The Global Demand for Migrant Care Workers: Drivers and Implications on Migrants’ Wellbeing

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Demographic changes across the globe create increasing demands for care labour mobility. The contribution of migrant workers to the long-term care (LTC) systems is not confined to the western world or countries that have already completed their ageing transitions; they also play an essential role in maintaining the care systems in countries with emerging ageing populations. However, despite the increased demand for LTC services, such jobs remain unattractive with difficult working conditions and insecure prospects in most European countries and are only emerging in the Middle East.

In most European countries, migrant workers, primarily women seeking new economic, social, and professional opportunities, contribute to meeting the escalating care demands. Such flows occur across the globe, between less economically and more economically developed countries, such as from Eastern and Central Europe to Western Europe or from post-colonial nations in the case of the UK or France. Moreover, this phenomenon is observed beyond Western Europe. For example, in South East Asia, many countries draw on migrants from neighbouring countries such as China, Taiwan, Indonesia, and Singapore.

In ageing transitioning populations, such as in many low- and middle-income countries (LMIC), a surplus of workers is associated with population dividends. However, the LTC systems in most of these settings are still emerging and characterised by informal working practices with minimal employment protection, hindering their ability to attract and retain workers despite these dividends. Yet, there are also strong mobility channels within regions including the far East, Africa and MENA. The increased demand for LTC and the informality of care arrangements increase the demand for migrant labour within these existing structures and potentially create new routes and channels. Hence, migrant workers fill in care demands and deficits within the host population and occur within labour structures that are either completely informal, as is the case in MENA, or within sectors that have structurally unfavourable working conditions and job security and prospects.

The demand for a diverse and sizable LTC workforce stems from several determinants. The prime among these is the changing demographic structure in many countries, especially countries that have observed aged populations for several decades, such as Western Europe, North America and Japan. The extent of population ageing varies globally but is generally at an advanced stage in more economically developed countries. Yet, the pace of population ageing is incredibly fast in MENA. For example, countries such as Qatar and Saudi Arabia are projected to complete their demographic transition in as little as 10–15 years.

Migrants working in LTC have traditionally been a flexible source of labour to fill gaps in staffing and are usually recruited from the pool of migrant workers already in the country or through specific migration schemes. Migrant workers are overrepresented in care occupations in several countries, and their share increases faster than in the rest of the economy, even during the economic downturn. Many factors shape the wellbeing of labour migrants, paramount among which are the terms, conditions, and contracts of their jobs, given that work is usually the facilitating mechanism of the mobility of this group. The significance of working conditions to migrant workers’ wellbeing is evident in different regions, including Europe and MENA. Migrants’ personal and social characteristics also influence the wellbeing of individual workers. In some countries, particularly in the MENA region, the lack of formal LTC systems and informalities of care provision extends the tasks of existing domestic workers’ duties to include LTC provision without formal training or labour protection. Reduced employment protection and poor working conditions adversely impact LTC workers. Migrants working in LTC are thus positioned within contexts likely to challenge their wellbeing due to difficult working conditions combined with limited social networks and demands posed by their caring demands in the host and home countries.

The analysis of primary qualitative interview data from the UK shows that, while the current dynamics of ageing and LTC create opportunities for migrant workers’ mobility and their ability to secure jobs in higher-income countries, these come with certain costs paid by migrant workers. These are associated with implications for their wellbeing and the difficult working conditions of the LTC sector combined with new care gaps in home countries created through mobility. The analysis found that migrant workers go through a considerable process of negotiating care arrangements in their home country. Such arrangements include the physical provision of care in the UK and across borders in their home countries by employing a detailed working rota. These arrangements were particularly relevant to EU migrants and non-EU migrants who can travel freely, for example, those from South Africa with Dutch passports. Others, who cannot travel freely and frequently due to financial or visa constraints, usually tend to finance and organise care provisions in their home country. The impact on the wellbeing of migrant care workers was found to be significant in both types of arrangements.

The demand for migrant care workers is global and not restricted to high-income countries or those at a later stage of population ageing. The flow of workers, particularly women, continues to be significant in maintaining LTC systems and the wellbeing of those using such services in many countries. Migrant care workers, thus, positively and significantly contribute to the enhancement and sustainability of the wellbeing of those in need of LTC in host countries. Simultaneously, these global mobilities create care gaps in home countries, with increased pressure on workers to provide cross-border care or organise care at a distance while compromising their wellbeing policies. Structures should be implemented in receiving countries to ensure the sustainability of migrant workers’ wellbeing to ensure continuity of care and meet current and future care demands.

The findings of this study have several policy implications. For OECD countries, the demand for LTC continues to escalate, and the reliance on migrant workers will continue with shrinking working-age groups. LTC workforce planning should be a priority area, with strategies focusing on enhancing LTC jobs and working conditions to attract home and migrant workers, realising the competitive landscape different countries operate within. For example, Western European countries continue to draw on migrants from Eastern and Central Europe, where individuals employ their subjective decision process to choose their destination. Similarly, countries in the far East compete for labour mobility from neighbouring countries such as the Philippines. Implementing interventions to support the wellbeing of LTC workers, including migrants, will improve retention and reduce overall costs associated with recruitment and retraining. For countries in the MENA region, the emerging trends of ageing transitions call for rapid strategic developments. Prime among these is establishing regulated LTC markets where the quality of services and employment contracts should be ensured.

Citation: Hussein, S. The Global Demand for Migrant Care Workers: Drivers and Implications on Migrants’ Wellbeing. Sustainability 2022,14,10612. https://doi.org/ 10.3390/su141710612

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Professor of Health and Social Care Policy, the London School of Hygiene and Tropical Medicine, UK

Shereen Hussein is a Professor of Health and Social Care Policy at the Department of Health Services Research and Policy (HSRP) at the LSHTM. She is a Co-Director of the PRUComm policy research unit. She is also an Honorary Professor at the University of Kent and King’s College London in the UK and the University of Southern Queensland in Australia.

Shereen is a demographer with expertise in labour-migration, sociology and economics. Her primary research revolves around ageing, family dynamics, migration and long-term care. Shereen has previously worked with the United Nations, the Population Council, the World Bank, and the League of Arab States. Her current research focuses on ageing demographics, long term care demand and migration within the UK and Europe and the implications on policy and practice.

Shereen has conducted extensive research on population ageing and its impact on long term care and health policy and practices in the UK, internationally and in the Middle East and North Africa (MENA) region. She has contributed to recent United Nations’ policy response to ageing in the region through collaboration with UN-ESCWA and directly providing expert consultations to several countries in the region including Turkey, Oman and Egypt. Shereen leads many large research projects on ageing and long-term care in the UK and contributes to a large project addressing responses to dementia in developing countries STRiDE. Shereen is the founder and lead of the MENARAH network.