As the United States population ages, the need for elder care grows, but the number of Americans willing to work in this field cannot keep up with demand. Increasingly, immigrants, both documented and undocumented, are making up the gap. About one quarter of the three million people currently employed as elder-care home health aides in the US are foreign-born—this when the proportion of immigrants in the population overall is only 17 percent. 

Such workers participate in what researchers call “global care chains”(GCCs) – in which migrants, primarily women, are drawn from poorer countries to wealthier ones, where they find employment as caregivers for middle-class elders, children and homes. Some migrate out of a desire for adventure or education, but most leave because of unfavorable conditions in their home countries: poverty and a lack of employment opportunities, especially for women; famine or other climate disasters; and violence, either domestic or political. For many, migration means separation from families, including their own children, but they reason that, whatever the emotional cost, they will be able to send back remittances—money that is essential to feed, clothe, house and educate loved ones and enable them to obtain medical attention when needed. But the one thing migrants cannot provide from afar is hands-on care. Thus global care chains serve to transfer “care labor” and resources from poor to rich across the world.

Participation in GCCs varies from one nation to another depending on circumstances at both ends of migration chains. Some sending countries try to prevent women from leaving; Sri Lanka, for example, bars exit for mothers of young children. Others facilitate emigration, recognizing the value of remittances for local economies. The immigration laws of many receiving countries bar entry to potential caregivers, despite obvious need; one is the US, which has no immigration category for such workers, considering them “unskilled” and therefore undesirable. As a result, many of the migrants who manage to enter the US and take care jobs are undocumented and as such, they are vulnerable to exploitation and deportation. A few countries, such as Israel, offer temporary work permits to immigrants willing to provide elder care and even offer them benefits. 

Racial and ethnic as well as gender stereotypes reinforce notions of who is qualified for caregiving, deeming some groups “ideal” for this type of work, others “ill-suited.” In fact, not all women, whether migrant or native-born, Black or White, are inherently suited for such a difficult occupation. Individual, not group, characteristics as well as good training are what qualify workers to perform the kinds of tasks, whether routine or specialized, that elders may require. Yet systematic training is not universally available, particularly for migrants, who may also face language barriers. These factors present risks to those being cared for. 

Caregiving is highly intimate work, and caregivers’ experiences vary. Many find jobs in private homes, where they have to face the tensions of working and sometimes living in close quarters. “Carees” and their families may be grateful for the help or they may feel uncomfortable having a stranger in their midst, and elders may resist accepting their dependency. Live-in workers have little control over their hours, accommodations, even diets. Many, especially the undocumented, have no benefits—no health insurance and no recourse in case of injuries due to lifting or other workplace stressors.

Perhaps the most poignant aspect of migrant-provided elder care is that the migrants themselves end up with few resources for their own retirement. Indeed, they may spend years, even decades, caring for others while unable to make provision for their own old age. Denied access to pensions such as social security in destination countries, they may return to their countries of origin no longer able to work but needing support themselves. Perhaps by sending a continuous flow of remittances to their families, they have built up social as well as financial capital, but there is no guarantee that they will find a warm welcome in their old homes. Undocumented migrants are often reluctant to make return visits because such travel is expensive, perhaps involving smugglers’ fees on top of regular transportation costs, and may well be dangerous; plus, there is the risk they may not be able to re-enter the receiving country where they have a job. This leads to prolonged absences that disrupt family ties and make it difficult for them to re-integrate. Or they may simply feel uncomfortable in their former surroundings after years of living abroad.

Much of this imbalance can be readily addressed. Worldwide redistribution of wealth would reduce workers’ need to leave their homes in order to earn a living, but that would require reversing centuries of global economic history—something that is unlikely to occur anytime soon. In the meantime, more flexible immigration laws would enable potential careworkers to enter receiving countries legally and return home regularly, thereby maintaining strong ties with their families as well as supporting them financially. Such laws would, ideally, also entitle migrant workers to receive the same benefits, including health care and old-age pensions, that citizen workers enjoy. More training and greater regulation of carework, both institutional and home-based, would benefit carees by improving the quality of care they receive while protecting workers from poor working conditions and other forms of exploitation. Population aging will continue, and with it, the demand for caregivers. As long as global economic inequality persists, global care chains are likely to form to meet this demand. But they need not continue to generate cruel inequities. Wealthy countries must acknowledge their own dependence on migrant caregivers and treat them with the respect and compensation they deserve.