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There are also numerous challenges when it comes to employing immigrants in eldercare positions, as evidenced by the factors presented in Figure 7. Many respondents commented that problems related to the skill sets of arriving foreign- born caregivers are of primary concern. Employers across all four countries noted that difficulties communicating with caregivers are a challenge to working with foreign-born workers and having them work with elderly clientele. Roughly two thirds of respondents across countries agreed that poor English skills could be a significant challenge when employing immigrants. Some immigrants face a steep learning curve when adjusting to host countries and limited English skills can compound the problem. In addressing these “softer skills”, some report that a lack of cultural awareness created problems for caregivers and recipients. Though generally not reported in other countries, in Ireland 68 per cent of the respondents stated that the lack of Irish cultural knowledge was problematic. In addition to learning and understanding host-country speech and culture, foreign workers must often learn new methods and technologies to perform in new working environments. This can create additional challenges for foreign workers to interact with both employers and the clients for whom they provide care.

figure 7: Challenges of hiring migrant workers

One home care worker in the United States commented on the challenges foreign pronunciation and English ability pose to elderly clients. “Limited English knowledge and heavy accents make communication with elderly clients with hearing deficiency complicated. Strong accents can make teaching difficult with elder, hearing-impaired patients.”29 A Canadian eldercare employer expressed a similar concern, indicating

that when foreign-born workers use their native language to communicate with co-workers, it can create distance between foreign-born caregivers and their clients and native-born co-workers. “If, for example, they’re using their foreign tongue when they’re on the premises, that’s not good. That alienates other workers and, uh, it’s just not appropriate ’cause English is the language that’s spoken here. So that would probably be the most difficult part of things.”30

Beyond language, other worker attributes posed challenges for employers using migrant workers. Sometimes the adjustment to a new care system required foreign workers to undertake necessary job training or perhaps gain new or additional certification. With the exception of the United States and Canada, where 43 per cent and 47 per cent of respondents agreed, respectively, more than half of the respondents stated the requirement of additional training as a disadvantage to employing foreign workers. Personal skills, such as decision-making skills and assertiveness, appeared as problems across countries but in varying degrees. The lack of decision-making skills was reported by less than one third of all respondents in Canada, the UK and the United States, while this problem was reported by 38 per cent of Irish respondents. Thirty-seven per cent of the respondents in Ireland maintained that assertiveness was a problem in working with foreign employees, while 25 per cent of the respondents in the UK, 17 per cent in Canada and 16 per cent in the United States cited this as a problem.



An additional challenge was the attitude of some non-migrant care workers towards their colleagues – a management issue which some employers felt ill-equipped to handle – and the fact that migrant caregivers were not always well received by older adults, with more than one in four employers in each country citing that as an issue. In other cases, however, older care users were appreciative of the migrants who cared for them.

A number of bureaucratic hurdles create additional difficulties in the employment of foreign-born eldercare workers. Regulations complicate the process in the UK, where 50 per cent of all respondents listed this as a constraint to taking on foreign- born workers. More than 40 per cent of the respondents in Ireland agreed with this assessment, while 35 per cent agreed within the United States and 26 per cent agreed in Canada. Roughly one third of all respondents in the four countries found that the acceptance of foreign labour certification standards is a problem when bringing in foreign-born workers, with slightly more than 40 per cent of the respondents in Ireland reporting that this factor complicated the hiring process.

High turnover rates, which were largely viewed as a difficulty in retaining native workers in eldercare positions, do not pose difficulties of the same magnitude for foreign-born workers. These workers tend to remain with an employer, with less than 25 per cent of all respondents reporting this as a problematic aspect of employing immigrants. This could be due to the strong networks that form among immigrant groups coming from the same nation or region, keeping them with the same employer. Some employers noted that sponsorship of foreign worker visas binds the worker to the sponsoring employer, which almost guarantees a specified length of employment.