The proposed project has several components in two broad categories that have been coordinated across all four country case studies:

1. A Background Contextual Analysis. We began by reviewing the immigration policies regulating the entry, employment and integration of foreign care workers in Canada. The second contextual analysis addressed the structure and demand for home and long term care for the elderly in the Canadian context. These first two components drew largely upon the analysis of policy documents, which include publicly available publications, reports, proceedings from meetings, memos and correspondence between various stakeholder groups involved in the migration of care workers and a review of the secondary source literature. The third component of the background contextual analysis involved the examination of the statistical evidence on the role that ‘native’ and foreign born workers play in the provision of health care services presently and projections based on future demand. This statistical portrait was developed largely using 2001 Census data and a methodology for projections agreed upon across the four case countries so as to ensure as comparable data as possible. These data provide insight into immigrant care worker’s demographic, socio-economic characteristics, qualifications and progression after migrating (details are noted in Section II below).
2. Empirical Studies of Immigrant Care Workers, Employers and Recipients of Care in a range of different health care institutions, home care agencies and private households in three provincial contexts: Hamilton/Toronto Ontario, Vancouver/Victoria, British Columbia and Montreal, Québec. In each location, care was taken to purposively sample from large and small institutional settings, from home care services and private households. Our aim was to interview 75 workers and 27 managers/employers and care recipients across the different sites. In the end we secured interviews with 75 workers, 23 employers and 29 care recipients (see Table 1).

The interview guides were semi-structured – providing an opportunity for interviewers to explore attitudes, experiences and interpretations – and all were coordinated across the four country sites to enable comparative analysis (see Appendices 1 through 4). Interviews with workers explored their reasons for and means of migration, choice of employment, working and living conditions, issues relating to turnover, aspirations and social integration to be analysed by such factors as country of origin, skill level, gender and length of stay. Interviews with current and potential recipients of care addressed issues of attitudes towards immigrant care workers and experiences – either personally or as family members. [Appendix 5 presents demographic data on workers not otherwise presented in the contents of this report]. Interviews with employers and personnel managers explore the demand for and experiences with immigrant labour, factors affecting quality of care, the client/worker relationship and those with other staff. In addition to the employer interviews, we set up an online survey for employers to complete which largely mirrored the questions from the interview guide. A total of 149 employers filled in the online survey of which 102 answered the full set of questions related to the employment of immigrant care workers. [Appendix 6 presents demographic data on the employers not otherwise presented in the contents of this report].

Data Analysis. Each taped interview was transcribed verbatim with participants’ approval. Transcripts were then entered into the NUDIST qualitative data analysis software program for coding. A preliminary comparative coding scheme was developed by the international research team and subsequently applied using this program to relevant segments of the interviews by four research assistants – three for the English interviews with workers, employers and care recipients and one for the French interviews across these three participant categories. Regular reliability checks through cross-coding of selected data were undertaken to ensure accurate coding of the data. These codes were then organized into higher-level categories according to the country report template created by the international research team. The analysis of the employer survey data entailed simple frequency and cross tabulations by different demographic characteristics (described more fully in the relevant sections below).

We begin our report with the background contextual analysis of the provision of health care for older people in Canada followed by the description and evolution of immigration policy. We then present the analysis of the labour force data which helps to project the need or demand for workers in the provision of care for the elderly. Following this background contextual analyses, we thematically present our empirical data gathered from workers, employers and care recipients in terms of the supply and recruitment of migrant care workers, the influences on employers’ demand for migrant care workers, migrant care workers’ relations with employers, working and living conditions and relations between older people and migrant care workers. We conclude with brief discussion of the policy implications of our research findings nationally and internationally.