With rapidly aging populations and rising levels of female employment, the United States and other wealthy nations are facing unprecedented demands for non-familial care. These nations vary in their ability to address such demands. Those with more robust welfare states, including publicly supported, high-quality child care and elder care services and facilities, are generally able to meet growing needs for care, while those with weaker welfare states experience severe “care deficits,” leaving families with few alternatives. Increasingly, in the United States and elsewhere in the developed world, families are turning to migrants—usually women—to solve their care dilemmas.

Migrants generally receive lower pay than native-born caregivers, and often agree to “live-in.”  But at what cost to themselves? For many, home-based caregiving falls into the category of “precarious employment”—working without a contract—which means their jobs may be terminated at any moment. For live-in workers, losing a job means risking homelessness. Their duties may extend beyond caregiving to cooking and housekeeping for an entire family. Their hours may be ill-defined, with little or no time for rest, few or no days off, or no paid vacations. Few home-based caregivers receive benefits such as health insurance, and many are paid “under the table,” accepting wages in cash and not paying taxes, but also forgoing old-age protections such as social security.

How is it that care work has become a precarious occupation? The explanation varies from one society to the next, but almost everywhere, one reason is that migrant caregivers differ ethnically or racially from the dominant population, which denigrates care and other forms of personal service and relegates such work to stigmatized “others.” Another, of course, is that care is considered women’s work, and devalued as such. In wealthy countries, native-born workers are increasingly unwilling to take caregiving jobs unless they are professionalized and well-paid, usually as part of the welfare state (like, for example, positions in public child care in France and the Scandinavian countries). Female caregivers who work in isolated private homes are vulnerable to racial, ethnic, and sexual harassment. They have little leverage vis à vis their employers because domestic and care work is seldom covered by labor laws, or well regulated.

Caregivers who are migrants may experience a higher level of precarity, due to flawed immigration systems that either subject them to strict conditions or deny them legal entry altogether. An example of the first is Taiwan, where migrants are restricted by law to providing elder care only (a restriction that employers often ignore, adding child care, housework or other chores to their duties) and where their immigration status is linked to specific jobs. If migrants quit or are fired, they must find another job within two weeks or face deportation. Often they owe unscrupulous brokers for transportation costs and exorbitant fees for both the placement itself and for “training.” Not surprisingly, few of these women (many quite young) are willing to risk challenging employers for mistreatment or worse and being deported.

While Taiwan has a specific policy, however lopsided, for admitting migrants to become caregivers, the United States has no immigration category covering such workers. Legal entry is granted to temporary or seasonal workers needed for “low-skilled” occupations such as agriculture and hospitality, and to those who can qualify as professionals in STEM fields, but potential caregivers fall through the cracks. Their work is not recognized as skilled, nor is it considered temporary or seasonal. As a result, many migrant women working as caregivers simply overstay tourist visas, while others rely on highly-paid “coyotes” to smuggle them across the border, frequently facing the peril of sexual assault, as the New York Times recently reported.

Like their counterparts in Taiwan, migrant care workers in the United States hesitate to demand better working conditions, lest they be deported. Moreover, they are reluctant to go home to visit family members (including their own children), since returning to the United States exposes them to the risk of interception or the perils of relying on a coyote. As a result, many migrant caregivers go years without seeing their loved ones—the very people for whom they are making considerable sacrifices.

Growing awareness of their plight has prompted both national and international organizations to seek improvements in the working conditions of migrant care workers. In 2011, the International Labour Organization adopted c.189, a convention on “Decent Work for Domestic Workers.” While comprehensive in scope and potentially offering protections to an estimated 50 to 100 million workers around the globe, the convention (like all ILO measures) must be adopted by member states in order to take effect. As of 2018, only 27 had done so. Although the United States is not among that number, c. 189 has inspired one U.S. organization, the National Domestic Workers Alliance, to fight for passage of Domestic Workers Bills of Rights, succeeding in eight states and the city of Seattle, with several more campaigns ongoing.

Care workers’ advocates have been less successful in reforming immigration laws. One program often cited as a model, Canada’s Live-In Care Program, in 1992 began to offer a path to citizenship for migrants who worked full-time as caregivers for one year. In 2014, however, a conservative government abruptly ended the policy. In the United States, repeated calls on Congress to create an immigration category tailored to care workers have been in vain.

In these and other societies, the need for non-familial caregivers will only continue to grow, and with it, very likely, the reliance on migrants to meet that need. At the same time, however, the families that migrants leave behind—especially children and elders—also need care, and while migrants’ remittances are crucial for those households, their absence takes its toll on their loved ones. Reformed labor laws and immigration categories would undoubtedly lessen some of the difficulties faced by these essential workers, but policymakers should also consider the broader long-term consequences and persistent inequities of the global tilt of care from the developing world to the richest countries.