The Migrant Direct Care Workforce: An International Perspective

As the world's developed regions continue to rely on migrant workers from developing countries to fill care gaps, we must embrace international guidelines for workforce hiring and training.Global aging is one of the most significant demographic trends in history. One in eight individuals worldwide will be ages 65 or older by 2030. And by 2050, 80 percent of the world's 1.5 billion older adults will live in developing regions (Fujisawa and Colombo, 2009). The aging of the world's population is most dramatic for the 85-years-and-older group, those most likely to have physical and cognitive disabilities and to need long-term services and supports (LTSS). This subcategory of elderly individuals is the fastest growing population in Europe, the United States, Canada, and Australia. By 2030, one in four Japanese older adults will be ages 85 or older. In thirty member countries of the Organisation for Economic Cooperation and Development (OECD), one in ten residents will be in the oldest old category by 2050; for the United States, that figure is 7.7 percent.Of all the implications of global aging, the increased demand for LTSS between now and 2050 has become a priority issue among policy makers, providers, older consumers, and their families in the world's developed and developing regions. Several other trends are raising concerns about the future supply of direct care workers-nursing home assistants, home health and homecare aides, personal care workers-to provide the hands-on care required to meet the increasing demand for services. Projections in Europe, Asia, the United States, and Canada suggest a likely decrease in the availability of family caregivers due to plummeting fertility rates, increases in childlessness rates, increased divorce rates among middle-age and older adults-all factors that lead to less stable and less predictable family caregiving patterns, and greater labor force participation among older and elderly women who were traditional caregivers for adult children or spouses (Colombo et al., 2011; Stone, 2015). At the same time, a recent OECD report indicates that the size of the working-age population (ages 25 to 64) as a share of the total population is expected to shrink, from 67 percent in 2010 to 58 percent in 2050. The percent shrinkage will be less than six percentage points in countries such as the United States, Australia, and Sweden, but more than 15 percentage points in several Eastern European countries and South Korea (Colombo et al., 2011). Furthermore, many women ages 25 to 54-the age group most likely to be employed as direct care workers-will be more highly educated and less likely to be attracted to LTSS jobs.Policy makers, providers, and consumers already are struggling to recruit a quality, competent direct care workforce to meet current demand for LTSS. The confluence of trends summarized above suggests that the availability of direct care workers is likely to become more challenging in the future. One major solution to this emerging problem is to recruit and rely increasingly upon foreign-born or migrant workers to ameliorate the care gap.This strategy already is in use in a number of developed countries (Redfoot and Houser, 2005; Colombo et al., 2011). Approximately one in five direct care workers in the United States, and one in four direct care workers in Canada and Australia is foreign born (Fujisawa and Colombo, 2009). In European countries as diverse as Germany, Greece, Italy, and the Netherlands, the proportion of direct care workers from other countries is increasing significantly. In the UK, the proportion of foreign-born care workers more than doubled between 2001 and 2009, from 7 percent to 18 percent (Cangiano and Shutes, 2010). In seventeen out of twenty-three European countries involved in the EUROFAMCARE study, family caregivers of older people relied on private migrant care workers at least occasionally (Bednarik, DiSanto, and Leichsenring, 2013). …