Violations of workers' rights and exposure to work-related abuse of live-in migrant and live-out local home care workers - a preliminary study: Implications for health policy and practice

Ohad Green, Liat Ayalon

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Background: Home care workers work in an isolated environment, with limited supervision and guidance which makes them more prone to abuse and exploitation. While past research focused mostly on the well-being of care recipients, this study aimed to shed light on the care workers' daily reality and explore if and how boundaries of professional care work are blurred. Our primary aim was to assess the working conditions and the prevalence of abuse and exploitation among live-in migrant home care workers and live-out local home care workers. Methods: A random stratified sample of Israeli older adults aged over 70, who are entitled by law to home care services was used to recruit 338 migrant live-in home care workers and 185 local live-out home care workers to a face-to-face survey. The participants were asked about their relationship with the care recipient and their exposure to violations of workers' rights and work-related abuse. Results: Almost all the participants reported exposure to certain workers' rights violations. Among the migrant live-in care workers, it was found that 58% of them did not receive any vacation days besides the weekly day-off, about 30% reported not get even a weekly day-off on a regular basis, and 79% did not get paid sick days. Local live-out care workers also suffered from a high prevalence of exploitation - 58% did not get any vacation days besides the weekly day-off, and 66% did not get paid sick leave. 20% of the local live-out care workers, and 15% of the migrant live-in care workers did not receive a signed contract. A smaller portion (7.4% among migrant care workers, 2.5% among local care workers) reported work-related abuse. When compared to local workers, migrant home care workers were more vulnerable to some worker's rights violations, as well as emotional abuse. Conclusion: These findings are disturbing, as work-related abuse and exploitation affect not only the well-being of the care worker but also the health of the care recipients, as the quality of care provided deteriorates. At the public policy level, more significant attention and regulation of the home care industry is needed. The frequency and the nature of home visits made by home care agencies must be changed. Also, home care workers should be offered emotional support.

Original languageEnglish
Article number32
JournalIsrael Journal of Health Policy Research
Issue number1
StatePublished - 21 Jun 2018

Bibliographical note

Funding Information:
This study was part of a research project regarding home care services for older adults. It was funded by the National Insurance Institute of Israel (NIII) and approved by the ethics committee of the authors’ University. As such, the recruitment focused on the “caregiving unit”, which was composed of an older adult, his or her family member and the care worker (either local or migrant). A random stratified sample of older adults over the age of 70 who lived in central Israel was drawn from a national pool of older adults who received financial assistance from the NIII under the long-term care community law. The home care workers were recruited indirectly, with the help of the older care recipient or his or her family members. A preliminary letter was first sent to a group of randomly chosen 2014 older adults and their primary family caregivers. Two weeks later, a recruitment phone call was placed to those who did not refuse further contact by phone, fax, or a pre-paid envelope sent to them. If the family member and/or the older adult confirmed that they were willing to participate, we asked them for the phone number of their home care worker, in order to invite this person to participate in the study. We chose the face-to-face method as some of the older adults are incapable of filling out a self-administrated questionnaire. For comparability reasons, this method was used also for the care workers. During the recruitment process, it was emphasized that all potential participants had the right to refuse participation in the study and may withdraw from the study at any time. The participants were explicitly told that their answers would be anonymous and confidential and that refusal to participate would not harm them in any way. Israeli home care workers were interviewed only if they were Hebrew-speaking. Migrant home care workers were interviewed only if they were English or Russian-speaking. The sample flow and the recruitment process are presented in Figs. 1 and 2, respectively. For a full description of the procedure and recruitment methods please refer to Ayalon L, et al [6].

Publisher Copyright:
© 2018 The Author(s).


  • Abuse
  • Home care
  • Immigration
  • Living conditions
  • Long-term care
  • Migrant workers
  • Older adults
  • Workers' rights


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