Health with Humanity

When discussing the widespread implications of health inequities it is important to not negate the fact that the need for improvements in health equity apply not only to patients and communities seeking care, but also to healthcare providers and all those who work to deliver care. Within the healthcare workforce, as with most other professions, workers come from diverse personal backgrounds and represent multiple intersections of race, gender, class, and other identities. In some areas of healthcare these complex identities affect the compensation, and working conditions, and professional environment of wide groups of healthcare providers. Recently, these working inequalities have come to light particularly within the workforce of long-term care and the care of older adults.

Long-term care (LTC) facilities are a unique branch of healthcare because they act not only as congregate living communities but also as spaces for administering sometimes significant levels of care from healthcare professionals, allied health workers, and personal support workers (PSWs). Within the LTC sector there is great importance placed on the understanding that staff should always treat the space as respectfully as anyone would treat someone else’s home, holding emphasis on the fact that LTC sites are communities where people both live and work. This mindset is essential in order to provide respectful and dignified care to those for whom LTC is their home, but it also highlights how some have begun to view LTC as more akin to home-based care than to hospitalized care, and this distinction has become key to furthering workplace inequities between hospital-based healthcare providers and LTC workers.

Across OECD countries, workforce demographics show that the overwhelming majority of long-term care staff are women and that they tend to experience worse working conditions and lower pay than hospital staff (OECD 2019). Historically, the LTC sector has been marked by inequitable economic working policies including lower wages and a higher prevalence of part-time and temporary contract work, which resulted in high staff turnover rates in the field (OECD 2020). Scholars have noted that many countries of the Global North have increasingly had migrant and racialized women take on the majority of caregiving roles in LTC, which has created unique impacts on this sector in the COVID-19 pandemic, most notably by the way that LTC work is viewed and devalued through the feminization of labour, systemic racism, and xenophobia. Due to the fact that women perform enormous amounts of unpaid care work for families and communities around the globe, when women represent the majority of workers in a paid care sector, their labour is often devalued as being feminized labour that is simply traditionally expected and which women should be inclined to do (Gahwi & Walton-Roberts 2020).

The irony of this treatment of women care workers, particularly for the migrant women who represent a significant number of care roles, is that they exist in a ‘care paradox’. As defined by the WHO, the ‘care paradox’ exists where migrant women work to fill essential gaps in the ageing healthcare systems of affluent nations, but yet their roles are undervalued to the point that many do not have access to equal healthcare services for themselves and their families (WHO 2017). Existing literature has also pointed to the fact that employers view migrant care workers as more willing to work in poor conditions with longer hours of shift work, and more likely to be hired in non-professional positions with lower pay (Gahwi & Walton-Roberts 2020).