CIHR/HEALTH CANADA CHAIR IN

HEALTH HUMAN RESOURCE POLICY

THE LIVE IN CAREGIVER
PROGRAM
Ivy Lynn Bourgeault
April 2012
Overview
The Live In Caregiver program

Experiences of LICs in Older Adult Care

Consequences for sending countries

Cross-cutting gender lens
LIVE IN CAREGIVER PROGRAM
LCP
Canadas shortage of care workers available to live in
the homes of the client for whom they are providing
care, and this is expected to become more acute with
the ageing of the population.
The LCP, established in 1992 (a replacement of the pre-
existing Foreign Domestic Worker programme in place
since 1981), is a variant of the economic class
program that enables workers to gain entry to work in
Canada without having to meet the qualifications of the
immigration points system, family sponsorship or
refugee status.

LCP
The term live-in caregiver as defined in the
Immigration and Refugee Protection Regulations is a
person who resides in and provides child care,
senior home support care or care of the disabled
without supervision in the private household in
Canada where the person being cared for resides.

LCP Requirements
a job confirmation letter from HRSDC to the employer which
outlines its opinion about the labour market situation
necessitating a live-in caregiver;
a written contract with the employer;
successful completion of an equivalent of Canadian secondary
school education
at least six months of recognized formal full-time training in a
field related to the job, or at least one year of full-time paid
work experience (including six months with one employer) in
the field related to the job within the three years preceding
the application;
good knowledge of English or French; and
a work permit before entering Canada (CIC, 2009).

Recent Changes to LCP
One of the key requirements of the LCP for transition to
permanent residency status was that they had to work
for at least 24 out of 36 months as a care worker in the
home of their client.
Recent changes that have come into effect April 1, 2010
include:
a one-year extension to the period allowed to complete the
employment requirement,
the option for an hours-based calculation of the employment
requirement based on 3,900 hours within a minimum of
22 months, and
the assessment of medical examination at the work permit
application stage with a long term view and the elimination of
mandatory medical examination at permanent residence
application stage
Demographic Data
The number of people who come to Canada under LCP
is substantially smaller when compared to some other
immigration categories, its overall increasing trends
suggests its growing significance in solving the problem
of shortages of elderly and childcare workers.
The number of LCP workers who became permanent
residents has increased from around 2,000 in 1996 to
6,717 in 2007 (CIC, 2008)
The vast majority of workers coming through LCP were
women from the Philippines (83%), followed by those
coming from Britain (2.3%), Slovakia (1.6%) and
Jamaica (1.7%) (Spitzer and Torres, 2008).

Concerns
Previous research has documented concerns that arise
with the status and working conditions of workers.
Arat-Koc (1999), for example, characterized the LCP
as a program that requires more from domestic
workers, without offering them rights and privileges
available to other workers, and further that it
enables Canadian employers to obtain higher
qualified labour for less pay.
Responses
Many positive changes have been made to address
some of these concerns including easier transitions to
permanent residence, enhanced protections to live-in
caregivers from potential exploitation and abuse,
including an LCP hotline and emergency processing of
new work permits for LCP victims of abuse in the
employers home.
LICS IN OLDER ADULT CARE
Granny nannies
This new class of caregiver is booming, and quite unregulated
by Katie Engelhart on Thursday, January 14, 2010
When Esther Heckbert told her mother she wanted to leave the Philippines to work as a
babysitter abroad, her mother was leery. ...Twenty-five years since arriving, Esther has helped
rear dozens of Canadian tots: first as a nanny and then as the owner of a nursery school. But a
few years ago, she sensed a changing wind. She left babysitting behind, sought retraining, and
now works under a more whimsical title: granny nanny. She joins a growing rank of
babysitters-turned-eldercare workers: a nod to shifting demographics. ...
The Role of Migrant Care Workers
in Ageing Societies: The Canadian
Context (2007-9)
The factors determining the demand for foreign workers
in the health care of older people;
The impact of foreign workers on the structure of care
and independent living of older people;
The impact of foreign care workers on older people and
their families and quality of care
The migration and work experiences of foreign care
workers: the means and motivation for migration, role
of recruitment agencies, choice of employment and
working life
A Canadian component to an international
comparative study examining the following
issues in the U.K., Ireland and the U.S:
1/4

Host Country

Direct/Social Care
Workers

Nurses & Professional
Care Workers
Canada Philippines, other
Asian, Sub-Saharan
Africa
Philippines,
Caribbean, Latin
America, Europe
Ireland Poland, Philippines,
Nigeria
Philippines, India
United Kingdom Philippines, Poland,
Zimbabwe, Nigeria
Philippines, India, Sub-
Saharan Africa
United States Mexico, Philippines,
Caribbean
Philippines,
Caribbean, Sub-
Saharan Africa
Recent migration routes
Migrant Caregiver Perspectives
Caring for older people is often social and cultural norm
for workers from some cultures
Some patterns of differential treatment were reported,
more weekend shifts, etc.
Language can be challenging difficult
I dont know if my English is good enough ... So my first
choice I chose the nursing home. Easier? Yeah. Thats
my start. So after that I get used to it and I know
everything about the nursing home. And so I thought I
should try hospital.
Some see LTC nursing and social care as a stepping
stone to other health jobs
Some Take Home Messages
Care system is the primary source of problems
Underfunding of the sector impact on wage levels
(staffing account for >60% of running costs)
High turnover and low retention create shortages in
long-term care occupations

Immigrant care workers make a substantial contribution
to older adult care, but double isolation
Workers have few opportunities to socialize with host
country citizens
Compounds difficulties with social/cultural integration
Gender Dimensions
The relative invisibility of the conditions of older
adult care can be seen as being mirrored in the
invisibility of the work and living conditions of
their immigrant care workers.
Not insignificant that both are predominantly women

IMPACT OF LCP ON SENDING
COUNTRIES



1/2
Global Care Chains
feminisation of migration,
limited safety nets, increased
longevity
Does female migration,
transnational households and
global care chains reliant on
grandparent and childrens
labour to replace that of
female migrants
Commoditising the relations of
care within families and
societies as well as between
countries
Impact/Consequences



Source Country Concerns/Issues



Bifurcation of concerns
coping with the consequences of out
migration of needed human resources for
health

whereas some (most notably the Philippines
and India) are using the migration of health
workers as a development tool



The Issue of Remittances
The most frequently cited is the hard currency returned
as remittances to family members by migrant health
professionals working elsewhere.
Remittances to India have been argued to be 2% of
GDP
Remittances in the Philippines constitute nearly 10%
of the GDP

Though these funds are substantial and may improve
household incomes, they do not translate into funds
for health systems sustainability
Key Principles in the Canadian companion
document to WHO 2010 Code
strive to create a self-sufficient health workforce
aim for transparency, fairness and mutuality of
benefits
all aspects of the employment of international health
personnel should be without discrimination of any
kind

WHO Global Code of Practice on the
International Recruitment of Health
Personnel
WWW.HEALTHWORKERMIGRATION.COM
Reports from previous studies

Video clips from YouTube on HWM

Bibliography on HWM (coming soon)

Key links