Angelite Nurses

This new class of caregiver is booming, and quite unregulated

When Esther Heckbert told her mother she wanted to leave the Philippines to work as a babysitter abroad, her mother was leery. “She said, ‘babysitter? You’re done university!’ ” The two were folding laundry at their home in Isabela. Esther, who has a degree in business administration, had high hopes. “I said, a babysitter abroad can make a lot of money. From there, you can upgrade yourself: you can get citizenship.” For decades, thousands with the same profile—young, female, Filipino—have come to Canada to work as babysitters. 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. In 2008, just under 14 per cent of the Canadian population was over 65; it will be more than 25 per cent by 2044. At the same time, seniors are increasingly shunning the option once pressed on them: nursing homes. Now, most care to frail, older adults is provided outside facilities, says Norah Keating, human ecology professor at the University of Alberta. As more seniors stay home, we’re racing to import and train professionals to care for them. That dash has created a new class of caregivers, many of whom are undertrained, unregulated and unprotected—and with this a new set of problems.

A sizable chunk of that class comes through the same provision that allows us to bring in people to care for our kids: Canada’s Live-In Caregiver Program. Unlike other temporary foreign workers, live-in caregivers are eligible for permanent resident status after meeting program requirements. More than 100,000 have come since the LCP’s inception in 1992. Most are Filipino. Most stay for good. In the early years, the LCP was effectively a babysitter-recruiting apparatus for parents. But increasingly, seniors are turning to it for 24/7 live-in care. Back in the Philippines, women are catching on. Erwin Pascual, a Filipina immigrant who runs a private career college in Toronto, says more recruiters in the Philippines are marketing eldercare courses. “The demand started going up about seven years ago,” says Pascual. And supply has risen to match. By some accounts there is a backlog of applicants in Manila, biding their time.

It can be a treacherous wait. “There are so many bad agencies out there that are exploiting and taking advantage of these girls,” says Tova Rich, who runs the Family Matters Caregiver agency in Thornhill, Ont. Many charge the women “upwards of $10,000.” (The federal government is reviewing a bill that would ban charging caregivers recruitment fees.) Then there’s the problem of what Rich calls “phantom employers.” The LCP mandates a single-employer contract, and agencies may promise a candidate, and the Canadian government, a job that doesn’t exist, says Rich. By the time the woman finds out, she’s already paid the fee—or moved here. Last year Rich was asked by a Filipino caregiver to help her relative, a woman brought over for a bogus job who, without work, was forced to live in a basement owned by the agency. “We had to rescue this girl at like 10 at night,” says Rich. “We were horrified.

We went in and there were three or four mattresses on the floor. There must have been 10 or 12 girls, all talking and cooking. We said: pack your bags.”
That’s an extreme case. But the reality of Filipinas being recruited into the homes of sick seniors and asked to function as de facto nurses is in itself a sign of a subtler kind of exploitation, says Leah Diana, who works at the Philippine Women Centre of B.C. LCP applicants, she explains, need two years of post-secondary education and relevant experience.

And so, many are professionals: midwives, nurses, and even the occasional doctor. For Diana, that requirement, in combination with a system that makes it tough for foreign-trained nurses to get accredited, means we’ve created a flow of low-cost “unregulated nursing” into Canada. Employers seek out Filipino nurses through agencies, she insists: women who can monitor insulin levels and give injections, in addition to offering personal care. But officially the women are brought in as babysitters—and paid minimum wage. It’s why Diana’s group has launched an “End it, don’t mend it” campaign, aimed at scrapping the LCP. Playing on that slogan, Immigration Minister Jason Kenney has pledged to “mend the program, not end it.”

Deanna Santos, a lawyer of Filipino origin who advises live-in caregivers about their rights, likewise wants to do away with the LCP’s live-in requirement, as well as employer-specific contracts. Both, she says, can bind caregivers to abusive households. “Because of their desire to gain the prized permanent resident status, they endure abuses.” Allegations levelled last spring at Brampton, Ont., MP Ruby Dhalla brought some of these issues to the fore.

Caregivers working with Dhalla’s mother said they were forced to do chores like shining shoes and washing cars: tasks outside the purview of the LCP.

Dhalla has denied the charges. But lately, complaints of this sort have reached the ears of higher-ups. In December, the federal government offered proposals to revamp the LCP, including instituting an employer blacklist.

Of course, potential for abuse existed when the program focused on babysitters. But working with seniors can amplify strains. Dementia patients, for instance—a group projected to grow in numbers, according to a report released this week—are prone to violent outbursts. Albert Banerjee, a York University Ph.D. student, found 90 per cent of facility-based caregivers in Canada have experienced “physical violence.” The situation is similar in home care. Caregivers contacted for this story reported abuse ranging from racial assaults to getting punched in the face. “Many older people were raised in a generation where the Chinese were the enemy—or where blacks were seen as lesser people,” says Charmaine Spencer, a gerontologist at Simon Fraser University. “Many changed their attitude over the years.” But as they age, or develop dementia, “they lose their inhibitions.”

For all the pitfalls, Esther Heckbert found the eldercare field to be an attractive one. And so, a few years ago, as many former live-in caregivers do, she decided to advance to the next level: she enrolled as a student in a personal support worker (PSW) course. The official designation qualifies caregivers to work in nursing facilities, for one, where they provide basic care like bathing and meal preparation. Some Canadians are referred to a certified PSW by a doctor; in such cases their needs are assessed by the Canadian Association for Community Care, which allots an amount of subsidized care. Families can also approach agencies to hire one.

Thousands of Canadians get certified as PSWs each year. But even that process has its hazards, sometimes opening doors to unfit caregivers. Last year, a number of private colleges were busted for selling fake diplomas and graduating woefully unqualified PSWs. A Toronto Star story featured one school that passed students in weeks, versus the year it takes at an Ontario community college. Miranda Ferrier of the volunteer group PSW Canada says she’s had to “break the news” to PSWs that “they can no longer work [because] their certification is nothing. There’s no regulation,” she says. “None.” PSWs have no professional body, no counterpart to the College of Nurses. New trainees are not required to sit for provincial exams. The courses are not standardized, and can be taken at either community colleges or private schools. All this, Ferrier insists, leaves not only seniors, but also their caregivers, unprotected.

“The baby boomers are coming,” says Ferrier. “We need to be prepared. And we’re not close.” She started PSW Canada as a hopeful precursor to an official college. But the Health Professions Regulatory Advisory Council rejected that idea in 2006, deciding Ontario PSWs should not be regulated.

“HPRAC also concludes that the closest alternate form of regulation—a personal support worker registry—should not be implemented,” the report noted. “They said they already belong to agencies and there is a kind of oversight through that,” says SFU’s Spencer. The other view, she says, was that PSWs are too poor to support a regulatory body. “It was kind of a Catch-22. Because without a regulatory body they weren’t in a position to improve their conditions.”

On the job, PSWs are rushing to meet growing demand. Pat Irwin, an eldercare consultant, describes many agencies as “body shops of people,” where hordes of exhausted caregivers are pushed from house to house. The typical time slot for care is one hour. Kirsten Elder, an Ontario PSW, describes a shift: just enough time, if she moves speedily, to give her clients “a bath, make them something to eat, medication reminders for most. Once they’re dressed, the paperwork. That’s usually the hour.” The pay: around $13.

For many granny nannies, whatever their designation, it’s a labour of love. Esther Heckbert, for instance, has a few tricks for working with dementia patients. “I sing. And while singing, I do my work.” What songs? “I have to know the person! I’ll ask them what they like. We can sing together.” Kelly McHaffie, of PSW Canada, still finds time to nickname patients: like “Chickadee,” the lady who eats like a bird. This year, one of McHaffie’s beloved patients died. She went in on her days off to care for the woman: “I got into bed with her. And she put her arms around me and we laid there together. It was comforting for her.”

But often, in the rush of one-hour time slots, the “chemistry” gets lost, says Irwin; agencies are too focused on the “great market opportunity.” Irwin’s inspiration for her career in eldercare consulting—her own father’s struggle to find care—is admirable. But it’s hard not to flinch at what she calls herself: a “rent-a-daughter.”