African migrant women in the aged care sector: Conceptualising experiences of racism,micro-aggressions and Otherness

Abstract

Existing commentary rarely systematically acknowledges racism in the Australian aged care field. This article begins to address this gap through a detailed focus on the experiences of 30 African migrant women workers, one of the fastest growing groups employed in aged care across Australia. Drawing on data generated through in-depth, semi-structured interviews, we argue that racist micro-aggressions, specifically micro-insults and micro-assaults, were a commonplace experience for this group of workers. Micro-insults and micro-assaults were perpetrated interpersonally, and also drew upon and reinforced colonial discourses about backwardness, inferiority and Otherness. We conclude that for these carers, micro-aggressions have a two-fold effect: they express everyday racism in interaction, and they position African migrant carers as unwelcome and unable to care for and care about clients.

Keywords

African migrants African women aged care micro-aggressions migrants racism

In this article, we apply the concept of micro-aggressions to African migrant women’s experiences of working in the Australian aged care sector. Drawing on 30 in-depth, semi-structured interviews, we argue that the racism expressed by clients, their families and their managers are micro-aggressions (Sue et al., 2007, 2008a, 2008b), the sometimes ‘small’, often taken-for-granted expressions of racism that are generated through interactions and are indicative of wider power structures. Micro-assaults and micro-insults were perpetrated in interaction, and rooted in and bolstered colonial discourses of ‘the West and the Rest’ (Hall, 1992) that have a long history of constructing non-Western people as Other to the West. Colonial and colonising assumptions about Otherness construct ‘the Rest’ through abject signifiers of ‘backwardness’, ‘savagery’ and ‘inferiority’. These were sometimes explicit and more commonly disguised and implicit in clients’ and colleagues’ assumptions about carers’ training, skills and commitment to caring, and in subtle messages that carers were not welcome in their workplaces. Micro-aggressions thus reinforced practices that normalise specific, White, carer and caring identities, while casting migrant Others as illegitimate and inferior.

Our discussion is motivated by the significance of aged care as a social and policy challenge (Isherwood and King, 2017; Mavromaras et al., 2017; Senate Standing Committee on Community Affairs, 2017) and the need to more directly and systematically acknowledge the existence and implications of racism in this field. Australia, in common with many Minority-world countries, faces a ‘care crisis’ (Fine and Mitchell, 2007), wherein the care needs of older people are difficult to meet through family-based informal care (Morrison-Dayan, 2019). In the marketised and commodified aged care sector, poor labour conditions and the physically and emotionally demanding nature of the work intensify the shortfall of carers (Isherwood and King, 2017). In response, migrants have been positioned as a useful cohort for servicing the ageing population, in Australia (Adamson et al., 2017) and internationally (Fujisawa and Colombo, 2009). However, workers’ racial or ethnic identities are treated as relevant primarily in terms of how such identities shape capacity to meet the needs of culturally and linguistically diverse client groups, most commonly discussed with reference to professional and language skills deficits (Adamson et al., 2017; Mavromaras et al., 2017). There is very little emphasis on the migrant aged care workforce as a group with specific needs and experiences beyond client requirements – and almost none on how race might shape these. Thus currently we have a truncated understanding of Australian aged care.

Where research does exist, Isherwood and King (2017) draw attention to the focus on ‘migrants’ as a homogeneous group, an approach which lacks nuance given that European studies have highlighted how assumed migrant status, country of origin and skin colour shape client and colleague racism, with African carers particularly subject to explicit racism (Doyle and Timonen, 2009; Munkejord and Tingvold, 2019; Stevens et al., 2012; Timonen and Doyle, 2010). There is the need for detailed descriptions of contemporary racism perpetrated against African migrant workers across aged care contexts – one of the fastest growing groups of employees in one of the largest industries in Australia (Mavromaras et al., 2017). In this article, then, we aim to build empirical knowledge of the experiences of these workers.

We also aim to extend the conceptualisation of contemporary racism in Australian aged care work. While there has been some ambiguous recognition of clients’ and co-workers’ racism (see for example, SA Health and Community Services Skills Board, 2011), existing literature has tended to marginalise racism in recommendations for institutional and industry change (Productivity Commission, 2011; Senate Standing Committee on Community Affairs, 2017). This is not to argue that racism is the only defining feature of aged care work but, as Mapedzahama et al. (2012) note with regard to nursing, there is a risk of portraying a race-less workplace and ignoring the experiences of migrant workers when racism is not a research focus. We use Sue et al.’s (2007, 2008a, 2008b) racial micro-aggressions theory to develop a more nuanced understanding of racism in aged care, extending beyond obvious expressions of racism to attend to subtle and pervasive discrimination. It is this ‘everyday racism’ (Essed, 1991) that constitutes the lived experience of African migrant workers, especially in contexts where policies forbid explicit racism and co-workers, managers and supervisors may be sensitive to the inappropriateness of obvious racism while perpetrating subtler forms that go unnoticed (Deitch et al., 2003). Together, the empirical and conceptual aims of this article offer a greatly strengthened understanding of aged care in Australia.

In the following section we introduce the concept of micro-aggressions and illustrate its relevance through reference to research on migrants working in aged care internationally and in Australia. We then outline this project’s research design, before presenting African migrant women’s experiences of micro-assaults and micro-insults as they were perpetrated by clients, clients’ families, managers and supervisors. We conclude that racism is a commonplace and normalised experience for African migrant workers, expressed through micro-insults and micro-assaults. We highlight how micro-aggressions work as expressions of everyday racism in interaction; discursively, they position African migrant carers as unwelcome in individual worksites and the wider aged care field by positioning them as incapable of properly caring for and about clients.

Racial micro-aggressions in aged care

Racial micro-aggressions are subtly degrading expressions of discrimination and inequality perpetrated against people of subordinate groups in mundane and ordinary interactions (Sue et al., 2007, 2008a, 2008b). They are commonly regarded as insignificant or harmless because they are often expressed in ‘small’ ways, such as snubs, dismissive looks, gestures and tones (Sue, 2004). They may be easily overlooked or dismissed, invisible to perpetrators and sometimes, recipients (Sue et al., 2007). Victims who recognise micro-aggressions do so because they have long experience of interpreting the racist implications of contextualised interactions (Sue et al., 2007, 2008a, 2008b).

The dominant taxonomy identifies three types of racial micro-aggressions: micro-invalidations, micro-assaults and micro-insults (Sue et al., 2007). Micro-invalidations are displayed through behaviours that omit, discredit or deny the thoughts, feelings or experiences of minority groups. Micro-assaults are outright racist expressions or acts directed towards minority groups (for example, through racial epitaphs, avoidant behaviour or purposeful racist actions). The third type of micro-aggression, micro-insults, is behaviours that are implicitly hostile, insensitive or send humiliating messages. In this article we focus on micro-assaults and micro-insults because these were the experiences described by participants.

The concept of micro-aggressions has not been widely applied in research on migrant workers in aged care. Sethi and Williams’ (2016) research is an exception, noting the perpetration of micro-aggressions by co-workers and managers through micro-insults (for example, tone, or implied assumptions about migrant workers’ trustworthiness, training and culture) and micro-assaults by clients and, less often, managers (specifically, racial abuse). Sethi and Williams’ (2016) findings on the existence of racism are reflected in studies of race and aged care more generally, with researchers describing racist interactions in ways we conceptualise as micro-assaults. These are primarily perpetrated by clients (Gillham et al., 2018; Nichols et al., 2015), for example, through rejecting care from culturally and linguistically diverse workers because of their visibly different skin colour (Doyle and Timonen, 2009; Nichols et al., 2015; Timonen and Doyle, 2010), a finding evident in Gillham et al.’s (2018) Australian study. This rejection often rests on assumptions about African carers’ lack of ‘appropriate care-giving approaches’, and their ‘not being gentle, bombastic, heftier, and of a darker colour’ (Nichols et al., 2015: 27). Mapedzahama et al.’s (2012, 2018) research on African nurses in Australia described similar attacks and rejection of care as an almost daily occurrence.

Managers’ and supervisors’ racist treatment of workers is most commonly evident through what we conceptualise as micro-insults. For example, managers may decide that African carers are incompetent or poorly trained (McGregor, 2007; Nichols et al., 2015), leading Timonen and Doyle (2010) to conclude that skin colour marks ‘difference’ in a way that migrant status does not. These findings echo Australian studies on aged care (Adebayo et al., 2020; Goel and Penman, 2015; Nichols et al., 2015) and nursing (Mapedzahama et al., 2012, 2018), which show that workers are assumed to lack skills and professional qualifications because of their race and country of origin. Aligned with such attitudes, African aged care workers describe their managers assigning harder and less desirable work and shifts (Goel and Penman, 2015). In the context of nursing, when African nurses report racist clients, managers may collude in the clients’ racism by failing to address the racism and re-allocating patients to White nurses (Mapedzahama et al., 2012) – behaviours we describe later in this article.

Liegghio and Caragata (2016) note that micro-aggressions, even when ‘minor’, reflect and reproduce a hostile and unaccommodating environment for marginalised groups, eroding psychological and emotional wellbeing (see also Sue, 2004). This environment extends beyond the immediate institutional or interpersonal context to structural and cultural inequalities. Micro-aggressions are interactional but, as Pérez Huber and Solorzano (2015) argue, their logic and expression are informed by ideas of White superiority that sustain racial inequality.

The ways in which micro-aggressions sustain racial inequality rest on historical precedents that inform contemporary racism. Stuart Hall’s work on colonial discourses deepens our understanding of contemporary expressions of racism because these exist as an extension of colonial frameworks of meaning which other specific racial groups. As Hall argues in his seminal article ‘The West and the Rest’ (1992), building on Said’s (1978) classic arguments in Orientalism, colonial discourses worked as a system of representation and a ‘categorising tool’ to produce constructions of colonial subjects as irrational, primitive, savage, backward, crude and inferior. Colonial discourses were also a ‘paradigm of comparison’ and a ‘benchmark of assessment’ through which the West becomes the ‘epitome of human progress’, competence and civility. These colonial frameworks remain pertinent, as Hall (1992: 221) argues:

Discourses don’t stop abruptly. They go on unfolding, changing shape, as they make sense of new circumstances. They often carry many of the same unconscious premises and unexamined assumptions in their bloodstream.

Thus, colonial meanings continue to confer racial inferiority on those constructed as Other to the West.

Research design

The concept of micro-aggressions privileges the interpretations of those who negotiate racism over the course of their lives, as a tool for identifying and understanding interactions that might otherwise be misrecognised or denied (Sue et al., 2007). In-depth, semi-structured interviews allowed us to centre these understandings. These were loosely structured around issues identified through a literature review and the first author’s informal discussions with her African migrant community. Participants were invited to reflect on discrimination and the satisfying elements of their work, their interactions with clients, clients’ families and co-workers, and institutional processes (e.g. training, complaints). Participants were also encouraged to discuss additional ideas meaningful to them. Thus, we sought holistic and contextualised accounts of aged care work as it was understood by the research participants.

Interviews were conducted with 30 African migrant women working in aged care in an Australian city. All participants identified as Black African women. Participants had migrated from six African countries: Nigeria (n = 19), Kenya (n = 7), Ghana (n = 1), Liberia (n = 1), Ethiopia (n = 1) and Congo (n = 1). Most had worked in professional roles in their country of origin. Twenty-five women held an undergraduate degree in their country of origin and were pursuing a health-related degree in Australia; three held nursing qualifications and were not undertaking further studies; two held high school qualifications and planned no further study. All participants had completed Certificate 3 training – an industry requirement. At the time of the research, participants had lived in Australia between one and 14 years; most (n = 22) had lived in Australia between one and five years. Twenty-two were temporary residents with visa restrictions on the length of their stay, four were Australian citizens, two were permanent residents (living permanently in Australia but without full citizenship status) and two were skilled migrants.

Purposive sampling was used to include women working in residential care (n = 22), home care (n = 3) and across settings (n = 5). Residential care clients can no longer live independently and require daily support; in home care, people receive support for daily living activities while remaining in their community. Most participants worked in roles associated with hands-on care and support; two women worked as nurses, responsible for assessing and meeting clients’ medical care and supervising other workers. Twenty-four women were employed casually, with 18 of those working in a single facility and six employed by agencies across multiple sites. One participant was contract staff, two held part-time permanent positions and three held permanent full-time positions.

We used thematic analysis to identify key patterns in the data (Braun and Clarke, 2020). After reading the transcripts, the authors collaboratively developed an initial coding frame that sought to categorise experiences of racism. This was then applied by the first author before being further refined through discussion and additional coding by all authors. Micro-aggressions were identified as a potentially relevant conceptual tool after initial coding highlighted pervasive racism that was sometimes explicit but more commonly difficult for participants to articulate. Thus, the data informed our use of existing theory to further refine analysis.

Our findings and conclusions should be read in light of the implications of our analytic approach and study design. Our analysis emphasises racial micro-aggressions over an intersectional analysis (for example, gender, language, training, skin colour), which would generate different nuances. Including only Black African migrant women does not allow for comparison across sex or other migrant groups. The high proportion of casual workers may have shaped participants’ vulnerability to client and co-worker micro-aggressions. The expression and significance of micro-aggressions may be different for African women working in diverse positions (for example, personal care staff compared to nurses) but our sample does not allow us to identify such patterns systematically. However, the sample is diverse in terms of countries of origin, language proficiency, Australian residence and workers’ professional backgrounds. In common with most qualitative research, the driving concern of this article is developing a nuanced understanding of a social phenomenon, not generalisability. Both the sample’s diversity and its homogeneity facilitate a contextualised and in-depth analysis of racism as a lived experience.

African migrant carers’ experiences of micro-aggressions

In the following section, we illustrate diverse micro-aggressions through participants’ quotes. While presented as specific examples, these accounts were contextualised in descriptions of the ongoing racism that constituted the logic of aged care work – they should not be understood as singular interactions. Our discussion centres on micro-assaults and micro-insults – the predominant forms of micro-aggressions described by participants. Micro-invalidations were absent from the narratives – we suggest this is due to the nature of the work, which did not position clients and managers in ways that assumed or encouraged their engagement with the lived experiences of aged care workers.

Micro-aggressions perpetrated by clients and their families

Micro-assaults were more commonly described by women employed in residential care facilities than in home care. This is likely a reflection of clients’ lack of control over the allocation of carers and the staffing and timetabling complexities that limited – but as we shall see, did not prevent – responsiveness to clients’ racist preferences. Participants commonly described micro-assaults perpetrated through racial epitaphs centred on care workers’ physical characteristics in ways that reflected dominant cultural understandings of ‘real’ racism (Sue et al., 2007). These micro-assaults drew from the negative cultural meanings associated with Black bodies in ways that echoed colonial constructions of ‘Black Others’ as crude and dirty (Hall, 1992), and reflected imagery described in Mapedzahama et al.’s (2012) research with African nurses in Australian hospitals. The following quotes are indicative of experiences across the sample.

There was a client that asked me, ‘When last did you have a shower?’ and I asked, ‘Why?’ He said, ‘If you shower, you will not remain like this, your skin is black.’ I don’t mind, I am proud of my colour. (Lizzy)

Some clients don’t want Blacks to attend to them or touch them, they think Blacks can change their colour or make them dirty. (Mide)

I and my Australian colleague were caring for a resident and she was like, ‘Can you tell this animal to get her hands off me.’ (Jennifer)

Clients drew on such imagery when rejecting care because workers were Black women from African countries. The following accounts from Jessica and Rebecca illustrate this rejection, common in residential care and evident but less widespread in home care:

There are some clients that don’t just want your colour – they are racist. They request for another carer, showing they don’t just want your colour. Some would say, ‘You are black, get out of my sight.’ For these ones, it’s demoralising, you feel, you have gone there to help someone and he or she is yelling, ‘You Black, get out of here.’ They want someone else and that person is a white carer. There’s nothing you can do; they keep yelling like you are doing something bad to them. (Jessica)

It’s a lot. When you go to their homes, just the other day I went to attend to a client and she told her brother, ‘The black one, I don’t want the black one.’ So, the client went to sit outside until my shift was over and I would send the brother to give her drinks, because anytime I just try to go close, she says, ‘I don’t want the black one.’ Some are a bit racist and the carer to relieve me was a white colleague and when she saw the White carer, she was very joyful and happy, like ‘Yay!!!’ (Rebecca)

These accounts reflect international studies, which also describe clients’ explicit rejection of ‘Black’ carers and ‘Black’ care (Bourgeault et al., 2010; Sethi and Williams, 2016; Shutes and Walsh, 2012; Walsh and Shutes, 2013). Jessica and Rebecca were clear that such rejection reflects clients’ racism. This racism draws from and drives the association of an inferior and abject Otherness with inferior and unwelcome care and conversely, the acceptable care offered by a ‘White’ person. While micro-assaults can be subtle, in this instance they were overt and aggressive. They were also normalised and embedded in mundane interactions: Jessica was clear that such behaviours could not be challenged or changed, and Rachel worked with, not against, this racism.

Rejecting care was also informed by racist assumptions about carers’ substandard skills and orientation to care. This was typically expressed through micro-insults – that is, implicitly hostile or humiliating interactions (Sue et al., 2008a). Chimanda described these assumptions in ways that echoed Hall’s (1992) argument that ‘the Rest’ is constructed through colonialist discourses as less capable, backward, and less developed than ‘the West’. She said:

When a carer talks, they just assume, especially being from the African continent, you are always being looked at as the inferior race. It’s not a surprise to me, because continuously, you do a good job, and you are still reminded, you are a migrant.

Chimanda’s comments indicate how skin colour and migrant status were mutually constituted in clients’ assessments of African carers and care, and how these denied the possibility of good care, in contrast to her own assessment of her work. Dara bluntly put the point: ‘They believe Africans are not smart or good in anything.’ Other participants also described micro-insults implying the inter-relationship between racial identity and a lack of skills. For example, Myra recalled, ‘I was changing a pad for a client and he was like, “Can you do it properly”?’; fixing an incontinence pad was a routine practice, not difficult or technical work. Similarly, Nimi reflected, ‘There are clients that think you don’t know anything while undertaking aged care work, and they report you to management and you are interrogated.’ This judgement diverged from Nimi’s own assessment of her orientation to her work: ‘I am a detailed and result-oriented person.’

Clients’ families perpetrated similar racist undervaluing of skills. For example, Christine described a client’s parents’ assumptions about her lack of skills, training and authority:

The client’s parents come in once a month and they assume this Black person is not who I should talk to. The assumption is you are not the nurse, maybe you are a personal care worker or a team leader [roles with less authority]. It’s not very direct, you’d see it in their faces, and it takes a minute before they can come around. When they are dissatisfied, they look for the nurse or team leader and it takes a while before they realise, I am the person they should talk to.

Michelle also described a client’s family rejecting the care of African migrants.

I’ve gone to a facility and a Black colleague told me the family of the resident was very racist and would never greet or say hi to a carer who is African, who would even ask the employers why they are employing Africans. It does happen sometimes.

In questioning the recruitment of African migrant carers, this family implicitly devalued their skills and capacity for care for clients; in refusing to acknowledge African carers, the family denied those carers a legitimate presence – indeed, they denied their physical presence – at the facility. These micro-insults were subtle, and participants recognised them with reference to past experiences and the racist context within which they worked. The racism was implicit in such misrecognitions and omissions, rendering it difficult to confront and so normalising and embedding it in interactions.

Clients denied participants’ orientation to care, as well as their skills and capacity. For example, they implied that African migrant carers were driven by pecuniary interests (see also McGregor, 2007, in the UK context).

It’s just a client, who can be verbal, asking why you came here, government is allowing people to come in, and you came here just for the money. (Emmanuella)

As Webb (2015) notes, migrating for financial reasons is not intrinsically bad, harmful or illegal. Indeed, the Australian government has clear policies for promoting economic migration – albeit for specific classed and raced categories of people. However, in the context of this reported exchange, claiming a carer’s work is motivated solely by money implied that the care was not ‘genuine’; an aged care worker must care about clients (that is, be concerned for their wellbeing) – an orientation implicitly denied to Emmanuella by the client – as well as care for them (the work of care) – a set of skills commonly ignored by clients and their families.

The assumption that African migrant carers do not care about their clients was also evident in clients’ implicit references to Black poverty and criminality, which again rest on colonial representations of savagery and backwardness (Hall, 1992). These assumptions have also been described in international studies (England and Dyck, 2012; Sethi and Williams, 2016). In our study, for example, when talking about the challenges she faced with clients in aged care, Mayo shared:

When you want to attend to some clients, they say their things have been stolen, someone wants to kill me, or someone wants to do nasty things to me when you want to care for them.

Nneka described a similar micro-insult by a client using home care:

The moment she asked which country I was from and I told her, she was, said we are all scammers there and she literally watched me like I was going to steal something all through the shift and I was not comfortable.

The array of micro-aggressions perpetrated by clients and their families was often discomfiting or confronting in the moment and reinforced the institutional and cultural positioning of African migrant carers as unable to appropriately care for or about, and as unwelcome and Othered in aged care spaces. These micro-insults and micro-assaults were normalised, a taken-for-granted element of the work; however participants were ambivalent about their significance and appropriate responses. Tolu’s comment highlighted the tension described by many: micro-aggressions were often perpetrated by clients who were frail and seemingly driven by historical beliefs or past experiences or their present illness or dementia, and they were also personally hurtful and denied workers’ professional identity and pride in their work.

With clients, yes, I experience discrimination, but I wouldn’t judge them, their behaviour. Even if I felt that way, you just have to take it, like that’s part of the job. The one I experienced was, there is this client that said he doesn’t like Blacks – in such a case they don’t send Blacks there. The reason can be based on past experience that could make them traumatised. It could be based on this, that he or she doesn’t want a Black worker. So, you respect what clients want. We are being taught not to take anything personal – whatever they do, don’t take it as discrimination. Though we are humans, sometimes I feel bad, but I don’t take anything personal – it’s part of the job that you experience a lot of things.

Phrases such as ‘you just have to take it’, ‘there is nothing much I can do’, ‘it’s normal’ and ‘it’s part of the job’ were repeated in almost every interview. However, such comments belied more complex responses, which included workers seeking support from supervisors and managers, typically unsuccessfully. In the following section, we turn to participants’ experiences of micro-aggressions as perpetrated by these supervisors and managers.

Managers and supervisors ignoring and perpetrating micro-aggressions

Managers and supervisors tended to ignore client micro-aggressions and micro-insults perpetrated against African migrant carers. When carers sought assistance from the institution to manage clients’ micro-aggressions, they were challenging racist denials of their professional skills and care work, while simultaneously acknowledging the limits of their authority to directly address clients’ behaviours. These processes intersected with the practicalities of managing and meeting clients’ care needs when they rejected African migrant carers. Here, Bola described her decision to report client racism to her supervisor:

What I did was, to report to the nurse on floor, I told her this client does not want me, and the nurse said, ‘Okay that is fine because clients have the right to choose who they want, it’s part of their right, there is nothing we can do about it.’ All the nurse said was that if the client does not want me, she will just take me over somewhere else where I can work.

Caroline also reported her experience of clients’ racism, hoping her concerns would be taken seriously:

Clients’ discriminatory attitude makes you a bit sad, but you soak your emotions and keep on going with work. What I do is report to the nurse and hopefully the nurse will talk to the client – which is not always the case.

In neither account is there a strong indication that supervisors and managers actively sought changes in client behaviour or demanded that African migrant care workers be respected. Indeed, Bola was explicit that these responses were precluded because clients’ standing to accept or reject care was prioritised over workers’ claims to professional respect and the opportunity to do their job. Racist micro-aggressions against African migrant carers were largely overlooked or unaddressed, perpetuating a sense Otherness experienced by migrant workers in this space. We suggest that this is, itself, a form of micro-insult in its marginalisation of African migrant carers’ work.

Managers and supervisors also perpetrated micro-aggressions but, by virtue of their institutional positioning, these took a different form compared to those of clients and clients’ families. Managers’ micro-assaults were not delivered as explicit racism – a finding that contrasts with prior studies (Doyle and Timonen, 2009; Sethi and Williams, 2016). Rather, their micro-insults implicitly rested on colonising tropes which positioned African migrant carers as less capable, less welcome and less valued, compared to other colleagues.

Supervisors and managers used their oversight and authority to highlight minor failings on the part of African migrant carers. Wura reflected,

Yes, I have met difficult supervisors. They find petty issues to pick with you, some might be very irrelevant, and they’ll make a big deal out of it, maybe to intimidate you, but you notice those issues, they wouldn’t be picking with Australian co-workers. Yeah, because it’s very easy to observe. They ask questions like, ‘Why did you leave that jug there? Why are you not wearing your name badge?’

A focus on formal rules (wearing name badges) or arguably normative expectations (the placement of a jug) may not on its face suggest that a supervisor was querying Wura’s capacity to care. But such questions, understood in a context of not ‘picking with Australian co-workers’, implied that Wura was not meeting the institutional expectations of care workers – her choices were presented by her supervisor as out of step with professional norms and, by extension, she was positioned as incapable of meeting the standards of ‘the West’.

Supervisors’ and managers’ micro-insults could also erode participants’ sense of belonging to the workplace more generally. Kemi explored these when reflecting on her supervisors’ leadership:

I have seen discrimination with my supervisors when it comes to the working relationship – like, they won’t engage you the same way they engage the other Australians workers or such – that’s one way. I don’t know, even when they have these social and end-of-year activities, most of them only engage the Australians, and we do not participate in suggesting ideas for the parties or anything. You are not given the opportunity to anchor any part of the program and even most of the ideas when we go to these meetings, when you make suggestions, they’ll just sweep it under the carpet. And some of the complaints – I know some of my friends whose ideas have been dismissed, but with the Australian workers, they make use their suggestions.

Supervisors interacting with African migrant carers in a different register and marginalising and ignoring their suggestions for group activities eroded those women’s position as carers and as members of the worksite and work teams. While not directly commenting on African carers’ abilities to care for or about, Kemi’s supervisors’ micro-insults communicated to carers that they were out of place and unwelcome.

Other micro-insults conveyed a lack of welcome in more material ways. Joke, for example, explicitly linked the allocation of shifts to racism:

Management could discriminate in terms of allocation of shifts. They tend to give some persons more shifts for reasons best known to them. Whoever employs you would not outrightly say you are Black or treat you Blackish – sometimes through the way shift is allocated you know this person does not like me and if you don’t know me and you judge me, it’s because I am Black and you have seen my colour.

Joke suggested that the unequal distribution of shifts reflected managers’ dislike for Black carers and a desire to withhold from then the benefits of increased work and pay. Her experiences echoed those of migrant carers in other studies whose managers allocated to them difficult or different shifts (Goel and Penman, 2015; McGregor, 2007; Nichols et al., 2015). These practices positioned carers as unwelcome in the field of care work, because they were not given opportunities similar to those of their Australian co-workers, thus limiting their capacity to care for clients.

Conclusion

The concept of micro-aggressions has been critiqued as overly sensitive to minor and subjectively interpreted infractions of civility. However, we argue that it is an important tool for highlighting the pervasive racism structuring aged care work. It offers insights into both the experience of racism in interaction and aged care as a site of ongoing colonial discourses, even as racism is formally rejected and censured.

Our findings indicate that racism is a widespread element of African migrant women’s experiences of aged care work. The extent of racism reported by participants in this study somewhat contrasts with prior research on migrant carers in Australia, which recognises but does not so strongly emphasise racism perpetrated by clients and managers (Gillham et al., 2018; Goel and Penman, 2015; Nichols et al., 2015; Willis et al., 2018). We suggest this difference emerges from our specific focus on African aged care workers, which in turn highlights the racist framings informing the perceived limits to their caring skills and orientation (Mapedzahama et al., 2012, 2018). Participants’ emphasis on Black identities and skin colour throughout the interviews suggests the value in thinking further about the intersection of migrant status and ‘Black-ness’ – an analytic question that is beyond the scope of this article but may offer additional, fruitful insights into race and migration in Australia and more broadly.

The significance of micro-assaults and micro-insults lies not only in the expression of racism in the moment, but in the positioning of African migrant carers as unwelcome and unable to properly care for or care about older people. This was overt in the rejection of care and racist slurs that comprised most micro-assaults. It was also evident through micro-insults perpetrated through clients’ and clients’ families’ refusal to recognise participants’ skills and commitment to care, or when managers failed to acknowledge and welcome participants’ caring work. These micro-aggressions powerfully positioned African migrant carers as ‘different’, problematic and unwelcome in the workplace.

Micro-aggressions must be understood with reference to the specificity of aged care. The experience of having people – often, essentially, strangers – enter one’s personal space is can be a discomfiting or threatening element of older people’s lives (Buch, 2013). This discomfort is intensified in the bodywork (Twigg, 2000) that much care entails, including intimate practices such as showering, assisting with toileting and fixing incontinence pads (Stacey, 2011). These practices can be undertaken in ways that acknowledge a client’s personhood or leave them feeling that they are simply another routine in the day. Thus, bodywork demands client trust (Stacey, 2011), a complicated and racialised connection when White clients fear or disdain African migrant carers, associating ‘Blackness’ with dirtiness or threat, and rejecting their care. Clients’ families may be motivated by a combination of protectiveness and racism. They may wish to protect their relative and ensure they are comfortable, happy and receive appropriate care, and racist assumptions mean they pursue this aim by removing African migrant carers from the care of their relative. Micro-aggressions highlight how clients’ definitions of and desires for trusted carers can be rooted in racism and expressed in ways that deny the personhood and professional capacity of those caring for them.

The weight of these sensitivities is reinforced through the commodification of care that positions clients and their families as consumers of care (Henderson and Willis, 2020). As consumers, they may legitimately accept or reject care practices, standards and attitudes as they associate them with particular categories of carers and require an aged care facility or agency to respond to their definitions of appropriate carers (Shutes and Walsh, 2012). The casualisation of the aged care labour force may also shape how micro-aggressions impact on workers. Casual workers do not have claim to job security or a reliable schedule and number of employment hours. Charlesworth and Isherwood (2020) have found that this precarity is racialised, with frontline aged care migrant workers from non-English-speaking backgrounds more likely to experience casual employment or be under-employed. It may be that the women in this current study – most of whom were employed casually – were not given schedules that offered regular interactions with clients, with the potential to build relationships of trust and erode clients’ racist assumptions. It may also be the case that casual workers did not feel secure enough in their employment to directly challenge clients’ racism or demand greater support from their supervisors. These issues were not explored in the interviews and would benefit from more systematic interrogation in future research.

For African migrant carers, the disjuncture between a commitment and ability to provide care and the client’s racist rejection of that care has a personal, emotional impact – Jessica described it as ‘demoralising’. Its impacts also reinforce the racial hierarchy that informs such racism and the assumed authority to determine and demand appropriate – White – care. Throughout this article we have used the language of ‘caring for’ and ‘caring about’ to indicate the affect and material dimensions of care, with our data suggesting that African migrant carers are often positioned by clients and colleagues as unable and unwelcome to fulfil either type of care. We suggest there is further conceptual work to be done on the different dimensions of appropriate and accepted care in the context of aged care. Tronto’s (1993, 1998) work on the caring process (conceptualised as consisting of three elements: caring about, care giving and care receiving) may offer rich possibilities in this regard. Our findings suggest the value of recognising a different dynamic to that addressed in much of the literature on the ethics of care in aged care, which emphasises care recipients’ dependency and disempowerment, and staff power to limit and deny clients’ choices about their care (Petriwskyj et al., 2015). Our findings also suggest the importance of interrogating how the marketisation of care renders the caring process more complex when care recipients are simultaneously dependent and positioned as having the authority to express their expectations of care and have them met (see also Schillmeier, 2017). A future, dedicated analysis of how racist micro-aggressions work to deny or allow migrant workers’ participation in the fundamentally relational caring process offers the opportunity to bring an influential feminist framework more directly into conversation with a gendered and raced site of care.

Micro-assaults and micro-insults were experienced interpersonally, but they drew upon and reinforced the wider, historical and contemporary colonial discourses that devalue African migrant carers as part of a much broader category of ‘the Rest’ who are made to the feel Othered in the aged care space. The colonial language of ‘savagery’, ‘primitiveness’, ‘backwardness’ and ‘inferiority’ (Hall, 1992: 186) was (thinly) disguised and reproduced in the assumptions that underpinned micro-aggressions – sometimes spoken, sometimes implicit – that African migrant care workers were incompetent, less intelligent and inferior, lacking the necessary caring skills, knowledge and orientation (Alexis and Vydelingum, 2004; Mapedzahama et al., 2012). Thus, the superiority and normalisation of ‘the West as Best’ sits at the heart of aged care.

Recognising the colonial echoes of contemporary micro-aggressions highlights the policy challenges of racism perpetrated against African migrant workers. Widespread racism occurs in workplaces that formally reject and sanction such discrimination. Earlier aged care studies have also noted a gap between policy and workplace practices (Nichols et al., 2015; Shutes and Walsh, 2012), but the challenges extend beyond questions of implementation. While institutional contexts will inform the specificity of policies and practices, we suggest that as a central principle, changes to policy and practice should critically interrogate if and how colonialist discourses are challenged. Policy and practice developments should privilege and support migrant care workers’ abilities and desire to care for and care about clients, and position them as ‘real carers’, as professionally skilled, and as welcome and able to provide care. Those interrogating and acting on the array of now well-established aged care policy ‘challenges’ (cultural competence, integrating multicultural teams, cross-cultural communication, training and care standards; see Isherwood and King, 2017; Productivity Commission, 2011; Senate Standing Committee on Community Affairs, 2017) must take seriously how Othering, which our study suggests is a defining element of African migrant carers’ experiences of aged care, structures aged care work and workplaces. There is a need to recognise that workers’ distress, disappointment or anger in these circumstances is not simply an individual emotional reaction to incivility or workplace challenges, but an indicator of the widespread, historical and contemporary discourses that limit and deny African migrant workers’ professional skills, identities and contributions to aged care.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Temi Olasunkanmi-Alimi

Kristin Natalier

Author biographies

Temi Olasunkanmi-Alimi is a PhD candidate in the College of Humanities, Arts and Social Sciences at Flinders University. Her research centres on interpersonal and institutional racism as experienced by African women working in the Australian aged care sector.

Kristin Natalier is an Associate Professor in Sociology at Flinders University. Her current research includes ARC-funded projects on mapping Australia’s domestic and family violence workforce, and understanding children’s experiences of home when their parents separate. She works with community partners to build effective responses to domestic and family violence.

Monique Mulholland works with feminist, queer and postcolonial/critical race theory, exploring young people’s negotiations and experiences of gender, sex and sexuality norms and subjectivities. Recent publications include Race and Sexuality: Colonial Ghosts and Contemporary Orientalisms (2019) and ‘“Western Sexy?” The West, the Rest and Sexualised Media’ (Feminist Media Studies, 2017).

References

Adamson

Cortis

Brennan

Charlesworth

(2017) ‘Social Care and Migration Policy in Australia: Emerging Intersections?’, Australian Journal of Social Issues 52(1): 78–94.

Adebayo

Nichols

Heslop

Brijnath

(2020) ‘A Scoping Review of Dementia Care Experiences in Migrant Aged Care Workforce’, The Gerontologist 60(2): e105–e116.

Alexis

Vydelingum

(2004) ‘The Lived Experience of Overseas Black and Minority Ethnic Nurses in the NHS in the South of England’, Diversity in Health and Social Care 1(1): 13–20.

Bourgeault

I. L.

Atanackovic

Rashid

Parpia

(2010) ‘Relations between Immigrant Care Workers and Older Persons in Home and Long-term Care’, Canadian Journal on Aging/La Revue canadienne du vieillissement 29(1): 109–18.

Braun

Clarke

(2020) ‘One Size Fits All? What Counts as Quality Practice in (Reflexive) Thematic Analysis?’, Qualitative Research in Psychology, online first: doi:10.1080/14780887.2020.1769238.

Buch

E.D.

(2013) ‘Senses of Care: Embodying Inequality and Sustaining Personhood in the Home Care of Older Adults in Chicago’, American Ethnologist 40(4): 637–50.

Charlesworth

Isherwood

(2020) ‘Migrant Aged-care Workers in Australia: Do They Have Poorer-quality Jobs than their Locally Born Counterparts?’, Ageing & Society, online first: 1–21.

Deitch

E.A.

Barsky

Butz

R.M.

Chan

Brief

A.P.

Bradley

J. C.

(2003) ‘Subtle yet Significant: The Existence and Impact of Everyday Racial Discrimination in the Workplace’, Human Relations 56(11): 1299–324.

Doyle

Timonen

(2009) ‘The Different Faces of Care Work: Understanding the Experiences of the Multi-cultural Care Workforce’, Ageing and Society 29(3): 337–50.

10.

England

Dyck

(2012) ‘Migrant Workers in Home Care: Routes, Responsibilities, and Respect’, Annals of the Association of American Geographers 102(5): 1076–83.

11.

Essed

(1991) Understanding Everyday Racism: An Interdisciplinary Theory. Newbury Park, CA: Sage.

12.

Fine

Mitchell

(2007) ‘Immigration and the Aged Care Workforce in Australia: Meeting the Deficit’, Australasian Journal on Ageing 26(4): 157–61.

13.

Fujisawa

Colombo

(2009) ‘The Long-term Care Workforce: Overview and Strategies to Adapt Supply to a Growing Demand’, OECD Health Working Papers No. 44. Paris: OECD Publishing, https://doi.org/10.1787/225350638472.

14.

Gillham

De Bellis

Xiao

Willis

Harrington

Morey

, et al. (2018) ‘Using Research Evidence to Inform Staff Learning Needs in Cross-cultural Communication in Aged Care Homes’, Nurse Education Today 63(April): 18–23.

15.

Goel

Penman

(2015) ‘Employment Experiences of Immigrant Workers in Aged Care in Regional South Australia’, Rural & Remote Health 15(1): 1–14.

16.

Hall

(1992) ‘The West and the Rest: Discourse and Power’, pp. 275–331 in Hall

Gieben

(eds) Formations of Modernity. Cambridge: Polity Press/Open University.

17.

Henderson

Willis

(2020) ‘The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia’, pp. 249–67 in Collyer

Willis

(eds) Navigating Private and Public Healthcare. Singapore: Palgrave Macmillan.

18.

Isherwood

King

(2017) ‘Targeting Workforce Strategies: Understanding Intra-group Differences between Asian Migrants in the Australian Aged Care Workforce’, International Journal of Care and Caring 1(2): 191–207.

19.

Liegghio

Caragata

(2016) ‘“Why Are You Talking to Me Like I’m Stupid?” The Micro-aggressions Committed within the Social Welfare System Against Lone Mothers’, Affilia 31(1): 7–23.

20.

Mapedzahama

Rudge

West

Perron

(2012) ‘Black Nurse in White Space? ethinking the In/visibility of Race within the Australian Nursing Workplace’, Nursing Inquiry 19(2): 153–64.

21.

Mapedzahama

Rudge

West

Kwansah-Aidoo

(2018) ‘Making and Maintaining Racialised Ignorance in Australian Nursing Workplaces: The Case of Black African Migrant Nurses’, Australasian Review of African Studies 39(2): 48–73.

22.

Mavromaras

Knight

Isherwood

Crettenden

Flavel

Karmel

, et al. (2017) National Aged Care Workforce Census and Survey: The Aged Care Workforce 2016. Canberra: Commonwealth of Australia.

23.

McGregor

(2007) ‘Joining the BBC (British Bottom Cleaners): Zimbabwean Migrants and the UK Care Industry’, Journal of Ethnic and Migration Studies 33(5): 801–24.

24.

Morrison-Dayan

(2019) ‘A Viable Care Migration Programme for Australia’s Ageing Population: Recruiting Migrant Personal Care Workers for Australian Aged Care’, Australian Journal of Social Issues 54(4): 371–85.

25.

Munkejord

Tingvold

, (2019) ‘Staff Perceptions of Competence in a Multicultural Nursing Home in Norway’, Social Science & Medicine 232: 230–7.

26.

Nichols

Horner

Fyfe

(2015) ‘Understanding and Improving Communication Processes in an Increasingly Multicultural Aged Care Workforce’, Journal of Aging Studies 32: 23–31.

27.

Pérez Huber

Solorzano

(2015) ‘Racial Microaggressions as a Tool for Critical Race Research’, Race Ethnicity and Education 18(3): 297–320.

28.

Petriwskyj

Gibson

Webby

(2015) ‘Staff Members’ Negotiation of Power in Client Engagement: Analysis of Practice within an Australian Aged Care Service’, Journal of Aging Studies 33: 37–46.

29.

Productivity Commission (2011) Caring for Older Australians, Report No. 53 (Final Inquiry Report). Canberra: Commonwealth of Australia.

30.

SA Health and Community Services Skills Board (2011) Innovation in VET Project: Supporting a Culturally Diverse Workforce in Aged Care. Adelaide: SA Health and Community Services Skills Board.

31.

Said

(1978) Orientalism. London: Penguin.

32.

Schillmeier

(2017) ‘The Cosmopolitics of Situated Care’, Sociological Review 65(2): 55–70.

33.

Senate Standing Committee on Community Affairs (2016) Future of Australia’s Aged Care Sector Workforce. Canberra: Commonwealth of Australia.

34.

Sethi

Williams

(2016) ‘Microaggressions of Caregiver Employees: What Has Social Work Got to Do with It’, Diversity & Equality in Health and Care 13(5): 365–71.

35.

Shutes

Walsh

(2012) ‘Negotiating User Preferences, Discrimination, and Demand for Migrant Labour in Long-term Care’, Social Politics 19(1): 78–104.

36.

Stacey

(2011) The Caring Self: The Work Experiences of Home Care Aides. Chicago: University of Chicago Press.

37.

Stevens

Hussein

Manthorpe

(2012) ‘Experiences of Racism and Discrimination among Migrant Care Workers in England: Findings from a Mixed-methods Research Project’, Ethnic and Racial Studies 35(2): 259–80.

38.

Sue

(2004) ‘Whiteness and Ethnocentric Monoculturalism: Making the “Invisible” Visible’, American Psychologist 59(8): 761–9.

39.

Sue

Capodilupo

Torino

Bucceri

Holder

Nadal

, et al. (2007) ‘Racial Microaggressions in Everyday Life: Implications for Clinical Practice’, American Psychologist 62(4): 271–86.

40.

Sue

Capodilupo

Holder

(2008a) ‘Racial Microaggressions in the Life Experience of Black Americans’, Professional Psychology: Research and Practice 39(3): 329–36.

41.

Sue

Nadal

Capodilupo

Lin

Torino

Rivera

(2008b) ‘Racial Microaggressions against Black Americans: Implications for Counseling’, Journal of Counseling and Development 86(3): 330–8.

42.

Timonen

Doyle

(2010) ‘Migrant Care Workers’ Relationships with Care Recipients, Colleagues and Employers’, European Journal of Women’s Studies 17(1): 25–41.

43.

Tronto

J.C.

(1993) Moral Boundaries: A Political Argument for an Ethic of Care. New York: Routledge.

44.

Tronto

J.C.

(1998) ‘An Ethic of Care: Generations’, Journal of the American Society on Aging 22: 15–20.

45.

Twigg

(2000) ‘Carework as a Form of Bodywork’, Ageing & Society 20(4): 389–411.

46.

Walsh

Shutes

(2013) ‘Care Relationships, Quality of Care and Migrant Workers Caring for Older People’, Ageing & Society 33(3): 393–420.

47.

Webb

(2015) ‘The Feminisation of Migration and the Migrants VET Policy Neglects: The Case of Skilled Women Secondary Migrants in Australia’, Journal of Vocational Education and Training 67(1): 26–46.

48.

Willis

Xiao

Morey

Jeffers

Harrington

Gillham

, et al. (2018) ‘New Migrants in Residential Aged Care: Managing Diversity in Not-for-profit Organisations’, Journal of International Migration and Integration 19(3): 683–700.