The aging of the population is expected to continue over the next 3 decades and is expected to reach 9.8 million by 2036, doubling the senior’s share of the population to 25.5% (Statistics Canada 2007) (see Figure 1). Many older adults suffer from one or more chronic disability and the likelihood increases with age. Further, with aging, vision, mobility, hearing, cognition, perceptual ability and general physical endurance may decline. This has implications for the care of the elderly and for the growing workforce that provides this care (Home Care Sector Study, 2003a; Carriere, 2006).

Care Work in the Context of Aging Societies

Many argue that Canada has a shortage of care workers and this shortage is expected to become much more acute with the aging of the population (CIHI 2007). According to this argument, Canada’s population is aging rapidly due to low fertility rates, greater life expectancy, the effects of an aging baby boom cohort and a high immigration rate. According to the 2006, Census Canada’s population age 65 and over stands at 4.3 million. (13.7%); 1.2 million are aged 80 and over (3.7%). The aging of the population is expected to continue over the next 3 decades and is expected to reach 9.8 million by 2036, doubling the senior’s share of the population to 25.5% (Statistics Canada 2007) (see Figure 1). Many older adults suffer from one or more chronic disability and the likelihood increases with age. Further, with aging, vision, mobility, hearing, cognition, perceptual ability and general physical endurance may decline. This has implications for the care of the elderly and for the growing workforce that provides this care (Home Care Sector Study, 2003a; Carriere, 2006).

In addition to the aging of the population, others point to how the aging of care workers creates even greater challenges to the sustainability of health care. The average age of people in health occupations in Canada was 41.9 in 2005 which is 2.3 years older than the average age of the general Canadian workforce (CIHI 2007). Specialist physicians have the highest average age at 46.4 years, family physicians, 45.8 years and RNs, 42.9 years (CIHI 2007).

There have been several responses to the current and projected shortages of care workers and the aging of the health care workforce and overall population. These include increasing spaces in local training programs, expanding the scope of practice of existing care workers, attempting to better retain workers in the system and developing new technologies that may substitute for, or reduce the need for care workers (CIHI 2007). Another important component is tapping into the existing resource of immigrant care workers. We know that internationally educated health professionals (IEHPs) demographically represent a significant proportion of all health professionals in Canada – nearly one quarter of physicians and seven to eight percent of RNs (CIHI 2007). We know much less about the extent to which immigrant or foreign born workers working specifically in the home and long term care sectors. In some cases, immigrant care workers may be recruited directly, migrate on their own initiative, join family members through reunification or seek asylum and subsequently seek jobs in this field.

The use of immigrant staff can have an impact on the perceptions of quality of care (relating to comparability of qualifications and to language skills, for instance); on the immigrants themselves (who can experience discrimination, exploitation and de-skilling – c.f., Calliste 1996); on the practices of recruitment agencies; and on the countries from which they came from and which may need their skills. Indeed, the full extent of the roles immigrant care workers play in the delivery of care in the context of an aging society in Canada is relatively unknown. Research has been conducted on the medical and social consequences of aging and on changing needs for care, but with surprisingly little reference to the migrants who often provide it. Knowledge of the contribution that migrants make to institutional or home settings, on client-worker relationships and on quality of care is indeed limited, especially with respect to the immigrant care worker’s immigration status, linguistic skills and cultural differences. We know little of the progress which skilled professionals make in the labour market and less about the progress of their low-skilled colleagues, or the factors which promote or impede their inclusion. Given a growing dependence on foreign born workers in health care, these are alarming gaps in our knowledge, leaving policy makers without an adequate evidence base for policy development.