getting. In people’s houses you knock on the door and you never know what’s behind that door in terms of person, cleanliness, you know, personal hygiene, or pets, or other family members that can affect the work (Ontario Care Worker A3).

Elaborating on last point, this immigrant care worker recalls:

It was elderly gentleman whom I gave him a bath and he just became pretty rude. He made some sexual comment. So I was quite upset because the agency, when I complained to the agency they said ‘Oh yeah, he does that.’ And I was upset that I wasn’t warned when they booked me for that shift with him. Yeah. Actually that was a bad experience. [laughing] (Ontario Care Worker A3).

Working under the Live-In Caregiver programme may also put unqualified workers in an inappropriate position of enormous responsibility. In some cases, the elderly they care for live far from family members, and as such, the live-in caregiver becomes entirely responsible for her charge.

Interviewer: Okay. So the family doesn't live with you. It's just you and this elderly person?Care Worker: Yeah, and they are living away, you know, they are just... sometimes it's during winter they are went to U.S. on vacation, they don't like to stay here.Interviewer: So they give you sort of decision-making power and they contact you only occasionally?
Care Worker: Yeah. But you know, I find them that they are not really... or really a hundred per cent concerned with their mom because she's a 100 years old, you know. Sometimes when I need the help from them it's so hard because they are not here. You have to contact them, or anywhere they are...So it's so hard for me.” (QUÉBEC Care Worker 11).

Furthermore, working in a home care setting as a live-in caregiver can be very isolating and lonely. Some of the respondents find that working alone in such a situation can be very trying.

Another thing ... you work in an institution, you know the level of care that they need ... like the twenty-four hours, there are three workers, right? ...Like day, evening and nights ... But doing the work, the work in the homes alone will get... you get lonely. That means only one caregiver for all... (QUÉBEC Care Worker 13)

The majority of the respondents feel that nursing homes are more demanding than home care, hospitals and retirement homes due to heavier work load, more difficult patients’ condition and an overall shortage of staff and supplies.

You have to be in a rush all the time. Yes, that’s a big difference. The others are one by one, so it’s really different the quality of the care and the quality of the working conditions. (Ontario Care Worker A2)

We don’t have time. When we are taking care of somebody, somebody is calling. We cannot leave that person like that and go for other. We have to finish it and we have to go. Very hard to have enough people to help. If they need help they have to wait. Sometimes they are falling. Sometimes they are... the people are getting mad at us. (Ontario Care Worker A13)

Also, some immigrant care workers feel that staffing/client contact is more intense in nursing homes than in hospitals and retirement homes, since they have to provide more intensive care for nursing home patients. Others maintain that such contact is strongest in home settings as workers get to know their clients much better.

They can take care of themselves in retirement homes but in a nursing home usually they don’t take care of themselves. Okay? They are very dependent. (Ontario Care Worker 6)

Yeah, they are different because mostly when I work at a hospital mostly I don’t do like most of the activities of daily living. There are some people who are like for example giving them food. Most of them they can eat on their own. So far almost all of them that I have taken care of in the hospital they can feed themselves. And most of them unless with just a little bit of help they can do their own bath. But at the nursing home is different. I have to make sure I help them with the bath. I have to make sure that most of them I have to feed them. (Ontario Care Worker A15).

The interviewees feel that due to the high number of clients in nursing homes and small number of staff, the carers’ job in this setting is physically challenging. In particular, they say that having to get more than a dozen of people up at the same time in the morning before breakfast which puts them under physical strain that often results in back problems.

This kind of job is very dangerous for your health ... You can get injury very easily in the back, in your muscles, in your arms. (Ontario Care Worker A2)

Others argue that work in hospitals is more challenging than work in other care settings for the elderly since the shifts are often very long and medical knowledge has to be constantly updated.

In the hospital, you need higher language skill so that’s why I’m taking terminology, I’m taking ESL, I’m taking critical care, continuing nurse education program. But in nursing home you don’t need to work so hard, need to learn so hard. But in hospital you have to keep on updating yourself. (Ontario Care Worker J9)