The quality of the relationship between carers and clients and the quality of care in turn is greatly affected by the language barrier between care worker and the older person. Many of the elderly people we spoke to felt that it was of utmost importance for care workers to have a minimum of English language proficiency. They argued that it is important for the carer to understand what the elderly person needs because if they do not, it can cause an accident possibly causing death.

There was just one situation where the woman didn’t really, um, her English wasn’t very good and happened to be she was only on the job for about one week and my father had a minor heart attack and she didn’t know what had happened and ...I kind of asked her what had happened ... and she couldn’t really understand me. (BC Care Recipient 2)

The quality of the relationship between carers and clients, and in turn the overall quality of care is substantially affected by the language barrier between the immigrant care worker and the older person. This was also salient in the immigrant care worker interviews:

I have had some difficulties at the beginning because my English was very poor once I came to Canada. Now I feel pretty much okay because my clients they understand me. They don’t feel any difficulties to understand me to see what I want, to see what I want for them, and to understand them so now it’s pretty much okay. (Ontario Care Worker J2)

Care Worker: Sometimes some people are very particular with the accent.
Interviewer: Okay. Do they complain about your accent?
Respondent: Yeah, they will tell you ‘I don’t understand you. (Ontario Care Worker J4)

Given the multicultural make-up of the Canadian population, these language barriers go both ways - not only on the part of immigrant care workers but also by clients. For instance, reflecting on that, one of the immigrant care workers noted:

Oh there’s a lot of them who don’t speak English. It’s a problem especially those who came from Europe or from the Asian countries. Some of them they don’t speak good English so it’s so difficult to deal with these kinds of residents. (Ontario Care Worker J5)

When employers were asked about the impact of the employment of immigrant care workers on the quality of care provided to the older people in their facility, the general consensus was that care had improved (see Figure VI.1). When asked to elaborate, one noted a “noticeable difference in the quality of care with respect to timely delivery” whereas another felt that the impact was “felt throughout the organization in terms of efficiency." Overall, in the words of another employer, “it appears as if the standard of care has improved...the atmosphere within the facility is much better.”

A broader contextual factor that greatly influences the quality of relationship and care is beyond the issue of the immigration status of the care worker and focuses on the shortage of staff and supplies. Describing how the shortage of staff in long-term care settings influence the interaction between workers and patients in one nursing home in which she is working, one care worker reveals:

In the nursing home you have more people, more patients, and usually you are short the staff. You have to do, you have to rush your work. You don’t have time to talk to the patients too much because you are rushing to finish everything” (Ontario Care Worker J6).

The immigrant care workers we talked to tended to find the quality of care to be higher in home care settings as the carer is fully devoted to only one patient.

Interviewer: Okay. What about working at home?
Care Worker: Oh it’s different because it’s my time. Just my client. And I no need rush because if I have one hour for him or her, I planning how can I do in one hour. But in the nursing home you have three hours for 20 clients. (Ontario Care Worker A4)

Some, however, do not concur since they think that in cases of emergencies, the carer in a home care setting is left without any help from co-workers, which could be decisive in such situations.

Quality of care in hospital is better. You know why? You have somebody to help you. In the home care if you are alone and your client falls down and you cannot ask for any assistance. (Ontario Care Worker J12)

One respondent who works in more than one care setting introduces the notion of flexibility and adaptability to the list of good carer qualities. Another respondent notes, however, that if one cannot recognize and respond to the needs of the patients due to workload, the care workers with the best intentions will not be able to have a positive impact on the quality of life of the patients.

“Ou des fois on voit quelqu’un pleurant, et ont va pas dire…Madame, vos médicaments! Et laisser ça. On les voit, et …qu'est-ce qui se passe? On doit parler un peu. Donc c'est... » (QUÉBEC Care Worker 6)

[Sometimes one sees somebody crying, and we don’t say… Madam, your medication! and leave it at that. We see them, and say… what’s going on? We have to talk with them a bit...]

In addition, the majority of immigrant care workers from nursing homes revealed that the quality of care in that type of setting is poor due to a great shortage of supplies:

Supplies, yeah. And sometimes there’s not enough supplies for everybody and maybe she needs a diaper. What can I do? Nothing because it’s in the nursing home. At home is different. I check every day and maybe if I see almost finished then I told to the client ‘Oh you need buy more diapers, more something.’ (Ontario Care Worker A4)

The interviewees think that through interaction, love, compassion and responsible caring for their patients they substantially improve the quality of provision of care for older people.