The world population is ageing, and the number of older adults who need assistance in activities of daily living has been increasing accordingly [
1]. At the same time, the ability to provide informal care to frail older adults within the family is declining, among other things due to drop in fertility [
2], women joining the workforce [
3] and increasing divorce rates [
4]. Consequently, in most western countries the home care services are provided by paid care workers - either locals or migrants [
5]. This solution is a win-win situation for both care recipients and governments. For the older adult, it allows them to stay in their homes as long as possible, as most of them hope and aspire [
6]. For governments, every day at home means a day less in public funded expensive long-term placement [
5].
While this arrangement is financially cost-effective, it entails other costs. Home care workers are particularly vulnerable to both violations of workers’ rights and work-related abuse. Violations of workers’ rights refer to disregarding rights that relate specifically to being a worker [
7], whereas work-related abuse refers to any violent acts against a person at work or on duty [
8]. The vulnerability of home care workers stems mainly from the intimate nature of their work, and the long-term and intensive relationships between the care recipient and the care provider.
Migrant home care workers might be at greater risk for exploitation and work-related abuse compared with local home care workers, as they are in the middle of the “three axes of disadvantage” [
9]. In addition to the intimate nature of their job and the gendered aspect of care work, their vulnerability stems from their migratory status as temporary visitors [
9]. As a result, their duties and rights are different from that of citizens [
9]. Moreover, many migrant care workers pay thousands of dollars to obtain a work permit in the host country [
10,
11]. Thus, in their first years of employment, most of their salaries are used towards settling these enormous debts. Under these circumstances, leaving an abusive employer is extremely difficult [
10].
The Israeli case
Whereas in many western countries such as the US and the UK, the support offered by the state to older adults is limited, and is mainly given in extreme cases of need [
12], the Israeli government offers relatively generous support, in order to assist family members who care for older adults in their homes. In the home care sector, there is no governmental limit to the number of working permits provided to migrant workers, as it is determined solely on the basis of demand. Thus, while in Western countries migrants in the care sector constitute between 18 to 25% of the care work for older adults [
13], in Israel about 50% of the care work for older adults is provided by migrant workers.
The government supports Israeli citizens aged 60 (females) or 65 (males) and up, who live in their homes and are unable to perform their activities of daily living (such as eating or bathing) independently. The result of this arrangement is that most older adults with functional impairments live at home, and only a small percentage lives in long-term care facilities [
14]. This arrangement is cost-effective, as the cost of paid home services is far lower than the price of long-term care facilities [
15]. This is also the preferred option of the older adults and their family members, who wish for the older adult to stay at home for as long as possible [
6].
The Israeli home care system offers two options for in-home care services for older adults with functional impairments who wish to stay in their homes: Live-out home care services and live-in home care services. Live-out home care service is given to older adults with mild to moderate impairments in activities of daily living (ADL). Older adults might be entitled to partial support (up to 9.75 h per week) or “full” support (22 h per week) [
16], depending on degree of impairment. Live-out care service is provided only by locals, i.e., Israeli citizens. There are about 70,000 local home care workers and most of them work part time only (average of 23 h per week) with multiple older adults [
6]. The local live-out care workers tend to view their job as a low-status one, and continue doing it because no other job opportunities are available to them [
17].
Live-in home care services are provided only by migrant workers. Live-in home care services are provided to older adults who need round-the-clock care. These individuals are severely impaired in their activities of daily living, or need constant supervision due to cognitive impairment. Currently, there are about 48,000 migrant workers who work as live-in care workers legally, and approximately 12,000 who work illegally [
18]. The majority of the migrant care workers are Filipino women [
19] as in other developed countries such as the UK, US and Canada [
20]. Israel constitutes an important case study, as the country with the second largest ratio of migrant care workers to citizens within the OECD countries, after Italy [
16].
As in other countries [
21], the social rights and workers’ rights of migrant care workers in Israel are restricted. For example, they are entitled to medical insurance, but at the same time, are excluded from other Israeli employment laws which would have ensured their right to overtime payment. This is similar to the US, the UK and Canada, where some of the regulations for institutional settings do not apply to migrant home care workers [
20]. Nonetheless, and similar to the US [
22], there are a few rights that are not linked to citizenship or residency, such as the right to a minimum wage and the provision of sick leave which apply also to migrant home care workers. Whereas in countries such as the US or the UK, the support offered by the state to older adults is limited [
12], and sometimes imposes bureaucratic hurdles [
20], in Israel, this process is smoother [
23]. Every older adult, who is severely impaired in activities of daily living, or needs constant supervision, is allowed to hire a round-the-clock migrant home care worker through a generous subsidy by the state (about 70%).
Although the process might be less bureaucratic for the older care recipient, this is not the case for the migrant care worker. As in many other countries, migrant home care workers need to go through a long process to get a work permit [
24] and need to pay thousands of dollars in illegal fees for brokers in the host and sending countries. Although the law allows the home-care companies to collect a maximum of 1100 USD [
24], in 2016, the average amount paid by migrant care workers in Israel was about 10,500 USD [
25]. These amounts are considered enormous in their country of origin. As a result, the migrant workers often are forced to borrow money from their families or communities. During the loan repayment period, many migrant care workers will do anything in their power to maintain their place of work, sometimes at the cost of tolerating serious exploitation and even sexual or physical violence [
25].
Social workers can play an important part in securing the welfare of care workers [
26]. Many services related to home care are coordinated, provided and supervised by social workers. Monitoring the psychosocial needs of older adults and helping to adjust to chronic conditions [
27] are among the roles of social workers in the home care setting. In addition, some social workers are responsible for the initial placement of the home care workers within the home and for the welfare of the care recipient as well as the care worker. As such, gaining knowledge into the working conditions of home care workers is crucial for social workers. Because this is an underserved population, social workers might serve this population and support its basic needs for welfare and emotional support.