Table 2.

Descriptive Summary of Included Studies (n = 18).

Reference	Geographical area	Long-term care system by authors	Effect of dependence on employment	Summary of results	Quality score
Bettio, Simonazzi, and Villa 2006	Greece, Spain, Italy, and Portugal	Informal	Migrant care workers crowd out the supply of specialized care	A new care model is generated by the arrival of female migrants: “Migrant in the family” model. It is cheap and flexible, resolving the deficiencies in public provision, while reducing the cost of the service	4
Browne and Braun 2008	US	NA	The need for LTC workers is increasing	Globalization, population aging, and immigration impact on the LTC workforce, which, in turn, affects global poverty and economic inequalities, the feminization and colorization of labor, and empowerment and women’s rights	4
Cangiano et al. 2014	Europe	Formal and informal	Demographic aging has led to growing reliance on migrant workers in the provision of older adult care in most European countries	Demographic aging and the shrinking of intergenerational care support have themselves been a powerful impetus for employment creation by generating additional labor demand within specific sectors of the economy. In many European countries, this labor demand cannot be met without migrant care workers	5
Chen 2016	Taiwan	NA	There is occupational segregation in care labor market	The gap between the dual care system and workforce regulations has clearly resulted in occupational segregation in the secondary care labor market. Foreign home caregivers should be made insiders, equally protected by labor regulations. This will allow service receivers to choose caregivers without exploiting foreign caregivers and will therefore guarantee more employment opportunities for local caregivers and an improvement in the overall quality of care	12
Da Roit, González Ferrer, and Moreno-Fuentes 2013	Italy and Spain	Informal	The lack of development of LTC policies and services have encouraged the use of migrant care workers	LTC policies in Italy and Spain have been aimed at neither the socialization of risks of dependency nor the creation of employment in the sector. A combination of factors has created a situation in which migrant labor plays a central role in the working of the Southern European welfare regimes, with predominantly female migrants filling roles in the low-paid and informal domestic worker market, while the growth of formal care employment has been more modest. This situation is likely to interfere with future development in care policies in these countries but may also affect the opportunity to develop a properly regulated care sector	4
Da Roit, Le Bihan, and Österle 2007	Austria, France, and Italy	Mixed: Austria and France Informal: Italy	Unconditional cash benefits develop a grey care market. They reduce employment creation	Countries differ in: 1) how cash benefit programs have been developed, and 2) how the benefits can be used to obtain care. In France, the benefits serve to fund specific care packages, encouraging a formal market. In Italy and Austria, beneficiaries are free to use the benefit as they wish, facilitating a grey market. In the three countries, the benefits are used to pay for care in the informal sector, which continues to be the largest source of LTC provision	4
Da Roit and Le Bihan 2010	Germany, Austria, France,Italy, the Netherlands, and Sweden	Largely unregulated cash benefit system: Germany, Austria, and Italy Highly regulated cash benefit system: France Social services model: The Netherlands and Sweden	In Sweden and the Netherlands, cash benefits are an attempt to bring care back to the family.In France, the cash payments are intended to boost employment. In other countries, cash payments allow and sustain the partial removal of care from the family through the reliance on an unregulated care market	The common trend is for cash benefit programs for care provision. The allowances have been used to maintain or increase informal care, contain costs and support the market. The benefits have created new forms of employment and have affected both informal care and the organization of care work and caregivers	4
Da Roit and Weicht 2013	Austria, France, Germany, Italy, Netherlands, Norway, Spain, Sweden, and UK	NA	The intersection of care, migration, and employment regimes shapes different patterns of migrant care work	This research studies two main outcomes: Migrant-in-the-family and migrant-in-formal-care. The migrant-in-the-family outcome depends on two necessary conditions: Limited public expenditure on LTC services and a high proportion of migrants in low-skilled jobs, but there are different paths in different countries. The migrant-in-formal-care outcome depends on four conditions: High expenditure on services, lack of expenditure on uncontrolled cash-for-care schemes, allocation of predominantly low-skilled jobs to migrants, and absence of an underground economy	9
Di Rosa, Melchiorre, Lucchetti, and Lamura 2012	Italy	Familistic	The use of migrant care workers has relieved many families of care tasks but partly “crowded out” formal care services	The findings show that the private employment of migrant care workers by families of dependent older people in Italy has relieved them of the most burdensome care activities, especially in case of live-in solutions. Professional services are being partly crowded out by migrant care workers in most usual care tasks, and they are reacting only very slowly to the growing request for more targeted investments and expertise to better train and properly integrate these new actors into the existing formal care network	5
Lundsgaard 2006	Australia, Austria, Canada, Germany, Ireland, Japan, Korea, Luxembourg, Netherlands, Norway, Spain, Sweden, UK, and US	Informal: Korea, Spain, Japan (mandatory insurance provides substantial formal services), US (informal, but now paid), and Canada (informal, but now paid) Mixed: Austria, Luxembourg, Germany, Ireland, UK, and Australia Formal: Netherlands, Norway, and Sweden	Payments for informal care can undermine formal care employment and normal labor market	Giving older adults a budget or cash to pay informal caregivers can help tap into a wider pool of human resources where there are shortages of professional care workers. On the other hand, a functioning market for formal home care services (or public supply of such services) is essential to allow relatives of older people in need of care to maintain their attachment to the normal labor market. Payments for informal care can risk creating “incentive traps” that attract informal caregivers away from the normal labor market, if the interaction between informal care payments, taxes, unemployment benefits, and other transfer incomes is not well-controlled. After having been away from a normal job for a period, it can prove difficult to return	4
Pavolini and Ranci 2008	Germany, France, Italy, the Netherlands, UK, and Sweden	Mixed and integrated: France and the Netherlands Mixed, services oriented: UKServices: Sweden Informal: Germany and Italy	Low quality employment may still increase due to the separation of funding and supply. This has made it very difficult to control the level of quality of both employment and care	Long-term care reforms have resulted in a general trend towards convergence in social care at three levels: a) macro: the continental countries have increased the number of people in receipt of care, but the northern countries have reduced the degree but not the intensity, of service provision. Italy continues to rely on families and the market; b) meso: a larger range of providers has been implemented, citizens have been empowered with the capacity to choose, but a major percentage of acquisition and control is in the public sector; and c) micro: the new forms of support for informal care have favored the regularization of caregiver employment and promoted the recognition of informal care as quasi-professional. Benefits have not helped to eradicate gender inequality in care provision	4
Shutes 2012	UK	NA	The employment of migrant care workers has emerged in the context of growing demand for care alongside processes of cost containment	Migrant mobility is conditioned by immigration controls, in both access to the labor market and job changes. Migrant care workers find employment in the care sector due to lack of opportunities in other sectors, accepting it out of necessity and not by choice. It is also difficult to change employer as the immigration authorities may view this negatively. On occasions, employers hold back, or do not pay, wages to migrant care workers. Their working days are longer than those of native workers are, and they are often used to cover staff shortages	7
Shutes and Chiatti 2012	England/UK and Italy	England/UK: Formal Italy: Informal	State policies in care and migration shape demand for migrant labor across both informal and formal models of care, and regular and irregular care labor markets	In England and Italy, marketization (contracting-out of services to private providers and the provision of cash transfers to older people to directly purchase their care) has contributed to the increasing employment of care workers in private sector services and in private households directly by older people and their families. However, the extent of these types of employment varies according to differences in levels of public provision and in types of provision, between services and cash transfers	9
Shutes and Walsh 2012	England and Ireland	Formal	Market-oriented and cost containment policies have created divisions of race, ethnicity, and citizenship in LTC provision	Market-oriented policy aims for personalization, as well as for cost containment, thus raising implications for divisions of race, ethnicity, and citizenship in increasingly marketized and privatized systems of long-term care, as regards the financing, purchasing, and delivery of services. By framing the provision of care in terms of the responsiveness of providers to the preferences of the individual service user, racialized hierarchies for the selection of care workers and their allocation to individual users are potentially legitimated	11
Simonazzi 2009	Germany, Austria, Greece, France, Italy, UK, and Sweden	Mixed, continental: Germany and Austria, Formal, continental: France Formal, Northern European: UK and Sweden Informal, Mediterranean: Greece, Italy, and Spain	Regulated markets secure an adequate supply of native workers. Conversely, unregulated markets have not been able to produce a sustainable solution in terms of the quantity and quality of care labor	France, United Kingdom, and Sweden have fostered the creation of a formal market. In Sweden and France, the workforce is native and in the United Kingdom, the workforce is mixed—native and migrant. Germany and Austria have used cash transfers to promote family and informal care. Germany depends on a native workforce and Austria on a mixed workforce—native and migrant. The Mediterranean countries have developed an extensive irregular supply of migrant care workers in an informal market	4
Spetz, Trupin, Bates, and Coffman et al 2015	US	NA	Demographic and utilization changes will have little effect on projections of robust long-term care employment growth between now and 2030	Given the movement toward non-institutional care for the coming generation of older adults, and the resulting forecast growth of the number of direct care provider jobs, now is the time to develop and enhance training and education programs for all direct care workers	6
Van Hooren 2012	Italy, the Netherlands, and England	Familistic: Italy Social democratic: the Netherlands Liberal: England	Cutbacks and need for elderly are likely to further increase the demand for migrant labor in care services	Social care policies and the way in which the state organizes the social care sector were found to have a considerable impact on migrant care work. The availability of public services crowds out the demand for private (migrant) care services. Moreover, a large public investment in public services makes the social care sector attractive for native employees and decreases the dependence of care providers on foreign labor. A familistic care regime induces a “migrant in the family” model of care, while a liberal care regime leads to a “migrant in the market” model of employment and a social democratic care regime creates no particular demand for migrant workers in elderly care	9
Williams 2012	Spain, UK, and Sweden	Spain: Informal, Mediterranean UK: Liberal Sweden: Social democratic	The number of migrant care workers is increasing	The intersection between care, immigration, and employment regimes generates variations between countries. In Spain, hiring migrants for care provision is a result of welfare payments, immigration policies and the worse working conditions make migrant employment accessible. In Sweden, migrant employment in health and social care is a reflection of cost-effectiveness and increased outsourcing in a modernized welfare state. In the United Kingdom, the increased use of au pairs and nannies reflects class preferences in home care, consumer discourse, and logistical difficulties in care responsibilities when there is more than one child in the household. The provision of elderly care, however, is dominated by the private sector	11