Canada’s demographics are changing in a variety of ways. Our population is both aging and increasingly made up of immigrants.1 Too often, these are considered separate demographic shifts by policy makers and the media, with older people thought of as primarily Canadian-born, and immigrant populations seen as predominantly made up of young families and adults in the prime of their working lives.
Case in point: in April 2021, the Long-term Care (LTC) commission on COVID-19 in Ontario published an important and scathing report on the province’s handling of the pandemic and its LTC system in general (Marrocco et al., 2021). However, the only mention of the ethno-cultural diversity of Ontario’s seniors is buried late in this 322-page report.2 The word “immigrant” appears only once, and only in the context of “a very high representation of racialized, immigrant women in personal support worker (PSW) roles” (p. 12). Thus, in a report responding to a crisis which disproportionately impacts racialized, immigrant Canadians (Ajadi & Thompson, 2021), there is no mention of the specific LTC needs of racialized, immigrant seniors. This omission is by no means exceptional.
This policy oversight is problematic for several reasons. First, it ignores a rapid demographic shift: immigrants over the age of 65 comprise 30.7% of their age cohort, which is the highest representation of immigrants in any age cohort (Statistics Canada, 2017b).3 Second, it overlooks systemic problems like poverty and a lack of culturally appropriate care that contribute to immigrant seniors in Canada having poorer health outcomes and more unmet care needs than non-immigrant seniors. Third, it obfuscates these systemic problems by employing and contributing to stereotypes about immigrant families wanting to care for their older family members at home. Fourth, this oversight obscures the important contributions of non-employed immigrant seniors, who are often active community members, volunteers, and grandparent caregivers.
Canadian policy makers need to address this policy oversight with increased consideration for the unique challenges and contributions of immigrant seniors and how these influence LTC needs. That is, we need to reconceptualize our perspectives on immigrant seniors. The following are some suggestions in this regard, followed by policy recommendations.
Unique challenges and contributions of immigrant seniors in Canada
1) Immigrant seniors are more likely to be poor than Canadian-born citizens and have lower or no access to pensions or savings. Low-incomes are directly linked to poorer health outcomes for immigrant seniors compared to their Canadian born counterparts (van Ingen et al., 2015).
2) Immigrant seniors are more likely to have unmet homecare or LTC needs, including but not limited to access barriers due to language, immigration status, and longer waitlists for multicultural LTC homes (Bowden, 2021; Um, 2016, 2021; Um et al., 2019b, 2019a).4
3) While immigrant families may be more likely to provide home-based care to their older family members than non-immigrant families,5 not all immigrant families can or do (Blakemore, 1999; Um & Lightman, 2016). Stereotypical assumptions about stronger filial values among immigrant families are not universal and should not be used as an excuse for not providing LTC services to immigrant seniors (Kobayashi & Funk, 2010; McDonald, 2011).
4) Relatedly, when family care for immigrant seniors occurs, this is not always by choice but rather due to a lack of alternatives; this puts additional burdens on an already disadvantaged population of second-generation Canadians as their immigrant parents age, resulting in financial challenges and caregiver stress and burnout (Um & Lightman, 2016; Um, 2021).
5) Pre-existing immigrant senior services (with some exceptions) tend to focus on offering multilingual services; while this is important, this emphasis disregards other barriers to care faced by immigrants such as poverty and systemic racism (Brotman, 2003; Brotman et al., 2020).
6) Immigrant seniors do not only require care; they also provide it. The contributions of immigrant grandparents to fill gaps in Canada’s patchwork childcare system are underrecognized and undervalued (Bélanger & Candiz, 2019; Dossa & Coe, 2017; Luhtanen & Braganza, 2009). There is evidence that many older immigrants migrate primarily in order to care for their grandchildren (McDonald, 2011).
Better recognition for immigrant senior populations
Better recognition is needed, at the highest policy levels, that immigrant seniors are a growing demographic with unique needs. There is no solution possible until an issue is acknowledged (Luhtanen & Braganza, 2009).
More research on the specific challenges faced by immigrant seniors and their families
More research on the challenges faced by immigrant seniors and their families is necessary to develop effective policies and programs (Ferrer et al., 2017; Johnson et al., 2018; Um, 2021; Um & Lightman, 2016). This should take policy intersections into consideration: for example, how does the slow immigration process vis-à-vis residency status impact immigrant seniors’ pensions and other retirement incomes? How can we better support and recognize the contribution of immigrant grandparent childcare to Canada’s economy and society?
Take an anti-poverty approach
Once we consider policy intersections, an anti-poverty approach to policy would both acknowledge the non-monetary contributions of immigrant seniors as well as the fact that existing public pension schemes don’t always serve immigrants well.6 For example, we could consider modified Canada Pension Plan (CPP) calculations for immigrant seniors who had a shorter Canadian career, such as excluding 10-12 (instead of 8) of their lowest earning years and/or giving pension credits for 2-3 settlement years, in recognition of the economic cost of immigration and integration.7
More funding for culturally diverse services from an anti-racist perspective
Increased funding for immigrant-focused seniors’ centres, home care services, and LTC homes is an important part of the solution. At the same time, we need to consider policy solutions that go beyond multilingual services. This will involve better addressing barriers to home care and LTC institutions as a result of systemic racism in our health and long-term care systems.
Ensuring new national long-term care solutions are accessible to immigrants
As several other academics and advocates have noted, national long-term care insurance could help ensure that all Canadian families, including immigrant ones, have real choice about meeting LTC needs, regardless of income or country of origin (Peng, 2021; Tuohy, 2021). Since a LTC insurance program would likely involve payroll contributions during one’s working life, we would need to ensure that this does not penalize immigrants who may have had a shorter career in Canada (nor any Canadians who work less than full time or not at all for reasons that may include childrearing or disability).
In sum, Canada needs to do a better job of recognizing that systemic gaps in immigrant senior LTC services are not only a care issue but also relate to economic inequality and systemic access barriers to health care and other public institutions. We need more research and thinking on these complex policy intersections to promote innovative anti-poverty, anti-racist LTC support for immigrant seniors. More comprehensive “fixes” to the Canadian LTC landscape, such as long-term care insurance, could be particularly beneficial for immigrant seniors as they are less likely to be able to afford private LTC. However, eligibility requirements must be designed to ensure that those with shorter employment history are not penalized as they currently are with CPP. To better support immigrant seniors, Canada needs to reconceptualize how we see them.
1 Distribution of Canadian population over age of 65: 12.2% in 1996 vs. 16.9% in 2016 (Statistics Canada, 2016). Distribution of immigrants in Canadian population: 17.4% in 1996 (Statistics Canada, 1997) vs. 21.9% in 2016 (Statistics Canada, 2017a). ▲
2 This recommendation noted that LTC homes should provide “culturally and linguistically specific care” including but not limited to “traditional food” and programming in numerous languages (Marrocco et al. 2021, p. 234). ▲
3 Older ethno-cultural adults are the fastest growing segment of the Canadian population (Ferrer et al., 2017; Johnson et al., 2018). ▲
4 For example, one study of seniors in the GTA (2007-2014) found that immigrants are less likely than non-immigrants to receive home care (6.8% compared to 8.8% for non-immigrant seniors) and are more likely to receive informal home care (5.3% compared to 3.5% non-immigrant) (Um & Lightman, 2016). ▲
5 One study found that older immigrants are just as likely to receive family care as Canadian born, but they are more likely to receive exclusively family care (McDonald, 2011). ▲
6 CPP provides a monthly maximum retirement income of $1,203.75 (January 2021). The average monthly amount in January 2021 was $619.75. CPP is calculated based on years and amount of CPP contributions and average lifetime earnings (Government of Canada, 2020). In short, those who immigrate to Canada mid-way through their careers are very likely to have a lower CPP income upon retirement. ▲
7 Additionally, we could consider permitting one parent to claim some (or all) of the 7 years of CPP child-rearing provisions even if some (or all) of their child-rearing years took place outside of Canada, or they did not work in Canada prior to child-rearing. We could also add grandparent child-rearing provisions to CPP calculations, if the grandparent is the primary child-care provider. These two suggestions would benefit senior immigrant women in particular, who are more likely to be poor than their male counterparts (Boyd & Vickers, 2000; Chandamala, Matsuo, & Peng, 2008). ▲
Ajadi, T. & Thompson, D. (2021, May 22). The two pandemics of anti-Black racism and COVID-19 are tied together. The Globe and Mail. https://www.theglobeandmail.com/opinion/article-the-two-pandemics-of-anti-black-racism-and-covid-19-are-tied-together.
Bélanger, D. & Candiz, G. (2019). The politics of ‘waiting’ for care: Immigration policy and family reunification in Canada. Journal of Ethnic and Migration Studies, 1–19. https://doi.org/10.1080/1369183X.2019.1592399.
Blakemore, K. (1999). International migration in later life: Social care and policy implications. Ageing and Society, 19(6), 761–774. https://doi.org/10.1017/S0144686X99007503.
Bowden, O. (2021). Care homes lacking for aging immigrants. Toronto Star. https://www.thestar.com/amp/news/gta/2021/02/15/shortage-of-nursing-homes-geared-to-ethnic-groups-a-disaster-for-aging-immigrant-population.html.
Boyd, M. & Vickers, M. (2000). 100 years of immigration in Canada. Canadian Social Trends, (11), 2–13. https://www150.statcan.gc.ca/n1/en/pub/11-008-x/2000002/article/5164-eng.pdf?st=jl0RSKHj.
Brotman, S. (2003). The limits of multiculturalism in elder care services. Journal of Aging Studies, 17(2), 209–229. https://doi.org/10.1016/S0890-4065(03)00003-3.
Brotman, S., Ferrer, I., & Koehn, S. (2020). Situating the life story narratives of aging immigrants within a structural context: the intersectional life course perspective as research praxis. Qualitative Research, 20(4), 465–484. https://doi.org/10.1177/1468794119880746.
Chandamala, J., Matsuo, T., & Peng, I. (2008). Older Immigrant Women’s Health: From the Triple Jeopardy to Cultural Competency. In P. Armstrong & J. Deadman (eds.), Women’s Health: Intersections of Policy, Research, & Practice (pp. 91–118). Toronto: Scholars Press.
Dossa, P. & Coe, C. (2017). Transnational aging and reconfigurations of kin work. In Transnational Aging and Reconfigurations of Kin Work. https://doi.org/10.36019/9780813588100.
Ferrer, I., Grenier, A., Brotman, S., & Koehn, S. (2017). Understanding the experiences of racialized older people through an intersectional life course perspective. Journal of Aging Studies, 41, 10–17. https://doi.org/10.1016/j.jaging.2017.02.001.
Government of Canada. (2020). Canada Pension Plan. https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-benefit/amount.html.
Johnson, S., Bacsu, J., Abeykoon, H., McIntosh, T., Jeffery, B., & Novik, N. (2018). No Place Like Home: A Systematic Review of Home Care for Older Adults in Canada. Canadian Journal on Aging, 37(4), 400–419. https://doi.org/10.1017/S0714980818000375.
Kobayashi, K.M. & Funk, L. (2010). Of the family tree: Congruence on filial obligation between older parents and adult children in Japanese Canadian families. Canadian Journal on Aging, 29(1), 85–96. https://doi.org/10.1017/S0714980809990341.
Luhtanen, E. & Braganza, S. C. (2009). Including Immigrant and Refugee Seniors in Public Policy. https://www.calgary.ca/content/dam/www/csps/cns/documents/including-immigrant-refugee-seniors-public-policy.pdf?noredirect=1.
Marrocco, F.N., Coke, A., & Kitts, J. (2021). Ontario’s Long-Term Care COVID-19 Commission: Final Report. http://www.ltccommission-commissionsld.ca/report/pdf/Ontarios_Long-Term_Care_COVID-19_Commission_Final_Report.pdf.
McDonald, L. (2011). Theorising about ageing, family and immigration. Ageing and Society, 31(7), 1180–1201. https://doi.org/10.1017/S0144686X11000511.
Peng, I. (2021, May). Long-term care insurance would better serve Canada’s aging population. Policy Options. https://policyoptions.irpp.org/magazines/may-2021/long-term-care-insurance-would-better-serve-canadas-aging-population.
Statistics Canada. (1997). 1996 Census: Immigration and citizenship. 1996 Census: Immigration and citizenship.
Statistics Canada. (2016). Age and Sex Highlight Tables, 2016 Census. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/as/Table.cfm?Lang=E&T=31.
Statistics Canada. (2017a). 2016 Census topic: Immigration and ethnocultural diversity. https://www12.statcan.gc.ca/census-recensement/2016/rt-td/imm-eng.cfm.
Statistics Canada. (2017b). Immigration and Ethnocultural Diversity Highlight Tables. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/imm/Table.cfm?Lang=E&T=11&Geo=00&SP=1&view=2&age=2&sex=1.
Tuohy, C. H. (2021). Federalism as a Strength: A Path Toward Ending the Crisis in Long-Term Care. https://centre.irpp.org/wp-content/uploads/sites/3/2021/03/Federalism-as-a-Strength-A-Path-Toward-Ending-the-Crisis-in-Long-Term-Care.pdf.
Um, S. (2016). Serving Seniors Better through Equity and Diversity in Long-Term Care. https://www.wellesleyinstitute.com/health/serving-seniors-better-through-equity-and-diversity-in-long-term-care.
Um, S. (2021). Reforming long-term care requires a diversity and equity approach. Policy Options. https://policyoptions.irpp.org/magazines/may-2021/reforming-long-term-care-requires-a-diversity-and-equity-approach.
Um, S., Laher, N., & Roche, B. (2019a). The Changing Face of Home and Community Care: Findings from Focus Groups with Family Caregivers of Older Women from Diverse Ethnocultural Communities in the GTA. https://www.wellesleyinstitute.com/publications/the-changing-face-of-home-and-community-care.
Um, S., Laher, N., & Roche, B. (2019b). The Changing Face of Home and Community Care: Findings from Focus Groups with Older Women from Diverse Ethnocultural Communities in the GTA. The Changing Face of Home and Community Care: Findings from focus groups with older women from diverse ethnocultural communities in the GTA.
Um, S. & Lightman, N. (2016). Ensuring Healthy Aging for All Home Care Access for Diverse Senior. Ensuring Healthy Aging for All Home Care Access for Diverse Senior.
van Ingen, T., Khandor, E., & Fleiszer, P. (2015). The Unequal City 2015: Income and Health Inequities in Toronto. The Unequal City 2015: Income and Health Inequities in Toronto.