For International Students Working in Private Nursing Homes, After-Graduation Work Permits and Higher-Paid Jobs Remain Elusive

A recent change in the government’s work permit rules for healthcare assistants means nothing to Carolina Lafaiete, she says.

This bright opportunity, Lafaiete says, throwing her hands up in the air and curling her middle and pointer fingers to put the word bright in quotation marks, hasn’t changed anything for her.

Lafaiete, like many carers in nursing homes across the city, works while on student visas, rather than on a general work permit.

In June though, the government added healthcare assistant to the to the list of jobs eligible for a general work permit, and with it the possibility of extra job and life security.

A post is only eligible, though, if the offered salary is at least €27,000 per year. Healthcare assistants working on student visas say they’re paid less than that and that private nursing homes are reluctant to raise their wages to the level needed to hire them through that route.

The government creates these kinds of rules to try to engineer the labour market that it thinks the country needs and to funnel immigrants from outside of the European Economic Area (EEA) into certain jobs with solid salary levels, where it perceives there are shortages.

A spokesperson for the Department of Enterprise, Trade and Employment said that the €27,000 threshold was set in line with the common salary range in the sector. “And the need to minimise any disruption to the domestic labour market.”

Kevin Figgis, a health division organiser with the trade union SIPTU, says the change in work permit rules, aimed at addressing a skills and labour shortage, is meaningless when the root cause of the healthcare assistant scarcity is the unaddressed issue of low pay in the private sector.

“Our issue is that, and we have raised this in the past, why the private sector doesn’t pay as much as public health, why the workers don’t have the same benefits,” he said.

None of the private nursing homes contacted responded to queries sent on 5 October about why they may not want to apply for work permits. Nursing Homes Ireland, an industry representative body, didn’t respond to similar queries sent on 8 October.

As a short-term solution, some healthcare assistants say that those who cared for the elderly at the pandemic’s peak deserve, regardless of salary, unconditional permission to work.

Earning Less, Doing the Same

Before Lafaiete started experiencing post-Covid symptoms, she rarely missed a shift at the nursing home where she works, she says.

She worked six shifts a week at the pandemic’s height, she says. “Like almost every day from eight to eight.”

Lafaiete fell ill with Covid twice, once last year and again this January, she says, and now struggles with weakness, vertigo, headaches, panic attacks, ringing in her ears – and partial sense of smell.

She covers a cup of cappuccino in front of her with her hands to indicate that without seeing it, she couldn’t recognise the smell. “Coffee, crap, smoke, it’s all the same to me,” she says.

Her managers didn’t seem to believe her, she says, when she started missing shifts due to post-Covid symptoms, often referred to as “long Covid”.

“I explained to my boss, I’m not okay. I have no reason to miss shifts because in Ireland if you miss a shift, you’re not paid,” said Lafaiete.

A doctor’s note from April says Lafaiete was unfit to work for a week due to “weakness, abdominal pain, stress and anxiety”.

She caught Covid, lost her favourite resident to the pandemic, and is still struggling with lingering symptoms, she says.

And while she’s been through all that, her employers have said they aren’t interested in hiring her, says Lafaiete.

Her pay of €11 an hour is too low to qualify for the work permit, she says. “I need to get paid at least €13, so I’m quite far from that.”

Like Lafaiete, Carla Oliveira is a qualified nurse in Brazil where she was born, she said last week, sitting outside a café on Dawson Street, fiddling with the zipper of her black Friends-themed purse with the words “How You Doin?” printed on it in white.

To become a nurse here in Ireland, she and others need to have very good English to pass the required exam and have their international qualifications recognised, which can take a long time, Oliveira says. So, for now, she’s a healthcare assistant at a private nursing home.

Like others, Oliveira says her current employers and other prospective employers told her they couldn’t get a work permit for her. “They told me that in the moment they don’t have the budget.”

Lafaiete says she and her colleagues deserve better than “begging the companies for a work permit”.

“I don’t like drama, but I came here today to share,” she says, pointing at the recorder in front of her. “I don’t know if they care, but I want the government to know that employers don’t care about us.”

The unregulated nature of the private sector, said Figgis, the healthcare division organiser with SIPTU, gives employers the freedom to exploit workers.

In the public health sector annual salaries for healthcare assistants start higher, Figgis said. They run from €29,000 to just over €40,000.

“We’re saying why is it that there is no parity in pay for the exact same service?” he says.

Public sector jobs aren’t plentiful because they’re secure and pay well, Oliveira says. “There are more opportunities in private.”

Figgis says SIPTU doesn’t support the department’s recent change in work permit rules for healthcare assistants at all. Its salary criteria is anti-worker, greenlighting private employers to pay less than what the Health Service Executive (HSE) has to pay, he says.

“We’re not going to support an initiative that facilitates low pay,” said Figgis. “The government might say well, that’s the minimum, but there are employers who would say, I’m not going to pay a dime more than that €27,000.”

The standard annual salary criteria for getting a general work permit is ordinarily €30,000 too, except for some graduates fresh out of university (although they have to get paid €30,000 to renew) and, recently, for healthcare assistants.

Oliveira says the government tried to set the bar low for people like her; for some private employers though, that wasn’t low enough.

Casual Jobs

On a recent chilly October afternoon, Bruno Ramos was busy calculating his wages on his phone’s calculator as a cup of marshmallow-topped hot cocoa in front of him went cold.

Ramos, also a qualified nurse, works two jobs, as a healthcare assistant in a private nursing home and as a “bank ward attendant” at Mater Private Hospital, to make ends meet.

Neither is willing to get him a work permit. His nursing home employers are not willing to cover its costs and sort out the bureaucracy of the process, expecting him to do that with no explicit guarantee, he says.

“I feel … ,” says Ramos, then pauses to find the right words. “I feel used,” he says, finally.

Bank ward attendant, his other job, is not a full-time job and is not eligible for a work permit anyway.

Ramos says it’s a more precarious version of the healthcare assistant job and shifts aren’t guaranteed. “You don’t necessarily need to give me a number of hours.”

Bank ward attendants don’t get time off either, said Ramos. “In the Mater [Private] Hospital, I don’t have holidays.”

A spokesperson for Mater Private did not respond to two emails before deadline.

Recently Ramos applied to work as a healthcare assistant at Beacon Hospital.

They invited him for an interview. At the interview, he asked them if they would apply for a work permit and they told him they would not, as it was for a bank ward attendant job, said Ramos.

Later the hospital sent him a job offer for a casual post doing emergency and short-term cover.

The offer letter says that the employer is not obliged to offer “any work on a daily basis and you are free to accept or decline any work offered to you by the Employer”.

A spokesperson for Beacon Hospital declined to clarify what “casual employment” as a healthcare assistant meant, so it’s not clear if that’s another way of saying bank ward attendant.

They said that the hospital actively obtains work permits for non-EU healthcare assistants, but can’t comment on individual cases.

“Beacon Hospital actively recruits Healthcare Assistants that meet the criteria of the role being applied for, and are capable of meeting the eligibility criteria to work in Ireland,” they said.

A spokesperson for the Department of Enterprise, Trade and Employment didn’t say how many employment permits it has issued for healthcare assistants since the law changed.

###An Uncertain Future

Being stuck on a student visa means that some non-EEA healthcare workers aren’t sure what the future could bring.

Lafaiete, who is on an English language student visa, says her Irish residence permit expires in January 2022.

She could enrol in a third-level course but she doesn’t want to spend thousands of euros on a course she doesn’t want to do, just to extend her stay, she says.

“I already have a master’s in Brazil, I am already qualified, I just need to improve my English to be a nurse,” she said.

Oliveira, who’s also on an English language student visa, says her visa expires in January too.

During the pandemic’s peak, “when they were clapping for frontline workers”, she said, she grew hopeful that the government would make it easier for non-EEA healthcare assistants to stay, but her hope eventually faded.

Ramos, who was also on an English language student visa, caved in and enrolled in a third-level course.

Oliveira has thought about enrolling in a third-level course too, but she’s not sure if it’s worth the investment. “Maybe I go back to my country,” she says, glancing at a Luas rail nearby.

“I just want to stay here to work, you know. I want to work and, after this, become a nurse helping Ireland improve the healthcare system,” she said.

[UPDATED: This article was significantly updated on 15 October 2021 at 12.34pm to take out one case study.]