More than 300,000 people have left their homelands in recent years to come and care for the elderly and sick in Germany. This is beneficial for Germany — but is it also positive for the caregivers? Many countries are competing for their labor.
Researchers have coined the term international “migration industry.” Geographer Stefan Kordel from the University of Erlangen-Nuremberg, southern Germany, told DW that labor migration in the care sector has become highly professionalized. Government and private sector players, even individual clinics and nursing homes, are competing for nursing staff and trainees. Economic interests are at stake.
In extreme cases, his colleague Tobias Weidinger added, it might go something like this: “They say to the recruitment agency, ‘Please deliver us five immigrants for the next training year. If one of them goes back to their home country, then just send us another one. We requested five, so that is how many we want.'”
Germany: Care work in a strained system
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On social media, clinics have been highlighting just how crucial it is to have people with an immigrant background as part of the team. More than 25% of Germany’s population has what is known in Germany as an “immigrant background,” a statistical category to describe someone who immigrated to Germany or who has at least one foreign-born parent.
According to the Federal Employment Agency, the care sector in Germany would collapse without immigration: “Almost one in four nursing staff in nursing homes is a foreign national.”
And in all care professions, one in five people come from abroad. This trend is rising. Many caregivers will soon retire, while others are leaving the profession due to excessive workloads.
Study: How are nurses with a migration background faring in Germany?
In addition to the new nursing staff that has recently arrived from abroad, many of the German specialists in clinics or in geriatric care are German nationals with an immigration background. Many doctors and nurses are former refugees from Syria or Ukraine. They are all helping to ensure that sick and elderly people in Germany are cared for — for the time being, at least.
But as society ages, demand is rising sharply, and the question remains: Are these care workers feeling good enough in Germany to stay?
An interdisciplinary team of researchers at Friedrich-Alexander University (FAU) of Erlangen-Nuremberg has researched how to successfully ensure that care workers with a migration background stay long-term. They surveyed care workers, managers in hospitals and care facilities, administrators, language schools, counseling centers and agencies.
In their study “Inclusion of Care Workers and Nurses with a Migration Background,” the researchers illustrate what is important for well-being: at work in the care sector, but also in everyday life outside of work.
Care exodus: From Manila to Germany
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Recruitment: Colorful brochures — who wins?
“Berlin is this beautiful, Heidelberg is this romantic,” is how colorful brochures promote the country, explained Kordel, adding that many immigrants end up in rural areas, where life is very different from what the brochures suggest. For care workers, it is often a matter of chance which facility they end up in and how much help they receive in building a new life.
There are government “triple win” programs for selected countries such as the Philippines, India, Indonesia and Tunisia. The aim is for everyone to benefit: the countries of origin, Germany and the recruits themselves, whose language course and plane tickets, for example, are covered. Private agencies can obtain a government seal of approval that insures “Fair Recruitment Care Germany.”
However, some agencies charge nursing staff a lot of money, reports Stefan Kordel: “Some pay €12,000 ($13,825), take out loans and pool money from their families.” Then they have to take on a second job on top of care work to pay off their debts. Kordel says that this is why better information is needed, as well as checks and sanctions.
Disappointed with the care jobs in Germany
In many countries of origin, nursing is not taught in a vocational training program as it is in Germany, but is rather part of a university degree. Those who have not been properly informed are disappointed to discover in Germany that, instead of performing medical tasks, they are expected to spend a lot of time providing basic care, washing people or serving food. In many other countries, these tasks are often performed by family members or assistants.
The disappointment is great when trained nursing professionals from the Philippines are not allowed to administer IVs or catheters in Germany, reports Myan Deveza-Grau from the Philippine diaspora organization PhilNetz e.V. to DW: “They can’t understand it: Why am I not allowed to do that?”
What it’s like to be Black in Germany’s health system
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Learning German: Dialects and a double burden
“I have to study German a lot in the evenings. That’s why I don’t have any time. At the weekend, we have to prepare for the exam and the German course. And we also have to attend the German course on Sundays.” This is how a trainee from Vietnam describes her everyday life as a trainee in the study. That leaves hardly any time to build social contacts. On top of that, there is a lot of bureaucracy. This makes mentoring programs and the understanding of colleagues all the more important.
Trainees and nursing staff take German courses in their home countries and bring language certificates with them. But there is often a long wait before they can enter the country. And in some regions of Germany, people speak dialects that are difficult to understand. Researchers at FAU recommend that targeted language courses be offered alongside work, and that institutions should network regionally to this end.
Some changes in nursing care could make life easier for everyone, say researchers. For interest, there are early shift teams that insist that all patients are washed by 8:30 a.m. so that the team can take a break. If a nurse has to take her child to daycare and cannot rely on her family because they live abroad, she cannot start work until 8:30 a.m.
So why not introduce a later shift for moms or dads, who could wash some people later? This would also help those parents who are not immigrants and would also please patients who like to sleep in.
In some places, not enough buses are running in the evening after the end of a late shift or there’s a lack of affordable apartments near the workplace — finding solutions to overcome such obstacles would benefit the entire workforce, not just immigrants.
Discrimination and racism
“What advice would you give to someone from abroad who wants to work in nursing in Germany?” the researchers asked nursing staff.
A woman from Guinea who has been living in Germany for over ten years and has a German passport replied: “You will definitely experience racism.”
As the study shows, hers is not an isolated case. Clinics and nursing homes have been making efforts to raise awareness among their employees. However, there is hardly any awareness-raising for patients and their relatives. Weidinger says: “If the person being cared for says, ‘I don’t want to be cared for by Black people,’ then it becomes difficult.”
Discrimination against minorities exists in all areas of life, as other studies have also shown: in government offices, on public transportation, on the street and in the housing market.
Imported caregiver: skilled, needed, stalled by bureaucracy
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It is up to society as a whole to ensure that nursing staff feel comfortable, says Stefan Kordel.
“Experiences of discrimination and racism influence decisions to stay — or to leave the workplace, the place of residence or even Germany.”
Filipino nursing staff are also concerned about right-wing populism and the Alternative for Germany party (AfD), reports Deveza-Grau. Some said, “I’ll give it a try. If it doesn’t work out, I’ll go somewhere else.”
Canada, for example, is actively recruiting them.
Nursing in Germany: stay or move on?
People want to be accepted and feel at home, as the study documents: “I’ll stay where my family is doing well. Where I’m not harassed and have friends.”
Researchers at the University of Erlangen-Nuremberg recommend more networking between political decision-makers, placement agencies and care facilities, especially with those who have immigrated themselves. This is also what Filipino organizations want, says Myan Deveza-Grau.
Many people now realize that a welcoming culture is needed, says researcher Weidinger.
“Getting immigrants to take part, to integrate, and to stay is a long-term process,” he says. It is a matter of “creating attractive working and living conditions in the long term, taking into account the special circumstances of immigrants. That means creating attractive working and living conditions for everyone.”
This article was originally published in German
