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Migrant workers are increasingly involved in health care for a variety of reasons and in a variety of levels. In recent years, there has been an increase in the immigrant proportion of care home work force, which makes the topic of immigrant experience in care homes relevant and important. At this time, there is not much literature that specifically relates to the experience of immigrant workers in care homes of the UK. This research uses a grounded research method to explore this area. In this study, the conditions of work, health and safety engagement between workers and management, and employee rights issues with respect to immigrant workers in care homes are explored. The research uses data from secondary sources as well as primary data collected from a sample of care home workers through interviews. This research finds that the experience of violence or other bad conditions of work in the care homes, particularly private care homes is not limited to the immigrant workers. These issues do not appear to affect immigrant workers disproportionately and are not related to the specific condition of their being immigrants. The research does find that immigrant workers may be exposed to bullying which can be linked to verbal violence where some immigrant workers may face bullying from the colleagues or even from the residents due to their inability to understand instructions being given to them. However, bullying as a common experience of immigrant workers in care homes is not supported by the findings of this study. This research finds that there are certain risks that are generally arising out of the conditions and nature of the work and these are not related to only the immigrant workers but to all workers involved in the work in the care homes.
There are more than 250 million people in the UK who are transnational migrants in the UK and approximately half of them are workers (Moyce & Schenker, 2018). Many of the workers who have migrated to the UK come from countries around the world and outside of the European Union. Therefore, there are many important factors that can colour the experience of the immigrant workers in the care sector; these factors include the nationality of the workers, their place in the immigration policy of the UK, their access to rights within the UK in context of the labour laws, to name a few. Research does indicate that immigrant workers work for lesser pay, longer hours, and in worse conditions; in some situations and workplaces their human rights may also be compromised (Moyce & Schenker, 2018). Research also suggests that immigrant workers have higher rates of adverse occupational exposures, have poorer health outcomes, and workplace injuries (Moyce & Schenker, 2018). Therefore, there are a number of areas of concern with respect to immigrant labour in the care sector of the UK. It may also be noted that the care sector is a part of the secondary labour market because of the lower wages in the sector and the generally poor conditions of work (Walsh & O’Shea, 2009). Moreover, the care sector is a complex combination of private sector and public sector employment market. All these factors have implications for how workers in general experience the care sector employment. However, the experiences of the native workers and migrant workers may be different as there are specific issues like immigrant status, nationality and even race, that may impact the experiences of migrant workers in the care sector.
Migrant workers are increasingly involved in health care for a variety of reasons and in a variety of levels. England and Dyck (2012) write that generally speaking, immigrants tend to fall to the bottom of the hierarchy of care work for a number of complex reasons. Eventually, care work is experienced by the immigrant care workers through a complex interaction between inequalities in the labour market and regulatory mechanisms of care provision and the national policies and culture that are reflected in such mechanisms (England & Dyck, 2012). The inequalities in the care sector may be due to a number of reasons. One may remember that in the first place, the care sector is a secondary employment market due to which the wages and work conditions are poorer as compared to other parts of the economy. In the second place, even within the secondary market, employees may experience differential treatment due to the organisation of the sector (public or private sector) or the citizenship status (native or immigrant).
Language and cultural barriers as well as documentation status have implications for the conditions of work for the immigrant workers (Moyce & Schenker, 2018). As many of the carers within the care sector come from countries like Philippines, India, and Poland, there may be language barriers and cultural barriers (Hussein, Stevens, & Manthorpe, 2013 ). These may have implications for the workers in the context of how they negotiate with employers for better work and pay conditions. Language and cultural barriers may also have implications for how migrant workers from non-English speaking countries interact with the beneficiaries of their care and how the latter treat them.
Van Hooren (2012) has conducted a comparative research on the conditions of work for the migrant workers in the area of elderly care services in Italy, the Netherlands and England. In this research, Van Hooren (2012) found that in both private and agency-based employment in the care sector, migrant workers work longer hours and do more night shifts than their native peers. Differences in social care policies and care regimes as well as the immigration policies in different countries have also been found to be relevant (Van Hooren, 2012). A liberal care regime such as found in England and Wales, as opposed to family oriented work regime, leads to a ‘migrant in the market’ model of employment (Van Hooren, 2012). In this context, the conditions of work for migrant workers may get subjected to different factors, such as, policies, laws and contractual arrangements with employers. With reference to the point made in the previous paragraph with reference to language barriers, migrant workers may not be able to understand the policies or laws or may not be able to negotiate effectively with the employers on their employment contracts and this may also influence their experience within the care sector.
Labour markets do need migrant labour for a variety of reasons, however, immigrant labour may not always get the same protection of policies, and same work conditions as native workers. Hussein, Stevens, and Manthorpe (2013) write that migrant workers are often considered an economic utility; this being more true and relevant for secondary labour markets of which care sector also forms a part in certain contexts. At the same time, there are a number of interacting macro level, state level, micro level, and personal level factors that impact the dynamics of how migrant workers experience work conditions in different markets. Immigration policies, and political and economic links between countries are part of the macro level factors that influence migrant work dynamics (Hussein, Stevens, & Manthorpe, 2013 ).
In this study, the conditions of work, health and safety engagement between workers and management, and employee rights issues with respect to immigrant workers in care homes are explored. A literature review of current literature on care homes and immigrant labour in care homes is conducted to explore this area of study.
This section is organised to present the review of the literature on the subject of immigrant workers in the care sector in a thematic sense. The first section within the literature review concerns care homes in the UK. This section explains the way the care home is a part of the social care sector of the UK and how the care homes are organised into private and public sector. Then this section discusses the different aspects of the care home work.
Care homes in the UK
Care homes in the UK are a part of the social care sector. The social care sector also includes home care services but excludes primary health care and hospital services which falls within the responsibility of the statutory National Health Service (Hussein, Stevens, & Manthorpe, 2013 ). Care sector is a secondary labour market due to the low wages and status of the workers involved in this market. As such, the workers that are employed in the care sector may consist of a number of qualified and unqualified migrants (Walsh & O’Shea, 2009). A significant number of the care sector workforce in England does comprise of migrant labour; between 16 % to 20 % of care sector workforce in England is comprised of migrant workers (Hussein, 2011). In major cities like London, workforce comprised by migrant workers can go as high as 40 % (Hussein, 2011). Workforce is largely recruited from the three countries of Philippines, India and Poland, with migrants from Philippines and India requiring work permits or permissions, and specific and minimum conditions on levels of qualifications, skills and language proficiency (Hussein, Stevens, & Manthorpe, 2013 ). The same is not applicable to Polish workers. Therefore, even in the way care workers are affected by the existing regulatory mechanisms and policies may differ on the basis of the nationality of the immigrant labour. At the same time, another research shows that migrant workers are also impacted by how trade union responds to them; while the trade union responses themselves depend on the interplay of national industrial relations systems, sectoral dynamics, EU regulation and the agency of the trade unions (Hardy, Eldring, & Schulten, 2012). Therefore, there are a number of reasons why the trade union responses between different countries may vary.
The workforce involved in care homes provides a significant service through social work support and day care to older people and dependant people (Hussein, Stevens, & Manthorpe, 2013 ). Care home services in the UK may be run by private or profit-making businesses, meaning that there is no uniform way in which care home services in the UK are organised and that the costs of the care home services are also paid through a combination of public and personal monies. A variety of reasons, including an increasingly ageing society that needs care, lack of family care, and other such reasons are responsible for the increase in population that needs care and the rise in the labour market for the care sector. In the UK, these demands have been increasingly met by the employment of migrants in the care sector (Hussein, Stevens, & Manthorpe, 2013 ). There have been labour shortages in the care sector as there have been in other parts of the economy, which have been met by employment of migrants. Migrants may be recruited by entities in the care sector either directly from their home countries, or through intermediary agencies as well as from the existing pool of migrant labour in the UK (Hussein, Stevens, & Manthorpe, 2013 ).
Workers are impacted by the existing model of the adult care that is a combination of public, private, voluntary and family provision , which is characterised by deficient funding and support structures for recipients and carers (Walsh & O’Shea, 2010). In Ireland, where a similar model like England is found, there is an increase in the use of migrant registered nurses and care assistants (Walsh & O’Shea, 2010). Within this model, both the migrant carers as well as the care recipients become somewhat marginalised groups (Walsh & O’Shea, 2010).
Health and safety engagement between workers and management
As per the law in the UK, employers have a duty of care towards their employees, which includes duty to protect the health and safety (Walten, 2012). As per this duty, employers must ensure that harm or injury does not unreasonably impact the employees (Uren v Corporate Leisure (UK) Ltd.  EWCA Civ 66, 2011). Statutory duties with regard to health and safety are made under the law. The Health and Safeties at Work Act 1974 and Occupiers Liability Act 1957;1984 are applicable to make these duties of the employers, which are also applicable vis a vis immigrant employees. Other legislations include Management of Health and Safety at work Regulations 1999 and the Electricity at Work Regulations 1989. These are the laws that are applicable to the employer and employee relations in terms of the duties of the employers to ensure health and safety of the workers in the workplace. Workers play an important role within a healthcare team and their involvement contributes to the health and safety of patients and beneficiaries of their care; the workers may also be exposed to certain risks in the care sector (Chenven & Copeland, 2013). It is therefore important that employers have safety and health of the workers also in sight.
One of the most important risks that is faced by the workers in the care sector is that of exposure to violence. This is discussed in the next section in this literature review. Due to such risk exposure, it is necessary that the employers abide by the legislations that are relevant to protecting their workers.
Violence in care homes
Scott, Ryan, James, and Mitchell (2011) have noted that abuse and violence against healthcare professionals is a common phenomenon, which relates to the nature of the work of the health care professionals and their clients. Indeed, violence in care homes is one of the biggest causes of injuries in care homes for both staff and residents (Health and Safety Executive, 2014). In this section, the literature on violence within care homes is explored with a specific reference to the exposure to violence of the workers.
Violent acts are not always physical and these can also be incidents where a “member of staff is verbally abused, threatened or assaulted by a resident or member of the public during the course of their work” (Health and Safety Executive, 2014, p. 52). The National Health Service Zero Tolerance Campaign in 2002 defined work related violence as incidents involving abuse, threat or assault against workers in circumstances related to their work, and where such incidents involve challenge to their safety, well-being or health (National Health Service, 2002). In both the definitions, there is a stress on exposure to abuse, threat or assault against the workers.
Therefore, violence that immigrant workers may be exposed to in care homes may include threats, verbal abuse, or physical abuse by residents or visitors or other members of the public. The key legislation with respect to violence at workplace and the rights of the employees to expect a safe and secure workplace environment is the Management of Health and Safety at Work Regulations 1999. Within care homes, workers, including immigrant workers may be exposed to violence that can take different forms. Incidents involving violence in care homes can include being bitten by a resident; verbal abuse from an angry visitor; verbal abuse and threats by a resident in the course of caring for that resident; and contractors being struck at by a confused resident (Health and Safety Executive, 2014). The nature of work in care homes and the nature of the residents may contribute to the exposure of immigrant workers to violence at care homes. There are different factors that can be responsible for this exposure which may include effects of medication; frustration of the residents due communication problems or boredom; impatience; anxiety due to lack of choice or space; resentment; and medical condition or mental instability (Health and Safety Executive, 2014).
Health care professionals are particularly impacted by violence in their work settings. The problem of increasing violence in health care professions has been reported for the last 2 decades (Rippon, 2000; Health and Safety Executive, 2014). In a research study in 2000, Rippon (2000) had reported that not only the number of incidents relating to violence in health care settings had increased but even the severity of the impact of the violence had increased for the primary, secondary and tertiary victims of such incidents. In the same study, it was noted that an increasing number of health care professionals were suffering from symptoms of post‐traumatic stress disorder due to the exposure to violence in the health care settings; many of these victims were professionals in the health care sector (Rippon, 2000). In another study from 2004, the issue of exposure to violence for the workers in the health care settings, and specifically care home settings was explored by the researchers (Büssing & Höge, 2004). This research was premised on the existing research on this issue, which had shown that health care workers are considerably more likely to be exposed to violence in their workplace as compared to all other professions, including prison guards, police officers, transport workers, retail employees, and bank employees all of which were less likely to be attacked in their work place as compared to health care workers (Büssing & Höge, 2004). Like the research done by Rippon (2000), which drew a link between health care work and post traumatic stress disorder, Büssing and Höge (2004) also found that there was significant incidence of negative psychological outcomes for those working in the health care settings due to exposure to violence at workplace even though majority of the incidents in the health care settings may be of lower intensity.
Therefore, a significant implication of exposure to violence in care home settings may be related to physical violence as well as psychological outcomes (Büssing & Höge, 2004). Despite this premise of the study, an important point made by Büssing and Höge (2004) is that there is a problem with respect to the gaining of a comprehensive understanding of the phenomenon of violence and its impacts in care homes, which is that when we are comparing data from different studies, there may be different definitions of violence and aggression used in different studies that makes it difficult to a common understanding of the phenomenon. Another problem is that the methodologies that are used to derive data relating to exposure of care home workers to domestic violence may differ in different studies, wherein some studies use data from officially reported incidents, and other use qualitative techniques like interviews or questionnaires making it difficult to draw an analysis based on comparison of results between different studies (Büssing & Höge, 2004). In this context, it may be useful to reiterate the definition of violence that has been propounded by the Health and Safety Executive (2014) which says that verbal abuse, threats or assaults by a resident or member of the public against a worker during the course of their work would constitute violent acts (p. 52).
While there has been significant amount of research that is now available on the phenomenon of violence in health care settings, there is still paucity of research that is aimed specifically at violence in home care settings. One of the first comprehensive research studies on this area seems to be by Barling, Rogers, and Kelloway (2001) who had investigated violence and aggression in a sample of home care workers. Another research study was conducted by Bu ̈ssing, Ho ̈ge, Glaser, and Heinz (2002), which was based on data collected through interviews with eight experienced home care workers. The interviewees for that research reported that they were exposed to verbal aggression by patients. Verbal abuse was reported to be the most prevalent form of violence, and physical aggression by patients was reported to be lesser form of violence in care homes (Bu ̈ssing, Ho ̈ge, Glaser, & Heinz, 2002). In some areas of care home work environment, violence may even be normalised. For instance, health care professionals who are dealing with patients with dementia or other mental illnesses have even more exposure to violence from residents in care homes, and in general exposure to violence in this context is generally considered to be a part of the job (Scott, Ryan, James, & Mitchell, 2011). Due to the normalisation or greater acceptance of violence in context of dementia patients in care homes, there is also the problem of underreporting of violence in such settings. These are therefore some specific issues with regard to care home and exposure to violence that may not have received sufficient attention from researchers studying this area (Scott, Ryan, James, & Mitchell, 2011).
With regard to immigrant workers in care homes, exposure to violence may have specific interrelations. A general problem for care home workers, especially those who are working with mentally ill patients is that they are afraid of being blamed for the violence due to which they may not speak about experiencing violence in such settings (Scott, Ryan, James, & Mitchell, 2011). This fear of being blamed is relevant to both national as well as immigrant workers in care home settings (Scott, Ryan, James, & Mitchell, 2011). There are other common fear factors for workers in care homes that are reported in research; these include job insecurity and an acceptance of abuse as being normal and common experience in the care setting (Scott, Ryan, James, & Mitchell, 2011). There is as yet not sufficient research as to how these factors are relevant to the experiences of immigrant workers in care home settings. Research does indicate that workers in care home settings, especially with dementia patients are more resigned to such violence and abuse in their work settings and that there is a cumulative effect of exposure to violence and resignation to violence which may emotionally exhaust the care workers (Scott, Ryan, James, & Mitchell, 2011). However, how immigrant workers in such settings specifically or uniquely experience the same issues has not been adequately researched as yet.
There is one study in American settings, which has done some research in the context of race and care home settings which may be insightful with regard to the immigrant work force in such settings (Dodson & Zincavage, 2007 ). This is so because in the United States, most of the labour in care homes (which is a low pay occupation) is provided by poor native born women and immigrants (Dodson & Zincavage, 2007 ). In the United States, the increase in demand for care home labour was due to the increasing number of dependent people like the frail elderly, chronically ill, and disabled in care home settings, which has remained a low wage labour market (Dodson & Zincavage, 2007 ). Consequently, immigrant employment in American nursing homes grew by 72 percent in the 1990s itself (Dodson & Zincavage, 2007 ). While Dodson and Zincavage (2007) do give us some insight into the reasons why immigrant labour and racialised minorities became a part of the care home workforce in significant numbers, it does not give adequate insight into the issue of violence in care homes and its experience by the immigrants.
There is some research that does shed some light on the use of immigrant labour in care home settings in the UK. For instance, Shutes (2012) writes that the shaping and exercise of choice and control of migrant workers over the conditions of their labour has some implication for the employment of migrant workers in long-term care. This study has used findings of in-depth interviews with migrant care workers in the UK to make an argument that there are differential rights accorded to migrants on the basis of citizenship and immigration status, which have repercussions for their entry into particular types of care work, the powers of ‘exit’ from the work place, and the conditions under which care labour is provided in the UK (Shutes, 2012). With regard to experience of violence by immigrant workers in UK care homes. The last point is particularly relevant because it notes that there may be an impact of citizenship and immigrant status in how immigrants experience work conditions in care homes and whether they report such violence or not.
For the immigrant workers in care homes of England and Wales, the problem is that the immigrant workers do not have the visibility in the political sense to bargain for better working conditions; this problem is similar to the problems faced by unregulated workforce in the American health care sector that wokrk in the homes of their employers (Boris & Klein, 2006). In the American context, while the workers in the public sector health care have been able to negotiate on better salaries and work conditions because of their stronger lobbying, the personal attendants working in unregulated sector like homes of individual or small employers have struggled for better working conditions and pay (Boris & Klein, 2006). For those who work in unregulated sectors like homes, there is a “clouded boundary of public and private”, which does not allow the workers in the unregulated sector to demand or negotiate on better working conditions (Boris & Klein, 2006).
The same problem is also applicable to the care home workers in the English and Welsh contexts as they are in the American context. It is a problem that may stem from the lack of political capital. Those who are in the private sector have lesser political capital due to weaker contractual rights, possible lack of unionisation and bargaining powers as compared to those who are in the regulated public sector. The immigrant labour fall even below in the list and those who are involved in care homes may be exposed to many problems in their work conditions and may not be able to respond to these problems through organising themselves (Hardy, & Clark, 2005). Moreover, trade unions may also not be the open to the membership of the migrant workers (Hardy, & Clark, 2005).
In general, foreignness of the workers, their particular nationalities or ethnicities and race can have implications for how workers experience their work conditions in the UK (Anderson, 2007).This is reported by McGregor (2007) in his research on Zimbabwean women and men working as carers in the UK care sector. McGregor (2007) investigated the experiences of a highly educated, middle-class migrant group from Zimbabwe and how the members of this group have been constrained due to domestic conditions in their own country to look for work in England. McGregor (2007) found that many Zimbabwean care workers do experience stress and deskilling when they come to England and find themselves working in a secondary sector of care where low-status and poorly paid work is given to them. McGregor (2007) also reports on the racialised nature of care sector workplaces, and argues that there is a need to consider the dynamics of race and gender in social care workplaces, where the rights of migrant care workers may be compromised.
Employee issues/casual workers and agency works
Simonazzi (2008) argues that it is the national employment model that shapes the features of the care labour market, including the quantity and the quality of the labour supply and the degree of dependence on migrant carers. In the UK, the health care system is Beveridge oriented in which social and health services are funded from general taxation so that the state is responsible to provide care to those who are dependant (Simonazzi, 2008 ). In national systems there are different combinations of three actors, which are the state, the family, and the market that provide labour to the care home market (Simonazzi, 2008 ). In what proportions such market is organised is important to understand the distinctions between different national systems and how countries organise their care sectors. In the UK, there is no particular familial obligation to provide care to the elderly family members. At the same time, there has been a shift towards privatisation in the UK which has meant that there is an emphasis on the contracting-out of services that were previously provided by local authorities (Simonazzi, 2008 ). The impact of that shift has also been felt in the care sector because the services that were previously provided by local authorities are now increasingly contracted out with families paying to private organisations for care of their care dependant family members (Simonazzi, 2008 ). For the care home workers, a shift to the private sector has meant that there may be lower wages and more flexibility in the labour market in the care home sector as compared to the public sector (Simonazzi, 2008 ). In the UK, the majority of the organisation in the care labour market is in the area of private and for-profit care organisations (Simonazzi, 2008 ). It may be summarised that in the UK, care services are provided by local government and by the private sector on contract to local governments and the share of the public sector has “declined drastically since the 1980s” (Simonazzi, 2008 , p. 11). The implications for the care workers in the UK is that there is a wide disparity in working conditions because while pay and conditions are well regulated in the public sector, the pay and conditions of work for the private sector or casual workers is not as regulated and is worse. Public sector working conditions are better, but this has meant higher labour costs, leading to an increasing contracting-out of services to private providers (Simonazzi, 2008 ). More and more care labour is being organised under atypical contracts, which means that the conditions of work are not as well regulated as the public sector care labour.
Walsh and O'Shea (2010) point out that in the care home settings, immigrant labour is the most impacted by negative conditions of work and lesser pay. Their research is based on the synthesis and comparison of study carried out during a multi-year project involving both secondary data and primary data collected from migrant care workers, care providers, and older adult care users (Walsh & O'Shea, 2010). The following conclusion from this research is relevant and is noted below:
“From the outset, one commonality observed across all four countries is a relative lack of prioritization of the provision of care for older people. Indeed, most of the central challenges raised by the demand for migrant labour are embedded in the context of an underfunded system of care provision, and an often-underpaid sector of employment. The increasing reliance on migrant care workers is a symptom of those challenges, and migrants, while making important contributions, are not the solution to those deficiencies” (Walsh & O'Shea, 2010, p. 7).
The important points that may be noted from the above excerpt is that care for older people is not prioritised and for that reason it falls within the area of low pay labour market. As it is a low pay market, migrant labour is generally involved in this area of care services. However, how this impacts the migrant workers in the UK’s care home settings also deserves to be noted from the findings of Walsh and O’Shea (2010) who write that there is a definite employer preference for migrant workers but that this preference is shaped by the general perception that migrants have a better work ethic as compared to native workers. Better work ethic in this context refers to the willingness of the migrants to do the job on the employer’s terms, for longer work hours and shifts and for lesser pay as compared to native-born workers (Walsh & O'Shea, 2010). Care organisations (in particular, private sector organisations) may view migrants as being more loyal to the organisation, which in itself is derived from the way the migrant workers feel themselves bound to the employer due to their immigration status; migrant workers with temporary work visas may feel tied to their sponsoring employer, which may mean that workers may agree to work under worse conditions for lesser pay so as to secure their immigration status from the sponsoring employer (Walsh & O'Shea, 2010).
With the growth of gig economy in the UK, there are concerns of casual and atypical work conditions that also impact immigrant workers. Immigrant workers are particularly vulnerable because of their immigrant status and there are problems with access to employee rights and statutory protections; as casual workers they are not ‘employees’ under a contract of employment; at times, workers may be described as ‘self-employed’ so as to avoid statutory rights to the employed workforce (TUC Commission on Vulnerable Employment, 2016, p. 4). Immigrants who are casual employees may be denied basic rights such as sick pay and paid leave (TUC Commission on Vulnerable Employment, 2016).
There is a problem of an unregulated market within which thousands of undocumented immigrants are working as illegal labour (Bales, 2017). The Byron Burger scandal in 2016 which saw the premises of Byron Burgers being stormed by immigration officers leading to many undocumented workers being deported is an example of such unregulated labour market (Gordon, 2016). However, Byron Burger cooperated with the government and escaped being charged for an offence. Therefore, one of the issues pertaining to immigrant workers in the UK is related to undocumented and illegal workers. The Immigration Act 2016 responds to this issue by creating a strict law and policy with regard to undocumented immigrants, which also has relevance to the labour market. The Immigration Act 2016 was enacted for the purpose of making provisions with regard to (among other things) access to services, facilities, licences and work (Crawford, et al., 2016).
There have been concerns about exploitation of the labour market with some employers letting undocumented immigrants work for them but under exploitative conditions, such as, lesser pay and poor work conditions. The Immigration Act 2016 makes it an offence for employers to allow work by illegal immigrants and penalises immigrants for ‘proceeds of the crime’, which means that the immigrants are liable to surrendering their earnings to the state. Immigration Act 2016 defines illegal working under Section 34 as work by an immigrant despite being disqualified from working. Under Section 34, an immigrant can be penalised for illegal working even if he had reasonable cause to believe that his immigration status prevents him from working but he still continued to work. Under Section 34 (3), such as immigrant can be imprisoned for up to 51 weeks. Under the Licensing Act 2003, employers who allow illegal working can be penalised.
Despite the changes made through the legislation, there are still areas that need attention from policy makers to improve the conditions of work for the immigrant labour in the care home settings. Some of the recommendations for policy makers are made by Walsh and O'Shea (2010) as follows:
“First, the migrant care labour market requires attention to recruitment, skill requirements, admissions, mobility, and residency issues. Secondly, the migrant care experience must be addressed in terms of the attitudes and expectations of employers and clients, the training required for foreign-born workers, and the discrimination experienced in some segments of the sector. Employment policies may need to shift to better address the issues unique to migrant workers in the long-term care sector. Thirdly, employment policies may need to seek the improvement of jobs in the sector generally, either through training, regulations on earnings and working conditions, or other means. Finally, there is little evidence that the admission of migrants in long-term care should be a priority, but future employer demand should be closely monitored and migrant admission policies may need reform and better integration with older adult care policymaking” (p.9).
In the previous chapter, the literature review explored some predominant themes related to migrant workers in the care homes. The literature review revealed that exposure to violence in care homes and vulnerabilities of the migrant workers in a low paid sector are some of the important interlinked themes on the experiences of the migrant care home workers in the UK. The literature review also revealed that there are gaps in the understanding on migrant care workers’ experiences in the UK, where the issues like exposure to violence may be experienced in a different way by those who are migrants as compared to those who are British care workers. Research is conducted with the purpose of increasing knowledge and contributing to the existing literature on the subject matter (Collis & Hussey, 2009, p. 3). Therefore, while the literature review has helped to identify some common themes in literature which will be further useful in the formulation of the research methodology, it has also identified some areas where more data needs to be collected in order to understand the issues of the migrant care workers.
This chapter discusses the research methodology that will be used for the research study on care workers in UK care homes. The research philosophy, research strategy, and other relevant aspects of research methodology are discussed in this chapter. As research is a systematic and methodological enquiry by the researcher, the methodology has to be created and explained in a systematic manner (Kothari, 2004, p. 1). This chapter seeks to give a clear and cogent description of the research methodology in keeping with the methodological nature of research so that data collection, analysis and interpretation methods are clearly identified and justified (Saunders, Lewis, & Thornhill, 2012).
This research will be conducted with the help of the positivism. The positivist philosophy is driven by an objective and scientific approach where the researcher accepts some assumptions about the way he views the world (Collins, 2010). The positivist research philosopher consider the data collected in the research in an manner and formulates the theory or findings based on the analysis of this data. The other research philosophies include realism, interpretivism, and Pragmatism. Although, any of these philosophies may be chosen by the researcher to conduct this research, the choice of the philosophy is based on the purposes or motivations of the researcher (Wilson, 2014). In this research, the researcher is driven by the purpose of gaining more insight into the experiences of the migrant care workers in the care homes of the UK. At this time, there is a paucity of data or research on this area, which would make it inappropriate for the researcher to make certain hypotheses about the experiences of the care workers. Instead, it would be more appropriate to create research questions and allow the data collected from the care workers to guide the researcher into formulating the findings on the experiences. Therefore, keeping in mind the methods the methods that would be used for identifying, collecting and analysing of data, this research philosophy is selected (Easterby-Smith, Thorpe, & Jackson, 2002). In this case, as there is a paucity of data on the subject matter, it is thought more appropriate to choose a research philosophy that allows the increase of empirical knowledge by collection of primary data (Bashir & Marudhar, 2018). The selection of the research philosophy is also relevant for the selection of the research design, which could be qualitative, quantitative approach or mixed research design (Saunders, Lewis, & Thornhill, 2012).
This research demands the identification, observation and analysis of aspects that are integral to the experiences of the migrant care home workers, in particular, with respect to exposure to violence and other vulnerabilities attached to their migrant status. As there is little data or research on the experiences of migrant workers in the UK care homes, this research will use an inductive approach. The inductive approach is explained and its application justified in detail in this section.
Inductive approach involves the researcher in a process of observation of cases which are subjected to analysis for the purpose of identifying a pattern. The pattern helps the researcher to formulate a theory on the subject matter. The purpose of a research approach, whether inductive or deductive, is to allow the researcher to relate their research to the theory (Bryman & Bell, 2015). Initially, the researcher may be involved in making broad assumptions about the research topic, for instance, in this case, a broad assumption may be made that the migrant workers in UK care homes are exposed to violence and that their migrant status may be leading to some vulnerabilities. However, in the course of the research, the researcher must be able to devise detailed methods of data collection, analysis and interpretation, which helps them to narrow the earlier made broad assumptions (Creswell, 2013). A deductive approach is appropriate where the researcher first identifies a general theory, applies that theory to the research and then creates a specific context of the research using that theory (Perrin, 2015). However, in the current study, where there is paucity of research on migrant care workers specifically, and where it may be argued that the experiences of the care workers in general cannot be ipso facto applied to migrant workers also, it may not be appropriate to apply deductive approach. This is the reason why the researcher chose inductive approach, where the phenomenon of the migrant care workers’ experiences will first be observed, and then a theory formulated that is specifically applicable to the migrant care workers (Perrin, 2015).
Research designs are “types of inquiry within qualitative, quantitative and mixed methods approaches that provide specific direction for procedures in a research design” (Creswell, 2013, p. 12). As such, depending on their orientation, the researchers may choose between qualitative, quantitative, and mixed methods research. This research is done with the help of qualitative research method. This section discusses the method and justifies its use in this research.
Quantitative inquiry is generally used to examine the link between what is known and what can be learned, through an analysis that seeks to understand the associations among components or variables (McLeod, 2013). Quantitative research is based on numerical data and is done to test hypotheses through the collection and analysis of quantitative data (Maxwell, 2013). However, the drawback of quantitative research is that it is not able to reveal deeper insight or knowledge into the participants’ opinions, ideas, and experiences and cannot reveal the many nuances in these experiences. In this research study, where the researcher seeks to gain better and deeper insight into the experiences of migrant workers in care homes in the UK, a quantitative method would be inadequate as it will not allow the researcher to explore in depth the experiences, and opinions of the care home workers, nor understand the nuances in the experiences from the perspective of migrant status. Therefore, the researcher has chosen a qualitative research method.
Although, it was earlier thought that positivism is not aligned to qualitative research, more recent scholarship on research methods has accepted that there is no fixed rule and researchers can have flexibility to choose their research method and research philosophy (Bryman & Bell, 2015). Therefore, the choosing of a positivist philosophical approach does not come in the way of adopting a qualitative approach.
Qualitative method is chosen for its ability to be flexible, which allows the researcher to do theory building (Opoku, Ahmed, & Akotia, 2016). In studies where the researcher wants to gather and analyse data related to experiences and opinions of the participants, qualitative research is appropriate. This is so because there is no fixed or rigid structure for qualitative research and the researcher is not bound to conduct the researcher in any fixed manner. This allows the participants to be more open about their experiences and opinions and also gives the researcher the space to explore the world of the participants in a more flexible manner (Creswell, 2013). In the current study, where the researcher is exploring the experiences of the migrant care workers in the UK, it would be necessary to give a flexible environment to the care workers to discuss their experiences. This will allow greater insight to the researcher and help the researcher to answer the research questions.
The grounded theory strategy is being applied in this research because there is paucity of research in this area and the use of grounded theory will help the researcher to formulate or develop theory that is more relevant to the experiences of the migrant care home workers. Grounded theory is among the qualitative methods that also include action research, case study research, and ethnography (Bryman & Bell, 2015). The grounded theory approach allows the researcher to explore the subject matter on the basis of the investigating questions and outcomes and also use existing information and build on it by adding his own research analysis on the subject matter (Saunders, Lewis, & Thornhill, 2012). Grounded theory is aligned to inductive approach as it involves collection and analysis of data for developing theory (Charmaz, 2014). It is also aligned to positivism philosophy because it is systematic and methodological (Charmaz, 2014). Theoretical formulation in grounded approach involves the researcher in the analyses of the data, and identifying patterns or codes, which can then lead to the formulation of concepts or theory (Glaser, Bailyn, Fernandez, Holton, & Levina, 2013).
Data collection and analysis
This research involves the collection of both primary data and secondary data. The literature review is part of the secondary data, where the data were collected from books, journals and reports including empirical studies conducted by other researchers (Bettany-Saltikov, 2012). , Primary data is the data, which is collected directly from the participants (Bettany-Saltikov, 2012). In this research study, primary data will be collected from participants through interviews. The interview would be semi-structured, which means that some of the questions would be predetermined by the researcher but based on the responses of the participants, more questions can be formulated during the interview. The interviews will be recorded and converted to transcripts, as per the consent of the participant to the method for recording interview. For instance, some participants may not agree to audio recording of the interviews. The transcripts will be analysed using grounded theory, which means that the researcher will identify patterns and themes that can lead to the formation of concepts. The research method adopted for data collection is qualitative interview with care workers, for which a sample of 15 to 20 care workers is being used. The inclusion criteria for the interviews would be migrant workers who are working in care homes for at least 1 year time.
The ethical issues involved in this research relate to the interviews of the participants. The first ethical issue is that of consent of the participant for the interview. The consent will be taken on a consent sheet, which will also include information about the research and the purpose for which the information collected by the participants will be used by the researcher. The participant can read the consent sheet and after reading it only, sign on the sheet signifying assent for the interview. This will serve the purpose of receiving informed consent from the participants. Another ethical issue that is involved here is that of confidentiality and anonymity of the participants. The participants are migrant care home workers. They may not desire for their personal information to be made known. For this purpose, the researcher will ensure that the participants’ personal information is kept confidential. This will be informed to the participant via the consent sheet itself. This is important for the maintenance of anonymity of the participants and their privacy (Sarantakos, 2005). If the participants are assured that their information is confidential, they may also be more forthcoming about information (Sarantakos, 2005).
Limitation of research method
That this research only applies qualitative method, it may be a limitation of this research because qualitative method involves subjective data. This may lead to questions on reliability of data (Bamberger, 2000). The sample size is also small at 15 to 20 participants, which would mean that the data is collected from a small sample where the findings may be subject to some generality issues.
Interviews were conducted with 10 participants who are migrant workers in care homes. Their names are not mentioned in this dissertation in order to protect the confidentiality of their personal information. Instead, numbers are allotted to them to identify them for the purpose of reporting the findings of the interviews. 10 questions were asked to the participants and the following sections thematically present the findings from these interviews. The findings are divided into different sections with each section representing a theme of the findings.
Problems faced in care homes
This section reports the findings based on the interview data on the issues and problems faced by the care home workers in their work place. As this section indicates there are a variety of problems, some of which are related to the personal circumstances of the participant. For instance, Participant 1 faced a problem due to language and understanding issues as noted: “One of the major problem faced is Language problem. I can’t understand what residents and colleagues are trying to convey me on initial days of work.” Participant 8 also reported to having had communication issues in the initial days of their work. Another participant whose problems at workplace were related to personal circumstances was Participant 5, who being in their first job faced a lot of problems because they were unaware about caring work.
There were other participants whose problems at workplace were related to the conditions of the workplace. For instance, Participant 2 noted that use of hoist was problematic and that they were “totally scared to lift up residents.” Such physical challenges of the work were also reported by Participant 4 who noted that “tranferring the residents from one place to other like from bed to chair, chair to wheel chair etc.” was one of the problems faced by them in their workplace. Similarly, Participant 9 reported to facing issues while giving personal care to the residents. These problems are related to the physical conditions of the work where the carers are required to pick up and shift residents or give them personal care.
Problems are also related to challenges related to managing the moods and behaviours of the patients. For instance, Participant 3 reported that “learning the residents that is their mood swings, likes, dislikes etc.” was a problem for them. Participant 6 also reported similar challenges related to learning the behaviour patterns of the residents. Participant 7 said that one of the problems faced by them was that they were not able to handle different situations. Participant 10 reported to having challenges related to “consoling the residents.”
Coping with problems
Participants also reported on the methods or means that helped them cope with the challenges related to their work. One of the most common response in this context is that participants often found that they found coping mechanisms in the support provided to them by their team mates. For instance, Participant 7 clearly mentions team mates’ support for coping with the problems. Participant 8 mentions that constant conversation with the team members and residents helped them cope with the problems. Participant 9 notes that working with experienced team helped them to cope with the problems. Some of the participants mention working with seniors or experts as coping mechanisms for responding to the problems and challenges related to their work. For instance, Participant 2 notes that “working with experienced carer help me a lot.” Similarly, Participant 4 also mentions that “help of senior carers” helped them. Participant 5 notes that “working with experts and proper training from management.” In the last response a crucial difference is that participant 5 also mentions training from management as one of the ways of coping with the challenges at workplace. Some of the participants have mentioned that observing their colleagues and patients have helped them. For instance, Participant 3 and Participant 6, who both mention close observation. Participant 10 notes that coping mechanism was found in the “deviating their mind by giving them on the base of their interest.” Only one participant was not able to fully cope with the challenges at workplace; Participant 1, who has language and communication related challenges said that “It was very hard and try to talk with them and listen carefully to their words.” It appears that Participant 1 was not able to fully cope in the beginning and did not find support in the team or seniors in this respect.
One of the behaviours that was reported on in the interview data relates to bullying at workplace. The findings indicate that not all participants faced bullying and while some did face bullying, others never experienced it. Bullying is not experienced only from the colleagues and there can be others within the organisation who may subject care workers to bullying. For instance, Participant 1 notes that they have faced bullying “not with all the colleagues but with someone. Purposefully they find faults on me and I report it and management solve the problem.” In this case, it appears that someone was bullying Participant 1 but the management was able to respond to the problem effectively. Participant 4 also reports to facing bullying from “some colleagues.” Similarly, Participant 6 says “yes, during the initial days of job I had some experience from the colleagues.” Participant 10 too reports to facing bullying at work and has noted: “yes , as I was new to this job, some team members tried to give complaints against me, because they had a prejudice that I am unfit for this job.” In these cases of bullying, colleagues are the ones who have subjected the participants to bullying and there is factor of newness to job which may be making the participants vulnerable to this behaviour as they specifically mention that they were bullied in the initial period of their job. Participant 10 also mentions prejudice that may have motivated bullying behaviour on the part of the colleagues.
Six of the participants have reported to never once facing bullying and also reported to the fact that their colleagues are always nice to them. For instance, Participant 2 notes: “No, my colleagues are really nice and help me lot to catch up everything.” This also suggests that the colleagues tried to help the participant to catch up on work. This is similar to the response by Participant 5 who notes that “No, all are nice to me because they that I don’t have any previous work experience.” This suggests that newness to their job was a reason for their colleagues to be nice to them and help them. Similarly, Participant 3, Participant 7, Participant 8, and Participant 9 report to never facing any bullying behaviour from their colleagues or anyone else.
One of the questions in the interview related to whether the participants felt that their workload was too much for them. Some participants have reported to workload being appropriate while others have reported to workload being too much for them. In some cases, workload may increase due to certain reasons. For instance, Participant 1 says that “when there is short staff and is difficult to do all the works properly and can’t finish it on time.” Therefore, shortage of staff may lead to more workload periods. This is also reflected in the response by Participant 10 who says that they “faced work load during the time of staff shortage.” The inability to finish the work on time seems to be an indicator of having too much workload as is also apparent from Participant 1’s response and the response of Participant 2 who notes that “I didn’t get speed to finish work on time so, I feel like lot of work load for me.” Workload may appear to be more in the initial period of work as reported by Participant 5 who says “for first 3 months I struggled a lot and with the help of my colleagues I learned everything.” Participants 6, 7, and 9 all felt that the workload was high. For those participants who felt that workload was appropriate, some responses suggest that team work helps to reduce burden of work. This was reported by Participant 3 who says that “we are doing everything as a teamwork.” Similar responses were made by Participants 4 and 8, the latter of whom particularly mention that workload is felt less because “because we have a good team.”
Barring one participant, that is, Participant 5, all the other participants reported to their salary being less than expected and that they would like an increase in their salaries. This suggests that the salary component of their work conditions does not satisfy most of the participants. Participant 1 says that the care home is just giving the basic pay and “in my point of view we need to get pay because we are doing a lot of work in a day.” In other words, the salary is reported to as being not commensurate with the work conditions. Other participants do not elaborate as much but they all say that they are expecting more salary or that more salary will be helpful to them.
Health problems are reported by most of the participants to the interviews. For some participants, back pain is common. Participant 1 attributes their back pain to the physical conditions of their work saying that “We have hoist for lifting and it also causes pains by moving the hoist.” Similarly, Participant 8 attributes shoulder pain to the work conditions. Participant 6 does not attribute their health issues to work but mentions “sudden climate change” as the factor. Indeed, shoulder pain and back pain have been reported by a number of participants in the interviews. Participant 2 reports to having joint pain, back ache, shoulder pain. Participant 3 too reports to having problems with shoulders. Participant 5 mentions backpain and stress as the predominant health issues. Participant 9 mentions leg pain and hand pain and Participant 10 mentions body pain. Only Participant 4 and Participant 7 say that they have no problems with their health.
Bad experiences attributed to residents
Participants were asked if they had ever faced any bad experiences that could be attributed to the residents of the care homes. Some participants have resorted to such experiences while some do not have any such experiences to report. Participant 1 says that “some residents have mental disorders and they will attack and hurt us by scratching , beating etc.” This is a clear indication of experiencing violence and abuse from the residents although the participant does attribute this to mental disorders that the participants may be afflicted with. Participant 7 too attributes such abusive behaviour to dementia. Participant 3 says that “some residents will try to beat me because they don’t to take shower and other personal care.” Again, this indicates abusive behaviour although this is not attributed to the resident’s mental condition, rather it may be due to the resistance of the residents to personal care. Similar response is given by Participant 9. Resistance and resultant abusive behaviour towards the carers may also happen in cases like Participant 6 describes where the carers “try to feed them they hold our hands tightly and cut us with their nails.” Participant 5 notes that “during the initial days of my job some residents was really angry and try to attack me.” Participants 2, 4, 8, and 10 report to never having faced any such bad experiences from the residents in their care.
Participants were asked whether they ever felt that they were not treated equally with other workers in the care homes. Majority of the participants have reported that the workers are all treated equally. However, some participants have reported that at times they have felt that they are not treated equally. For instance, Participant 1 says “I feel in some situations some of the team members show partiality.” Participant 10 has reported that the staff does not all get treated equally as the senior staff gets more attention presumably from the management. Other than these two participants no other participant has reported to unequal treatment at workplace and have reported that they are always treated equally.
Participants were asked whether they received adequate periods of rest during their work day. Some participants have reported to receiving adequate rest while some have reported that they are not able to get sufficient rest during the work day. For instance, Participant 1 says “most of the cases I can’t utilise the break because of heavy work.” Participant 2 also says something similar that they cannot finish the work on time utilise the full break time. Some participants like Participant 9 clearly say that they need more break time. Participant 10 says that they “usually we get one hour of break, please raise it to two hours.” Participant 4 says that they get sufficient break mentioning that they “get 1 hour break from 12 hour shift.” Although some participants do say that they get enough break time, the majority feels that the time is not enough.
Most participants report to working in 12 hour work shifts. Five of the participants (Participants 5, 6, 7, 8, 9,) are reportedly happy with the work hours but the others say that they are not happy with the work hours. Participant 1 says “We usually have 12 hours of shift in day if it is reduced to 10 hours then it will be really helpful.” Similar observation is made by Participant 10 who also suggests 10 hours work shift. Participant 3 says that “instead of 12 hours of shift expecting to reduce the shift timing from 6-8 hours in a day.” Participant 4 says that there should not be continuous shifts duty should only be on alternate days.
Participants were asked for suggestions on how their work place can be made more conducive for them. There are a variety of suggestions that were given by the participants. Participant 1 suggests relaxation activities for both the residents and staff. Similar suggestion for recreational activity is made by Participant 9. Participant 2 suggests more carers to be appointed as that will be helpful to them. Participant 3 suggests employment of machineries like hoist. Participant 6 also mentions advance equipment. Participant 4 suggests keeping the residents and staff happy although they do not specify how this can be done. Participant 5 suggests providing more supervision. Participant 7 suggests health insurance for carers. Participant 8 suggests more annual leave. Participant 10 suggests increase in rest periods to two hours during the work day and use of wrist bands to easily identify the residents with dementia.
While some of the findings of this research can be linked back to the existing literature, some of the findings are contrary to what has been reported in the literature about immigrant workers or work in care homes in general. For instance, while literature suggested that immigrant workers may be subjected to partial treatment vis a vis other workers; the findings of this study do not support that contention, at least not in the care homes. In this study, participants were asked whether they ever felt that they were not treated equally with other workers in the care homes, and the majority of the participants reported that the workers are all treated equally; only two participants reported to unequal treatment at workplace. Even for one of the participants who did report to unequal treatment, the disadvantage they were made to face did not relate to their foreignness but to their junior status at the workplace as the senior staff was getting more attention.
However, there are some gaps between the existing laws for workers’ rights and the actual situation on the ground. Firstly, there is a gap between those who are working in public, private, voluntary and family provision with those in the public getting better work conditions as compared to the others (Walsh & O’Shea, 2010). For immigrant workers the problem can be compounded by the lack of ability to exercise choice and control over the conditions of their labour (Shutes, 2012). Moreover, immigrant workers in care homes of England and Wales may also have the problem of lack of visibility in the political sense to bargain for better working conditions (Boris & Klein, 2006). In general, the workers in the private sector have lesser political capital due to weaker contractual rights, possible lack of unionisation and bargaining powers as compared to those who are in the regulated public sector. In particular, the immigrant labour may fall even below in the list and may not be able to respond to these problems through organising themselves or may not be welcome in the unions already there (Hardy, & Clark, 2005).
Secondly, in all kinds of care homes, there is a problem of underreporting of violence (Scott, Ryan, James, & Mitchell, 2011). Laws that are meant to safeguard the workers’ work conditions and rights, do try to address the issues related to health, safety, occupiers’ liability. Relevant legislations revealed in this research that address these issues are the Health and Safeties at Work Act 1974, Occupiers Liability Act 1957;1984, Management of Health and Safety at work Regulations 1999, Electricity at Work Regulations 1989. These are the laws that are applicable to the employer and employee relations in terms of the duties of the employers to ensure health and safety of the workers who are exposed to certain risks in the care sector (Chenven & Copeland, 2013). It may be assumed that these legislations work to address the issues of workers’ health and safety at the workplace, but the findings of this study reveal important gaps.
Health, and safety of the workers are not always assured in the care sector. While this is applicable to all workers, immigrant workers may be more disadvantaged due to problems with language proficiency or lack of cultural understanding. This was revealed by the findings of this study, where some participants mentioned that they faced problems with understanding the English language which led to lack of understanding of what residents and colleagues were saying. Therefore, the language barrier can be a significant problem for the new immigrants, which may lead to difficulties in adjusting to the work in the care home. In such situations, the problems may be internalised because of the immigrants’ own inability to understand the language or externalised when they face bullying or other abusive behaviour because they are not able to understand the work or cope with it. This will be discussed later. On a general level, there are some serious health and safety related issues with regard to care home work, which may put the nature of the work conditions at odds with what is expected under the legislation. Participants in this research have noted that they have problems with the use of the hoist with which they need to lift up the residents. Moreover, at times, transferring residents from one place to another can put the care workers at risk of affecting their own health because they may not have the necessary tools for such transfer. Indeed, participants in the research specifically noted that their work can be made more safer if they are given proper machinery and advance equipment. They also suggested that they should have health insurance. As participants have also reported to having a number of health problems that are related to the nature of their work, this suggestion is relevant. These suggestions speak to the nature of the work and the way it affects the health and safety of the health workers. Indeed, the interview responses revealed that most of the participants have some health problems, with the most common one being back pain. The physical conditions of their work, including the lifting of the residents with the hoist. In general, the issues of health problems may include joint pain, back ache, shoulder pain, leg pain and stress.
Participants also have a lot of workload with the majority of the participants reporting that their workload can be too much for them; sometimes, this is temporary and sometimes unmanageable workload is a constant issue for them. Temporary increase of workload may be due to shortage of staff. The indicator of having too much workload was identified by some of the participants as the situation where they cannot finish their tasks on time given to finish them. Even for those who felt that the workload was appropriate, the responses of the participants suggest that teamwork is essential to finishing tasks on time. Reading these responses together, i.e., responses on shortage of staff leading to more workload, and teamwork for appropriate workload, it can be said that for those care workers who work in poorly or inadequately staffed care homes, unmanageable workload can be a serious concern.
There are also issues related to adequacy of salary. Only one participant reported to having adequate salary and all the others said that they were paid less than expected and that they would like an increase in their salaries. For those workers who are overworked, the salary may appear to be a poor compensation for the amount of work done by them. This is consistent with the literature on this point; for instance, Walsh and O'Shea (2010) report that immigrant labour is the most impacted by negative conditions of work and lesser pay in care homes. In this research, the findings suggest that immigrant workers work long hours for poor compensation. Most participants have reported to working in 12 hour work shifts
Although violence has now come to be addressed by the existing laws and regulations, the responses of this research suggest that there are gaps between the law and the reality of work conditions in care homes. Literature recognises that one of the most important risks that is faced by the workers in the care sector is that of exposure to violence (Büssing & Höge, 2004; Rippon, 2000; Scott, Ryan, James, & Mitchell, 2011). There is also a key legislation that addresses the right of the workers to safe workplaces in the Management of Health and Safety at Work Regulations 1999. However, as this research found, workers are exposed to a variety of violence in the care homes. One of the ways in which workers may be exposed to verbal violence is through bullying, as reported by a number of participants in this research. is also a problem for many of the care givers. While all the workers do not face bullying, many did experience it. Bullying could be experienced through the behaviour and actions of the colleagues, residents, or visitors. For immigrant workers, bullying can be experienced by colleagues or residents who may not be accepting of their foreignness. Some responses do show that bullying was more intense in the initial period of their job, when they had problems with language or understanding the job. Literature suggests that language and cultural barriers as well as documentation status have implications for the conditions of work for the immigrant workers (Moyce & Schenker, 2018). As many of the carers within the care sector come from countries like Philippines, India, and Poland, there may be language barriers and cultural barriers (Hussein, Stevens, & Manthorpe, 2013 ). Prejudice is specifically mentioned by one participant. Therefore, clearly, some immigrant workers may be exposed to verbal abusive behaviour in the care homes. Literature indicates that violence can be of varied nature, including being bitten by a resident; verbal abuse from an angry visitor; verbal abuse and threats by a resident in the course of caring for that resident; and contractors being struck at by a confused resident (Health and Safety Executive, 2014). Therefore, the bullying against the immigrant workers can be classified as violence.
It is not just the immigrant workers who are exposed to violence in the care homes as others may too experience it. Literature indicates that health care workers are considerably more likely to be exposed to violence in their workplace as compared to all other professions (Büssing & Höge, 2004). Scott, Ryan, James, and Mitchell (2011) too noted that abuse and violence against healthcare professionals is a common phenomenon, which relates to the nature of the work of the health care professionals and their clients. Violence in care homes is reported as one of the biggest causes of injuries in care homes for both staff and residents and can include physical as well as verbal and psychological violence (Health and Safety
Executive, 2014). The findings of this research are consistent with the literature on violence in health care, however as these findings are specifically related to care homes (which has not been explored to a great extent in the literature), the findings add to the literature. Most of the participants have shared bad experiences that are attributed to the actions or behaviour of the residents; this includes being scratched or beaten by the residents. For some participants the problem is related to the mental disorders of the residents, like dementia. Sometimes the residents are violent only because they are resisting the care given by the carer as noted by some participants.
Interestingly, in the apparent absence of legislative or management support against the violent behaviour of the residents or their visitors, the care home workers seem to have evolved their coping mechanisms. This has not been reported in the literature considered for this study but was an important finding in the research. Participants have reported on the methods that help them cope, which include, support provided to them by their team mates. This seems to be one of the most common coping mechanism. However, it also suggests that immigrant workers may also be getting essential support from their team mates for coping with the challenges of their work. Working with seniors or experts can also help the immigrant care workers in coping as reported by some participants. This also suggests that immigrant workers may not always face prejudice from their co-workers and management, but may sometimes find support systems. This may go against the literature which points at prejudice against immigrant workers. What can be said is that the conditions of the immigrant workers may be poorer because of lack of unionisation or working in the private sector, which is in any case not comparable with the public sector in terms of salary and unionisation.
The findings of this research add to the existing literature on the immigrant care home workers because there is little research on this area at the moment and what has been revealed by the current research reveals some significant points. First, immigrant workers in the care sector may face some bullying from the other colleagues because of their initial problems in understanding their work. This may generally be due to the lack of proficiency in the English language that some of the immigrant workers may have or it may be due to cultural differences that the immigrant workers may have with the dominant culture and which may make it difficult for them to understand what is required of them. However, this research also reveals that it is not necessary that all immigrant workers would face such bullying as there were a significant number of participants who reported to never facing bullying.
Similarly, there are a number of participants that did not think that the workplace had culture of unequal treatment or prejudice. It is therefore not necessary that the immigrant workers in care homes would face prejudice or unequal treatment because of their immigrant status. Literature does suggest that immigrant workers face such unequal treatment and prejudice, however, this research has not been able to uncover evidence of such treatment or prejudice with regard to care homes and immigrant workers. However, this research has not been able to link the actual experiences of the workers with the literature. It is possible that the experiences in the care homes are different from general health care settings and as most of the existing research is related to health care sector in general and not specifically on care homes, this may be a reason why there is a difference between the literature and the findings of this research.
The conditions of work in the care homes are generally disadvantageous for workers, be these nationals or immigrants as revealed by this research. To some extent, literature also has noted that with care homes that are in the private sector, the work conditions, particularly related to salary and unionisation are not the same as the public sector workers. In this context, it may be said that both the national as well as the immigrant care home workers may be in the same position. As salaries in the private sector care homes are generally lower than the public sector and the immigrant participants do not report any specific unequal treatment, it may be surmised that the lower salaries in the care homes is a general phenomenon and not specifically related to the immigrant workers in the care homes. In other words, where salaries are lower in the care homes, it is a general phenomenon and not specifically related to immigrant status.
Another issue that may not be limited to the immigrant worker experience alone is safety and health conditions at workplace. The nature of the care home work is such that care workers are often exposed to some risks to their health and safety. This is particularly relevant to the tasks of lifting the residents or moving them from one to the other place. Care workers may not always get the safety related tools or harnesses that are needed to get these tasks done without risk to their health or safety. This is however not just a condition that exposes immigrant health care workers but also affects other workers in the care home workplace. Again, it is difficult to say that immigrant workers are more exposed to these issues as compared to those who are not immigrant workers. This is a phenomenon that may equally affect both immigrant as well as other workers because it relates to the general conditions of the work and not specific conditions related to immigrant workers.
Similarly, the phenomenon of experience of violence by the care home workers does not seem to be experienced by the immigrant workers alone. Literature suggests that experience of violence in care home settings is a common phenomenon due to the work conditions of the care homes where the workers have to deal with residents who may be suffering from dementia. In this context as well, this research did not find that the experience of violence was limited to the immigrant workers or affected them disproportionately or was related to the specific condition of their being immigrants. There is no basis for saying that care home workers that are immigrants experience more violence than those who are not immigrants. An exception can be made in the context of bullying which can be linked to verbal violence where some immigrant workers may face bullying from the colleagues or even from the residents. However, the findings of this research suggest that such bullying is linked to their inability to understand instructions or the nature of their work, which may be related to the initial phases of their work and does not seem to be an ongoing experience. What the findings do suggest is that many immigrant workers find support in their colleagues and are helped by their team mates to do their work. Most participants in this research have responded that they were able to cope with the challenges of their work due to supportive colleagues and many denied ever being bullied at all. This suggests that immigrant workers in care homes may not be particularly victimised by bullying because of their foreignness or immigrant status, although there are some who may be victimised for these very reasons. The evidence from this research does not suggest that there is a major problem of bullying for the immigrant workers based simply on their status as immigrants or foreigners. Therefore, it is difficult to align the findings of the dissertation in this context with the notion that immigrant workers in care homes are made to work under more disadvantaged conditions as compared to the other workers. What can be acknowledged is that some immigrant workers in the care homes may experience bullying by their colleagues or by the residents because of their inability to understand instructions or work requirements as they may have language barriers.
Certain recommendations suggest themselves based on the findings of this research. The first of these recommendations is related to the salary of the workers. This research found that although the work conditions in the care homes can be difficult and involve overwork at times, the salaries of the workers in the private care homes are not commensurate to the conditions of the work or the nature of the work. With relevance to this, it is suggested that care home workers should get more salaries. It may be mentioned that this recommendation is based on the suggestions given by the participants of this research study, most of whom have mentioned that salaries are less than expected or not commensurate with the nature of the work. In this regard, it is suggested that if not similar to the public sector employees, salaries of the private sector care home workers should be at least commensurate with the work that they do.
The second recommendation of this research is that the care home workers should have health insurance provided by the employer. Most of the participants in this research have reported to health problems that arise from the nature of the work, such as, lifting of residents and shifting them bodily from one to the other place. These health related problems were reported by almost all of the participants. While health related problems may be common, most care home workers have reported to getting paid less than expected. Therefore, it can be assumed that care workers may sometimes have health related issues due to which they may not be able to work for some time. Therefore, it is important that they are safeguarded against such contingencies. For this purpose, as suggested by one of the participants of this research, there should be health insurance of the care workers.
The third recommendation is related to provision of safety equipment and appropriate machinery. As care workers are required to take care of the residents which may include bodily shifting and lifting of the residents, appropriate equipment should be provided to them. Most of the participants reported to facing health related problems due to this lack of safety equipment of the care workers. Thus, it is recommended that the care workers’ exposure to such health risks me mitigated by providing adequate equipment for their work involving lifting, shifting or at times even restraining of the residents. This suggestion is also put forth by some of the participants in the research.
The final recommendation relates specifically to immigrant care givers. As new immigrant care workers can have language barriers or may take time to understand the cultural contexts of the new country and their workplace, it is important that special care is taken of them in the initial period of their entry into the care homes if they are new to the UK. Management must take such care and also ensure that immigrant care workers are not being bullied or harassed by their colleagues or residents. It is not that immigrant care workers are the only ones who are exposed to violence; violence is a common phenomenon of the care home work conditions. However, immigrant care workers are more vulnerable than the others especially in the new phase of their work in the UK and therefore, there should be some mechanisms in place to allow escalations of any complaints related to bullying or exposure to violence. This should be in place for all workers but some extra care can be taken of immigrant workers initially so as to provide them support and ensure that they are not exposed to bullying or harassment at this time.
One limitation of this research is that the sample size was very small. Due to constraints of time and resources, only 10 care home workers were interviewed in this research study. This is a small sample and it may be that the findings have not been able to reveal general patterns which can only be done with a larger sample. Thus, a future research study with a larger sample can be undertaken to conduct a more extensive exploration of experiences of immigrant workers.
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