Insights on Canadian Society
Women working in paid care occupations

by Farhana Khanam, Manon Langevin, Katherine Savage and Sharanjit Uppal

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Acknowledgment

This study was funded by Women and Gender Equality Canada (WAGE).

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Introduction

The care economy, which refers to activities related to the provision of care, including care for children, seniors and people with disabilities, as well as health care, education, personal, social and domestic services, is a fundamental component of societies^Note ,^Note  and is a fast-expanding sector of the economy.^Note ,^Note  In Canada and around the world, demographic and socioeconomic transformations—notably the aging population—are increasing the demand for care workers. Indeed, the total number of seniors^Note  surpassed the total number of children^Note  for the first time in Canada’s history in 2016. In addition, seniors could represent between 21% and 30% of the Canadian population by 2068, according to recent demographic projections.^Note 

There is growing concern that the aging of Canada’s population, especially the rapid growth of the population aged 80 and over that generally requires the most care, will strain Canada’s health care system. The COVID-19 pandemic has exacerbated and actualized this concern. It has taken a toll on people residing in long-term care facilities, as well as on staff. Residents of these facilities have accounted for a disproportionate number of infections and deaths caused by COVID-19 in Canada.^Note 

The pandemic has also illuminated the challenging working conditions of staff in these facilities, such as irregular work schedules, overtime, excessive workload and stress, which are known to cause mental and physical tiredness, reduce work satisfaction and affect intentions to stay with the employer. As a result, the pandemic situation may have long-term implications for the delivery of health care in Canada.^Note 

While the majority of research on care work focuses on unpaid activities and its redistribution between women and men, the pandemic has highlighted the importance of certain crucial paid care occupations. These include nurse aides, orderlies and associates, which are more likely to be held by women and immigrants earning low wages and working part time.^Note  The importance of these occupations is also felt in the context of job vacancies, which have increased since the beginning of the pandemic and remain high in health care and social assistance positions.^Note  Finding and recruiting skilled workers to fill these essential positions is and will remain an important challenge for Canadian health policy makers.

At the same time, the pandemic disproportionately and negatively affected certain care occupations, such as child-care workers. Since the onset of the pandemic, employment among child-care workers has fluctuated more, compared with all workers. In December 2020, employment among these workers was 11% lower than in the same month in 2019. By comparison, the gap between December 2020 and December 2019 employment was 3% among all workers.^Note 

Given these circumstances, it is important to understand who the workers in paid care occupations are, what type of jobs they hold and how they are compensated. This study uses data from the 2016 Census of Population and from the Labour Force Survey (see box “Data sources, methods and definitions”) to examine the personal and job characteristics of workers in paid care occupations through a gender lens. This study also looks at how the pandemic has impacted the employment of paid care workers, compared with other workers.

Outcomes from specific population groups, such as those identifying as visible minorities, immigrants and Indigenous people, will be examined wherever sample sizes permit since members of these groups generally face additional barriers in the labour market compared with non-Indigenous Canadian-born people. Additionally, some groups are disproportionally represented in certain crucial lower-paying care occupations, such as nurse aides, orderlies and associates.

Workers in care occupations make up nearly one-fifth of the employed labour force

People of all ages have physical, psychological, cognitive and emotional needs requiring varying degrees of protection, care or support. Paid care workers contribute, in various ways, to meeting these needs. The definition of care work used in this study is taken from the International Labor Organization (ILO) report^Note  on the care economy.^Note  According to the ILO, care work is broadly defined as consisting of activities and relations involved in meeting the physical, psychological and emotional needs of adults and children, old and young, frail and able-bodied. Care workers’ activities and responsibilities include direct, face-to-face, personal care activities such as teaching, caring, helping, mentoring, counselling, etc. It also includes indirect care activities, which do not entail face-to-face personal care, such as cleaning, cooking and other maintenance tasks, and that provide the preconditions for personal caregiving.

Care workers may be employed by a private individual or household, a public agency, a private for-profit enterprise, a private non-profit organization, or they may be self-employed. Finally, paid care work is performed within a range of settings, such as private households, public or private hospitals, clinics, nursing homes, schools and other care establishments.

In 2016, there were approximately 3 million persons employed in paid care occupations, making up nearly one-fifth (19%) of the total employed population in Canada (Table 1). Among individuals in paid care occupations, 79% were employed in care-related industries, including health care and social assistance and educational services, and 2% in private households. The remaining were employed in non-care industries (19%), for example, as a nurse or doctor in a factory or as on-site childcare staff in a private company.

Care workers include a wide range of workers who differ in terms of education, skills, sector and pay, from university professors, psychologists and doctors at one end of the spectrum to childcare workers and personal care workers at the other^Note . However, registered nurses and registered psychiatric nurses (9%), elementary school and kindergarten teachers (9%), nurse aides, orderlies and patient service associates (8%) and light-duty cleaners (7%) are the most common occupations among care workers. These occupations accounted for one-third of all these workers in 2016.

Women make up the majority of paid care workers in Canada

Women represented the majority of paid care workers in Canada, accounting for three-quarters (75%) of them in 2016 (Table 1). Therefore, most care occupations were either female-dominated^Note  or had a high proportion of women.

Care occupations with the vast majority of workers being women included dental assistants (99%), dental hygienists and dental therapists (97%), early childhood educators and assistants (96%), home child care providers (96%), and dieticians and nutritionists (95%). Only a few care occupations had a higher proportion of men. Moreover, some of these male-dominated occupations, such as janitors, caretakers and building superintendents (76% men) or cleaning supervisors (64%), are somewhat atypical among care occupations, as they do not necessarily entail face-to-face personal care. Other male-dominated occupations were essentially in the health sector: denturists (65%), paramedical occupations (64%), chiropractors (64%), dentists (61%) and specialist physicians (61%).

Workers in care occupations were slightly older than workers in non-care occupations. Indeed, since most care occupations require postsecondary education, there is a lower proportion of these workers in the youngest age group, which may be related to the fact that many future care workers are still in school at this age. The proportion of care workers aged 15 to 24 was thus half that of non-care workers (7% and 14%) (Table 2). In addition, a higher proportion of care workers were considered within the core working age (25 to 54 years), compared with their counterparts in non-care occupations. Specifically, 71% of care workers belonged to this age group, while the corresponding proportion for non-care workers was 64%.

Care workers are also more educated than those in non-care occupations. Almost one-half (46%) of care workers had a university certificate or a degree at the bachelor level or above, compared with one-quarter (25%) of those in non-care occupations. Furthermore, non-care workers were two times more likely than care workers  to have an education level equal to a high school diploma or less (39% vs. 19%).

There were, however, notable differences in the educational attainment of men and women working in care occupations. Women in these occupations were more likely than their male counterparts to have a college credential as their highest level of education (29% vs. 16%), whereas a larger proportion of men than women held a university certificate, diploma or degree at bachelor level or above (51% vs. 44%).

Women from visible minority groups were less likely to work in professional occupations in health than their male counterparts

Overall, workers in care and non-care occupations were as likely to belong to a population group designated as a visible minority (22% vs. 21%), to be immigrants (25% vs. 24%) or to identify as an Indigenous person (4% each) (Table 2). There were however slightly higher proportions of Black and Filipino people among care workers (4% and 5%) than among non-care workers (3% and 2%), particularly in specific occupational groups. For example, Black and Filipino people represented 10% of workers, respectively, in assisting occupations in support of health services and were highly overrepresented among nurse aides, orderlies and patient service associates.^Note 

Within care occupations, men were more likely than women to belong to population groups designated as visible minorities (24% vs. 21%) and to be immigrants (27% vs. 24%), but a similar proportion of women and men identified as Indigenous (4% each) (Table 2). In general, immigrant care workers were particularly overrepresented in assisting occupations in support of health services (34%), in service supervisors and specialized service occupations (34%) and in service support and other service occupations (32%). By contrast, they were underrepresented in occupations in specialized middle management (18%), professional occupations in education services (18%) and in professional occupations in law, social, community and government services (16%).

There were also some notable gender differences regarding type of position held based on immigrant status or belonging to a visible minority group (see Tables A1 and A2 in appendix 2), as is the case for all care workers. For example, a higher proportion of immigrant men than immigrant women were working in well-paid occupations, such as professional occupations in nursing (33% vs. 22%) and in health (except nursing) (35% vs. 24%). By contrast, immigrant women were more likely than their male counterparts to work as executive housekeepers and cleaning supervisors (37% vs. 30%) and in service support and other service occupations (36% vs. 29%).

Women from population groups designated as visible minorities were also less likely to hold well-paid positions than their male counterparts. In particular, Filipino and Black men were overrepresented in professional occupations in nursing (11% and 7%, respectively), with Filipino men twice as likely to be in professional occupations in nursing (11%) as Filipino women (5%). In contrast, Filipino and Black women were overrepresented in assisting occupations in support of health services (10% each), such as nurse aides, orderlies and patient service associates. Filipino women were also overrepresented in care providers and educational, legal and public protection support occupations (12%), such as home child care providers and home support workers, housekeepers and related occupations.

There were also higher proportions of South Asian and Chinese men (11% and 8%, respectively) than South Asian and Chinese women (7% and 6%, respectively) in professional occupations in health (except nursing) and technical occupations in health. These two occupational groups include well-paid occupations, such as general practitioners and family physicians and medical radiation technologists.

Indigenous people were underrepresented in most health-related occupations, particularly among professional occupations in health (except nursing) where Indigenous people only represent 1% of all care workers in this occupational group. Specifically, First Nations, Métis and Inuit people represented respectively 0.5%, 0.7% and 0.02% of all workers in this group. Care workers who identify as Indigenous were, however, overrepresented in paraprofessional occupations in legal, social, community and education services (7%), in professional occupations in law, social, community and government services (6%), as well as in care providers and educational, legal and public protection support occupations (6%). Male Indigenous people represented from 6% to 9% of all care workers in each of these three occupational groups, and Indigenous women represented 6% of workers in each of these groups. These occupational groups include, but are not limited to, social and community service workers, elementary and secondary school teachers and teacher assistants and home support workers, housekeepers and related occupations. First Nations people represented the majority of Indigenous workers in each of these three occupational groups (4% of all care workers in each group) but Inuit people were particularly overrepresented in paraprofessional occupations in legal, social, community and education services and in care providers and educational, legal and public protection support occupations. Indeed, although Inuit represent 0.1% of all Canadian workers, they represented 0.3% of all care workers in both occupational groups.

Women in care occupations reported lower average employment incomes than men

There are differences regarding the type of positions held by men and women within care occupations. For example, in health-related occupations, women were more likely to hold professional occupations in nursing^Note  (29% vs. 11%), such as registered nurses and registered psychiatric nurses and nursing coordinators and supervisors, whereas men were more likely to be found in professional occupations in health^Note , such as general practitioners and family physicians, specialist physicians and dentists (45% vs. 16%).

Differences in the type of occupations held by women and men were reflected in gender differences in employment income. In 2015, the employment income of women in care occupations was, on average, lower ($59,300) than that of men ($73,400) (Table 3). Nevertheless, the income gap observed between women and men in care occupations (-$14,100; -19%) was lower than that observed among non-care occupations (-$20,500; -27%).

Although the employment income of men in care occupations was higher than that of women for the vast majority of occupations^Note , the income gap was generally wider in professional occupations in health (except nursing) (-29%), care providers and educational, legal and public protection support occupations (-29%), service supervisors and specialized service occupations (-29%) and service support and other service occupations (-27%). In health-related occupations, for example, women working as specialist physicians earned, on average, 23% less than their male counterparts. The gap was even wider among the home child care providers, where women earned 40% less annually than men.

Income gaps were also found for certain population groups (Table 4). Overall, and as in non-care occupations, immigrant ($61,900 vs. $64,100) and Indigenous people ($53,400 vs. $63,700) working in care occupations fared worse than their non-Indigenous, Canadian-born counterparts. This was also the case for those from groups designated as visible minorities ($57,700 vs. $64,600). Furthermore, male workers who were either immigrants, a population group designated as a visible minority, or Indigenous had higher employment income than their female counterparts.

Among population groups designated as visible minorities, Japanese ($72,600) and Chinese ($70,900) care workers had the highest average employment incomes, being greater than those who did not belong to a visible minority group ($64,600), while Latin American ($43,800) and Filipino ($47,500) care workers had the lowest ones. This is consistent with the fact that Japanese and Chinese workers are better represented in professional occupations in health (except nursing), such as general practitioners and family physicians and specialist physicians, than Latin American and Filipino workers. These trends were the case for both women and men. While income gaps between men and women were observed for each of the visible minority groups, the gender gap was particularly high among Arab (-$27,300; -35%), South Asian (-$20,100; -26%) and Korean (-$16,000; -21%) people and the lowest among those who reported an identity not included elsewhere (-6%), were Black (-12%), or reported multiple identities (-12%). Again, some of the gender gap by population group identified as a visible minority may be explained by the fact that men are better represented than women in well-paid professional occupations in health (excluding nursing). For example, the representation of women in these occupations is more similar to that of men among Black Canadians (2% for both gender) than among Arab (2% compared with 5%) and South Asian Canadians (7% compared with 11%). Of course, these differences alone cannot account for all the gender differences observed among population groups identified as visible minorities. Other socio-economic factors, such as job tenure, may play an important role.

When looking at employment income of care workers in light of skill levels and the educational requirements of occupations, results show that a gender pay gap exists at all skill levels (Chart 1). In 2015, women earned, on average, 23% to 31% less than men working in occupations requiring similar skill levels or educational attainment. The gender pay gap was particularly large among occupations requiring only on-the-job training (-31%), although it was also notable among management occupations (-29%) and occupations requiring college or apprenticeship training (-28%).

Ordinary least squares regressions were estimated to examine the difference in women and men’s employment income after taking into account personal characteristics of care workers such as age, marital status, education, immigrant status, Indigenous identity, number of children, age of youngest child, province of residence and occupation held. Interestingly, the gender pay gap increased when controlling for personal characteristics only (from 15% to 17%), meaning that women in care occupations have personal characteristics usually associated with higher incomes. This is mostly explained by the fact that women working full time full year in care occupations, have higher levels of education than men^Note . When occupation—in addition to all the other factors—was taken into account in the regression, the gender pay gap reduces to 11%. This is a result of women being more likely to work in lower-paying occupations.

A large portion of the remaining gender wage gap in care occupations can also be explained by many other characteristics not covered in this study. For instance, part of the gap may be explained by the fact that women remain underrepresented in leadership roles and in more senior positions. Factors such as gender bias, discrimination in the workplace and in hiring practices may also play an important role, as women are more likely than men to face difficulties in entering certain occupations as well as obtaining promotions. Inequalities in unpaid care performed at home may also be another important factor. For example, some women may turn down promotions because they take on more parenting and domestic responsibilities.

Workers in care occupations were more likely to be covered by a collective agreement, but less likely to have a permanent job

In the following sections, data from the Labour Force Survey (LFS) are used to examine select job characteristics of care workers in Canada, as well as the impact of the pandemic on these workers. Job characteristics are based on the 2019 LFS data, which is the most recent data collected prior to the COVID-19 pandemic. Although the LFS data are more recent than those of the Census, they cannot provide as much detailed information regarding specific occupations. For instance, the sample size of the LFS does not allow to look at the job permanency by gender and specific care occupation, such as for nurses, which would be possible with Census data if information on job permanency were collected.

In 2019, workers in care occupations (83%) were less likely to have a permanent job^Note  than those in non-care occupations (89%) (Chart 2). They were, by contrast, more than twice as likely to be covered by a collective agreement (57% vs. 25%). This last finding reflects the fact that care workers are employed primarily in the public sector (schools, hospitals, etc.), where unionization rates are highest. Additionally, women in care occupations were slightly more likely than their male counterparts to have a permanent job and to be covered by a collective agreement, while the opposite is found for women in non-care occupations.

Workers in care occupations were also slightly less likely to work full time (75%) than those in non-care occupations (82%). This was entirely explained by the gap in full time work of men in care and non-care occupations. Indeed, male workers in care occupations (80%) were 7 percentage points less likely to work full time than their counterparts in non-care occupations (87%), while women in both care and non-care occupations were equally likely to be working full time (74% for each).

The fact that women, in both care and non-care occupations, are less likely to work full time than men is consistent with general findings on women’s employment. Indeed, although women have increased their participation in the labour market over time, the majority of unpaid work and family responsibilities are still undertaken by women. This may affect their ability to work longer hours and access better jobs.

Employment in care occupations and non-care occupations was impacted differently during the pandemic

At the onset of the COVID-19 pandemic, in mid-March 2020, all Canadian provinces and territories implemented strict public health measures, effectively putting large parts of Canada under lockdown. Many provincial and territorial governments across Canada ordered schools and clinics offering health services, such as dentist clinics and physiotherapy clinics and the majority of stores and businesses selling non‑essential goods and services, to close.

As a result, employment fell by around 6% in March 2020 in both care and non-care occupations (Chart 3).^Note  In April, the impact on employment was more severe for non-care workers. Indeed, while employment in care occupations was 9% below that of February 2020, the comparable decline in non-care occupations was 17%. This can be explained by the fact that many of the non-care occupations were in businesses that were deemed non-essential, and which continued to be closed, by contrast to most care occupations related to health which were deemed essential.

Around mid-May 2020, several provinces and territories including Ontario, Quebec, Alberta, Manitoba and Saskatchewan began to ease restrictions on certain economic and social activities and allowed select nonessential businesses to reopen. This led to an increase in employment in non-care occupations, however employment among care workers remained stable overall.

In June 2020, more restrictions were being lifted for businesses and workplaces in most parts of Canada. As a result, employment in both care and non-care occupations continued to rebound—compared with February 2020, it was down by 6% for non-care occupations and by 5% for care occupations. As restrictions were still easing, the reopening of economic activities continued in July and August. However, in July 2020, though employment increased in non-care occupations, it declined in care occupations. This decline was mostly driven by a decline in employment in management and education occupations.

In September 2020, schools across the country started to reopen and this led to an additional, sharp increase in employment in education occupations. This is a seasonal effect that occurs at the beginning of each school year. This had a positive impact on employment in care occupations overall. In the following months, employment improved slightly in care occupations while remaining unchanged in non-care occupations. By December 2020, employment in care occupations was almost the same as the February 2020 level, while it was down 3% for non-care occupations.

Employment among care workers fluctuated in the first half of 2021, but by October 2021, it was around the same level as in February 2020. For non-care workers, employment continued to improve in 2021, and by June of that year it surpassed its pre-pandemic level for the first time. In November 2021, it was 3% above the February 2020 level.

When same-month year-to-year comparisons are examined, we can note that the difference between comparable months of 2019 and 2020 peaked in April 2020 for non-care occupations (-17%) and May for care occupations (-7%) (Chart 4). Compared with 2019, employment in 2020 was much lower for non-care occupations than care occupations. For care occupations, employment in December of 2020 was even slightly higher (1%) than that in the same month of 2019. Employment continued to grow in 2021. In general, monthly employment, during the first half of 2021, was higher than that of comparable months in 2020. However, employment growth between 2020 and 2021 was more pronounced in non-care than in care occupations.

Women and men were affected differently during the pandemic

At the onset of the pandemic, both men and women experienced immediate and negative impacts in terms of employment. However, women were affected more than men in the first few months following the pandemic. For example, in April 2020, women’s employment in care occupations was 10% below the level it was in February 2020, compared with 7% for men. The comparable numbers for women and men in non-care occupations were 19% and 15%, respectively. By October 2020, employment for both men and women in care occupations had gone back to levels similar to February 2020. Nevertheless, women’s monthly employment in 2020 remained lower than that in the same months of 2019, throughout 2020, while men’s employment recovered faster and was even higher than that in the same months of 2019, from August to December 2020. However, the situation evolved differently for men and women in 2021: the employment of men in care occupations slowed while that of women continued to increase. Thus, in November 2021, employment among men in care occupations was similar to the February 2020 level, while for women it was 2% higher.

Conclusion

Care workers make up an essential component of our society and economy. Canada’s aging population, combined with the impact of the COVID-19 pandemic, has put a strain on Canada’s health care system with the demand for care work being higher than ever This article is the first to provide a detailed portrait of care workers in Canada.

In 2016, care workers made up nearly one-fifth of the total employed population in Canada, with approximately 3.2 million Canadians being employed in care occupations. Most were employed in the care-related and private households industries, but a significant proportion were also employed in non-care industries.

Women made up the majority of paid care workers in Canada, accounting for three-quarters of all care workers in 2016. The distribution of men and women varied across care occupations. For example, in 2016, almost 4 in 10 female care workers were registered nurses and registered psychiatric nurses, elementary school and kindergarten teachers, nurse aides, orderlies and patient service associates or early childhood educators and assistants. The top care occupations held by men were janitors, caretakers and building superintendents, light-duty cleaners, secondary school teachers or elementary school and kindergarten teachers.

There were also differences in the educational attainment of men and women working in care occupations. Women were more likely to have a college credential, while men were more likely to have a university certificate, diploma or degree.

In addition, men had higher employment income than women, although the income gap between men and women in care occupations was lower than that of non-care workers. The gender income gap remains significant even after taking into account diverse personal characteristics and the occupation held. This means that the persistence of a relatively high level of occupational segregation among care workers does not alone explain the gender pay gap in this sector. Factors such as gender bias or discrimination in the workplace and in hiring practices could also play an important role.

Immigrant women and those from groups designated as visible minorities fared worse than their male counterparts overall. While income gaps between men and women were observed for all population groups, the gap was particularly high among Arab, South Asian and Korean people. In addition, Indigenous people were underrepresented in most health-related care occupational groups, notably in professional occupations in health. Indigenous people were, by contrast, overrepresented in paraprofessional occupations in legal, social, community and education services as well as in care providers and educational, legal and public protection support occupations. These occupational groups include positions such as social and community service workers, early childhood educators and assistants and home support workers, housekeepers and related occupations.

The COVID-19 pandemic has had a large impact on many Canadians, including care workers. Many schools, child-care centres, dentist clinics and physiotherapy clinics closed, as well as stores and businesses selling non-essential goods or services. This impacted the Canadian labour market, but workers in non-care occupations had a larger employment decrease than those working in care occupations, since many care workers continued to work providing essential services.

While the immediate impacts of the pandemic on all facets of society are undeniable, many effects will be felt in the much longer term. These include the increased recognition of the importance of care workers to society. As such, the need to fill the many vacancies in this sector will likely remain a priority in the coming years. The current article provides information to help meet these objectives by contributing to a better understanding of the current profile of these essential workers and the challenges they face.

Farhana Khanam, Manon Langevin, Katherine Savage and Sharanjit Uppal are all researchers at the Centre for Social Data Insights and Innovation at Statistics Canada.

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