According to Hoens’ research, both foreign health workers and community health workers are insufficiently valued on an economic, social and political level. Resident foreign health workers earn less than Belgians and do not always work in the best conditions. Community health workers are too often employed as volunteers instead of professionals and are not always considered a full member of the healthcare team within a healthcare organisation.
The vital role of alternative care workers is often seen as a low status job. However, their knowledge is crucial. Some community health workers have care qualifications from their country of origin and foreign caregivers often have previous informal care experience. Being able to call on these strengths makes their role more important, and thus they fill gaps where formal care is inadequate.
The care needs of older people are changing rapidly. For example, they would often like to continue living at home but may need 24/7 care, they may always want to be helped by the same caregiver, or they may have specific expectations linked to their culture. In addition, there are many barriers to accessing formal care, such as affordability, accessibility, long waiting times and language differences. Older people therefore look for alternatives themselves and put together their own care package according to their needs. One of the options is to call on alternative care providers.
Resident foreign caregivers
The concept of live-in foreign caregivers is well established in countries such as Germany, Italy and Austria. In Belgium, too, more and more people of foreign origin are being called in to provide care for elderly people living at home. They are mainly responsible for housework and minor care tasks. Older people may also call on a home nursing service for more serious medical tasks.
Foreign caregivers offer significant added value and respond to different needs, as was shown in Hoens’ survey of elderly people and care professionals about their experiences. The system enables older people to live at home longer and it can be a great relief for their family or informal caregivers. Another positive aspect is that resident caregivers become a companion, breaking the social isolation of many elderly people. In addition, elderly people have a greater say in how their care is provided, they experience more autonomy, and the care and household tasks are always done by the same person, in a more personal way. One caregiver from a home care service said: "The problem is that all home care services are provided by different people. In the morning, the nurse comes, then a household help, then a cleaning help... This is complicated for older people. With a live-in caregiver, you have one person who does everything. They are always available."
Hoens also spoke to caregivers from Romania, the Philippines and Guatemala, among others. For them, different motivations play a role in taking this job and migrating. They may want to escape an unsafe environment or build a better financial future for their children, even if it means living apart for a long time, and their role as caregiver contributes to self-recognition and pride.
Unclear regulations and little control
It’s important to note that there is not always a written employment contract or a fixed description of the tasks. In Belgium, there are still no clear regulations for live-in foreign caregivers and there is hardly any control on working conditions. Live-in caregivers often have to be available 24/7 and are entitled to one day off per week, which they do not always get in practice. One of the caregivers interviewed said: "I have free time, but I can’t leave the house because I have to be on standby. She needs help walking and every night she wants to look at the moon in the garden and I have to help her. She has a certain daily schedule and I have to follow it."
Community health workers
Older people with migrant backgrounds experience additional barriers to formal care, for example language barriers or limited knowledge of the healthcare system. In addition to individual obstacles, there is also a responsibility for care organisations, which do not always understand the wishes of older people with a migrant background. Their culture may affects their vision of care, and there can be uncertainties around intercultural encounters or even discrimination.
Community health workers bring care closer to the people and make care organisations more accessible to older people with a migrant background. They visit elderly people in their own neighbourhoods, inform them about the services on offer and build bridges between care providers and the community. Community health workers with a migrant background often have more knowledge about the cultural expectations and needs that elderly people with a migrant background have and work in a culturally sensitive way to address doubts and questions.
Prof An-Sofie Smetcoren, [email protected]
Prof Liesbeth De Donder, [email protected]
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