The Guardian Australia
Joven Flores worked long hours in a care home. Was he too rundown to survive Covid?
For most of his life, all Joven Flores did was work. Back-to-back shifts as a chef, working weekends, overtime. Uncomplainingly, Joven tossed, marinated, sliced, kneaded, ordered produce, wiped down worktops and stacked plastic food boxes. On his occasional days off, Joven would prepare meals so that his family wouldn’t have to cook during the week. Then he’d collapse on the sofa. Then TV, sleep, an early morning drive through deserted streets and more work.
Joven was born in the village of Patimbao, in the province of Laguna in the Philippines. Growing up, he lived in a simple house, made of wood and concrete. Joven’s father died when he was young. His mother, Mely, worked as a housekeeper for a middle-class family, and also sold fruit and vegetables in the market to support Joven and his three sisters. Money was tight. Sometimes, Mely would have to beg for credit at the shop to buy a sack of rice. In adulthood, if one of his children spilled food on the floor, Joven would get upset, and tell them: “When I was young, my mother didn’t have enough money to buy us rice.”
But most of the time, Joven didn’t say much at all. He was taciturn, the type of person who would show you how he felt through his actions, not his words; and besides, he was tired. Joven was the head chef at Magna Care Centre, a 63-resident care home in Poole, Dorset, run by the Caring Homes Group, which owns 69 homes across the UK. In the home, Joven was well known for baking cakes for the residents’ birthdays. “The salary was very low,” says his wife, Aurora, 64; he earned £11.50 an hour. “But my husband loved his job, and he was dedicated.”
Aurora also used to work at Magna Care Centre, but moved jobs to care for people with dementia, for which the pay is better, even if the work is harder. “They shout at you,” says Aurora. “Sometimes they spit at you. They open their bowels in the corridor. That’s dementia.”
Before coming to the UK in 2001, Joven and Aurora lived in Kuwait, where they worked as a chef and a nurse. The hours were brutal: six days a week, 12 hours a day, for 18 years. They were always sending money home. Joven built his mother a concrete house to replace the wooden one. The couple couldn’t afford to have their three boys with them in Kuwait, so they left them with Mely, and paid for their education. Only when the children were teenagers, and Aurora found work as a nurse in the UK, were they financially stable enough to send for them, and live as a family for the first time.
In middle age, Joven could feel his body giving out from standing up all day. His right hand hurt because he used it to mix food. Aurora would rub pain relief gel on his wrist. She felt that he looked older than he was, his face prematurely aged by the heat of the kitchen. In the evenings, after work, he’d be so exhausted that he could barely talk.
This was how Joven entered the Covid pandemic: shoulders stiff, legs sore, wrist sticky with anaesthetic gel. He knew his mother was safe and provided for. His eldest son, Jehtro, 30, was a qualified nurse, and Jerrold, 24, was an accountant. Jericho, 22, who has special needs, lived in an assisted living facility nearby. All his labour was for them. They had made it. It was a better, more prosperous existence than the life Joven had been born into.
But Joven wouldn’t get to enjoy his old age, see his mother again or sleep in the house he built. He died of Covid-19 on 6 February 2021. He was 59.
Because Filipino people in the UK often work in frontline health and social care jobs, they are disproportionately susceptible to the virus. Research from Health Service Journal looking at NHS workers’ deaths in the first wave found that Filipinos were the single largest group by nationality, after British people, with Filipino nurses (just 3.8% of all NHS nurses) accounting for more than a fifth. The first Filipino healthcare workers to die were Elvira Bucu and John Alagos, who both died on 3 April 2020. Alagos, a nursing assistant at Watford general hospital, was only 23. After he died, Watford town hall flew its flag at half-mast to honour him.
Filipinos are one of the world’s largest diaspora communities, spanning more than 100 countries, but mostly concentrated in the US, the UK, Australia and the Gulf states. In the UK, 22,043 NHS workers are Filipino, the third-biggest national group, after British people and Indians. In adult social care, 9% of the English workforce are non-EU nationals, and about 7% of those workers are Filipino, making them the fourth-biggest non-British nationality after Romanians, Poles and Nigerians.
The foundations for this mass migration of Filipino workers were laid in the late 19th century, when the US colonised the Philippines. According to Prof Rhacel Salazar Parreñas of the University of Southern California, the US adopted a policy of “benevolent assimilation”, introducing the US education curriculum in the Philippines. “The population was schooled in English,” Salazar Parreñas says. One goal, she says, was to have Filipinos working in the healthcare sector, so they set up nursing schools. As a result, by the 1940s, there was an accessible labour pool of Filipino nurses who had been required to pass English language exams. The US started bringing them over in the 40s, as a solution to nursing shortages, but it ramped up recruitment in the 1960s.
From the 1970s onwards, Filipino workers also migrated to the oil-rich countries of the Gulf, encouraged by the government of the dictator Ferdinand Marcos. “Marcos pivoted towards a labour-export economy,” says Prof Catherine Ceniza Choy of the University of California, Berkeley. “By exporting Filipino labourers abroad, they remit part of their earnings in foreign currency back to the Philippines. That became a multimilliondollar moneymaker for the Philippine government.”
Both academics are critical of this labour-export economy. “It separates parents from their children,” says Choy. It also takes a toll on those left behind, like Mely. “There is a large pool of women who end up taking care of these kids,” says Salazar Parreñas. “Often, the grandmothers are physically ailing, and they find themselves being caregivers all over again.”
In 1983, the year Joven and Aurora left for Kuwait, 434,207 Filipinos migrated overseas. “It’s no fun,” says Aurora of life in the emirate. “You always work, work, work.” As a nurse, Aurora was one of the lucky ones. Her friends who were domestic workers were routinely raped, beaten and abused. “If you were a domestic helper,” says Aurora, “it was rare for your employers to be good people. Most of them were bad. Maybe 70% bad, 30% good.”
On Fridays, her only day off, Aurora would go to church with the other Filipino workers, and then to a Swiss cafe, where Joven worked in the kitchen. It had the best cakes. “When I went to pay the bill, it was already paid,” Aurora says. “Joven had paid it. I hadn’t even met him yet.” Aurora got shy, and stopped going to the cafe; after that, her friends found they had to pay. “When I was there, it was free,” she laughs. “When I wasn’t there, it wasn’t free.”
Aurora wanted to know why Joven kept paying her bill, so she agreed to let him visit her at her dormitory. Dating in Kuwait was nearly impossible because Aurora and Joven lived in single-sex dorms. “Four beds in one room,” Aurora says. “No privacy.”
Joven wasn’t the sort of person to be showy with his affections. “He would only say: ‘I love you,’ on Valentine’s Day or birthdays,” says Aurora. “But I could see he loved me. Because of his actions.” They married in 1989; they waited because they wanted to be able to send more money to their families back home before starting a family.
After marrying, they had Jehtro in 1991, leaving him in the Philippines to be raised by Mely. “It was the only way,” Aurora says. “There are lots of nurses in the Philippines. It’s hard to find a job.” When Jehtro would ask Mely where his parents were, she’d tell him that they were working in another country, to provide him with a better future, and that they always thought of him. Growing up, Jehtro would stare at the photos of his parents Mely kept in the living room. “I was always asking where they were,” he says. Every few years, Aurora and Joven would use their holiday to come back to the Philippines. Jehtro was shy around these strangers who showered him with kisses and gifts. He was sometimes jealous of other children, who got to live with their parents.
In 2001, Aurora got a job in the UK. She was able to do so because in the 90s the New Labour government relaxed the requirements for skilled non-EU migrantsto meet staffing shortfalls in the NHS. Aurora came first, and Joven followed. “It was cold and green,” Aurora says. “That’s what I liked. In Kuwait, it was never green. It was sandstorms. Full of dust.”
They were able to send for the kids. “It was always Joven’s ambition that we stay together as one family,” Aurora says. In Poole, they struggled with racist neighbours in the first block of flats they moved into. “They were always knocking on our door,” says Aurora. “They told us that we needed to go back to the Philippines. They thought we were here to be supported by the government. I told them: ‘We are here to work.’”
The experience for many Filipino people of moving to the UK can be fraught with stress and uncertainty. “It’s exhausting,” says Susan Cueva of the Kanlungan Filipino Consortium, a charity working on behalf of migrant communities in Britain. “We have to adjust to a country that’s completely different to our own, where we have a big family support system and a sense of community. There’s always a
lot of fear because of the hostile immigration environment towards migrants as a whole. We never really settle because we think that if we do something wrong, we will be kicked out of the UK.”
For the first time, Jehtro got to know his father as an adult. “We bonded,” Jehtro says. Joven taught his son how to cook Filipino dishes like sinigang, a sour soup. “You could sense from his voice that he wanted me to do it correctly,” Jehtro says. “Because he had his chef training. I overcooked the vegetables, and he told me: ‘Only put the vegetables in during the last three minutes of your cooking.’” Joven continued to support Mely, sending between £80 and £120 for her food every month. In the last years of his life, he travelled back to the Philippines more regularly because Mely was in the early stages of dementia. “He wanted to spend more time with her while she still recognised him,” Jehtro says.
Joven stayed at the Magna Care Centre for 18 years. “He was loyal to that place,” says Aurora. When they were on shifts together, Joven would make Aurora lunch, and bring it to the nurse’s station. On his rare days off, Joven would frequent charity shops; he refused to buy anything new for himself. Joven would wait until the rest of the family had upgraded their mobile phones, and then use their old handsets.
“His family came first,” says Jehtro. “He never complained that he was working too hard. That was his way of showing love to us. If he was working hard, it was for us.”
Joven and Aurora easily found work in the UK because the care home sector has long struggled to recruit and retain staff. Pay is low, the job demanding and stressful. Nurses get paid more by the NHS, and there is more opportunity for progression, so many choose to work in hospitals instead. “There isn’t the same path in social care,” says Omar Idriss of the Health Foundation, a charity focused on improving the healthcare of people in the UK. “You’ll be in a lowpaid job your entire life.”
Most care worker jobs are minimum wage; people can earn the same in retail or hospitality where there are opportunities for career progression to store manager, or supervisor. As a result, the sector has long relied on migrant workers. People from EU or non-EU countries make up 17% of the workforce, rising to 38% in London. Up to a quarter of social care staff are on zero-hours contracts.
“There’s this widely held misconception that care homes are all large profit-making organisations,” says Adam Gordon, a professor of the care of older people at the University of Nottingham. “While there are some companies that do pay dividends, about 60% of care homes are run by charities, or small companies with a handful of homes. Funding is precarious.” Unlike the NHS, social care is primarily funded by local authorities, and the years of austerity that followed the 2008 financial crisis have led to a 12% real terms cut between 2010 and 2019. The Caring Homes Group, which owns Joven’s care home, posted a loss of £13.1m in 2019.
Joshua (not his real name) spent eight years working as a care assistant at a residential home in south London. He is Filipino-British, and worked throughout the first wave. But the problems he saw in the sector far predated the arrival of Covid-19. “It’s a high-skill, physically and emotionally draining job,” he says. Because of the low pay, there was high staff turnover at Joshua’s home, forcing management to rely on agency staff. “Agency staff work the minimum they can,” says Joshua. “They won’t tire themselves out as much as regular staff, and they’re less well trained.”
Joshua became so alarmed by how some care workers were handling the residents, who were sometimes left with bruises, that he volunteered as a trainer, teaching staff to use hoists safely. Management did not make this training mandatory, so most staff didn’t show up. Nor did they pay Joshua for the additional work of running the sessions.
He stayed as long as he did because he truly cared for the residents’ wellbeing. “I can stack shelves, no problem,” he says. “But not everyone can come to a workplace where they are making a difference to someone else’s life. I would come in, make sure they have a good day, feel good about that and go home happy.” He saw many staff come and go during this period, but the migrant workers tended to stay. “I can’t commend the Jamaicans and Ghanians who worked in the home enough. When something needed to be done, they always got it done.”
Successive governments have kicked the can down the road when it comes to social care reform. Between 1998 and 2017, there were 12 white papers and consultations on the subject, plus five independent reviews and commissions. “Social care reform is difficult to implement. It costs money,” says Idriss. “We had the financial crisis and the Covid crisis. They’ve been an excuse for governments not to do anything.” Plus, the people who suffer in poorly run care homes that they have to pay for themselves, often through the sale of their home, can’t lobby for reform. They are elderly, and may have Alzheimer’s or dementia. “The majority of people think social care is free, like the NHS,” says Idriss. “They only realise when their family hits the system. And by then, they’re absorbed in caring for that person, rather than agitating for change.”
An overstretched system, then, scraping by with inadequate funding and heroic staff often ground down by the long hours and poverty pay. And then Covid hit, and the people most vulnerable to the virus – elderly people and the low-paid workers recruited from overseas to care for them – were the ones to get sick and die.
The carnage in our care homes is a familiar story by now. Personal protective equipment (PPE) stockpiles diverted to the NHS. A “protective ring” supposed to protect residents from Covid-19that crumbled to ashes. At least 24,919 care home residents died in the period from April 2020 to January 2021. But the death rate among social care staff is less well known. Social care staff are twice as likely to die from Covid-19 as the general workingage population. They die doing a job for which they are paid around as little as £8.72 an hour, often without benefits.
Aurora thinks that she knows how she got Covid. One of the residents in her care home had the virus, but refused to self-isolate in her room. It’s challenging with people who have dementia. You can’t lock them away. “She kept walking and walking … we couldn’t do anything,” says Aurora. “We couldn’t avoid her. That’s how I became positive.”
Aurora fell ill first, on 27 December, Joven two days later. Jehtro stayed at home, to care for them. He wasn’t unduly concerned. He’d worked in the intensive care unit (ICU) during the first wave of the pandemic, and seen much older patients pull through. “I thought that it would pass, and everything would go back to normal,” Jehtro says. He set up two TVs in his parents’ bedroom, so his mother could watch her favourite channels from the bed, while Joven watched football, from a mattress on the floor.
Jehtro was monitoring his father’s oxygen saturation levels, and when on 5 January they dropped to 83% (a normal range is 95%-100%), he called an ambulance. Joven hated hospitals, but Jehtro insisted that his father needed to go. “At first, he was really refusing, but I told him that I’d called the ambulance already.” Joven was taken to Poole hospital, where Jehtro worked. They took him straight to the ICU. Over the next month, Joven would be moved from the ICU to a critical care ward, and then back to the ICU again. Jehtro was allowed to visit him after his shifts because he worked on an adjacent ward.
On 14 January, Jehtro visited his father on the critical care ward. It was evening, and he was falling asleep. They talked about the Liverpool v Manchester United game that weekend. Joven was a Liverpool fan, and Jehtro urged him to pay to watch the game on the hospital TV. It would be the last time they spoke. Joven was sedated and placed on a ventilator the next day.
In recent years, the government has narrowed the options for Filipino people to live and work in the UK. In 2012, the then home secretary, Theresa May, tightened the visa rules for foreign-born domestic workers, making it harder for them to escape abusive employers and switch jobs. Since 2017, there has been a requirement of a job offer with a minimum salary of £30,000 for non-EU workers. (This threshold was lowered to £25,600 in 2021.) Nurses are exempt, but entry-level social care workers are not. In 2020 the government increased the surcharge non-British citizens are expected to pay to access the NHS from £400 to £624. (After public outcry, the government scrapped plans to make health and social care staff pay the fee.) Before 2003, applying for indefinite leave to remain was free. Now, it costs £2,389 an applicant. “Isn’t that extortion?” Cueva exclaims. “We’re providing the health and social care services in this country, and we have to pay for it.”
The rising cost of coming to live and work in the UK, and the UK’s hostile immigration environment, combine to form an environment in which many frontline Filipino health and social care workers are frightened to speak out. In June 2020, a Public Health England report found that racism drove higher death rates in BAME communities. “Historic [sic] racism … may mean that individuals in BAME groups are less likely to seek care when needed or as NHS staff are less likely to speak up when they have concerns about PPE or risk,” the report concluded. A report by the Kanlungan Filipino Consortium after the first wave found that 19% of all frontline BAME respondents felt that they had been required to undertake less desirable tasks than their white colleagues.
“As Filipino migrants, we don’t know the structure, and we have trust in authority,” says Cueva, of the Kanlungan Filipino Consortium. “We think: ‘They wouldn’t send us to our death, would they?’” She knows of a pregnant woman who died of Covid after being made to work when she was supposed to be shielding, and another nurse who had cancer who was also made to work on a Covid ward, and who also died.
Aurora believes that the reason that Joven was hit so hard by Covid was because he was rundown and overworked. The part-time chef who usually assisted him had stopped working because of Covid. “My husband worked for five months without time off,” Aurora says. “That’s why he had no resistance or strength to recover from Covid. He was overworked.” Even when Joven was sick, he kept working. “He was still ordering the supplies for the kitchen,” says Aurora, “because they didn’t know what to order, and he was the only one with the password. He had a high temperature, and they were still calling him and he was ordering. Until he couldn’t cope. Even when Jehtro rang the ambulance and Joven went to hospital, he was still working – really.”
Much of the work that the Kanlungan Filipino Consortium organisation has been doing during Covid is to educate Filipino migrant workers about their workplace rights. “We’ve been running workshops explaining that people should be more assertive and ask for support, particularly if they have underlying health conditions and need to shield,” says Cueva. “But we find that even people who are union members don’t go to their union because they fear they will be in trouble with their employers.”
When Covid hit his care home, Joshua worked relentlessly to keep his residents safe. There were so many staff off sick that, some evenings, there would be just one care worker to look after 10 residents. (Usually, the ratio was one to five.) Initially, management discouraged staff from wearing masks, because they believed it would frighten the residents. (This changed when the government changed its guidance to mandate mask wearing on 17 April.) There was such pressure on PPE supplies that the number of gloves usually available in the home dwindled. “They had to get brands that weren’t as good,” Joshua says. “It was a waste of money, and dangerous for staff. The gloves would disintegrate, and you’d be stuck there with an open hand, doing personal care.”
Perhaps inevitably, Joshua fell ill with Covid, although he made a full recovery. In July, he was offered a better-paying job as a personal care worker to a private client. His new salary is £15-£20 an hour, depending on how much he works. Joshua misses the residents in his old home dearly. “I worry about them every single day,” he says. “I wish I was still working there. They were like my grandparents. I knew what music they liked, what they like to cuddle. I was a part of their lives.”
I ask him how much his old care home would have had to pay him to stay. He thinks for a moment, and says: “£12 an hour. That would have made a difference.”
On 5 February, a doctor on the ICU ward pulled Jehtro aside at work and told him that Joven’s prognosis was not good. Jehtro went home, to prepare his mother, who had by then recovered from Covid. They went in the next day. “She was really crying,” Jehtro says. “I told her to be strong and that we had to continue to pray and ask for healing, from God. She managed to pick herself up and we went into his hospital room.
That’s when she started crying again.”
At the hospital, Jehtro told his father, who had been fighting for his life for a month, that he shouldn’t worry if he had to give up. “I told him that if he wanted to rest it was OK,” says Jehtro. “We’re going to be OK. I’m going to take care of my mother and brothers.” He believes his father heard what he was saying, even though he was sedated.
“I am used to people in my nursing home dying,” says Aurora. “But it’s really different when it’s your husband.” What stings so bitterly for Aurora is that Joven’s lifetime of hard work had come to fruition. His children were in stable jobs, his mother was taken care of. These were supposed to be their years of rest. “We thought we could spend more time as a family together when we were retired,” Aurora says. “But this is gone.”
“For 19 years, Joven was a muchloved member of our team,” said a spokesperson for the Magna Care Centre, “and he is deeply missed by his colleagues, the friends he made working here and our residents. We ensured staff were offered increased support and counselling following his death as we understood how popular Joven was at the home.
“Our priority throughout the pandemic has been the health and wellbeing of our colleagues and our residents. We are extremely grateful to all our staff who have worked tirelessly throughout the pandemic to continue to provide high-quality care for our residents. We understand how difficult Covid-19 has been to manage and it has been important for our staff to not feel compelled to work extra hours. This is why we put in place protocols to ensure appropriate staff cover to allow staff to take breaks. We also increased managerial support in the home when needed. When colleagues are unable to work, we always organise relief cover to support them and their team.
“After his wife contracted Covid-19 in December, Joven followed all necessary protocol and quarantined at home. During this time, he undertook a couple of tasks, such as placing a food order, as we believed he did not have any symptoms. As soon as we were made aware that Joven had also fallen ill, we immediately ceased all communications about work and only contacted the family to send our best wishes, offer support and check in on his condition.” ***
On 8 December 2020, the British Filipina nurse May Parsons made history by being the first healthcare worker to administer a Covid-19 vaccine. “I’m very proud to be saying to everyone that I’m a Filipina-British [person] today making history,” she declared.
Eight days before Parsons injected 91-year-old Margaret Keenan, the government published its post-Brexit immigration rules. Although nurses like her would still be able to come to the UK under the new regime, entrylevel social care workers would not. “We will not introduce a general low-skilled or temporary work route,” the government announced. “We need to shift the focus of our economy away from a reliance on cheap labour.”
From the supermarket workers who kept us fed to the care assistants who looked after our grandparents, so-called low-skill workers had helped the UK through its worst crisis since the second world war – but now that
the Covid-19 pandemic was receding, it was thank you and goodbye. “We are the frontline,” says Cueva. “We live in overcrowded accommodation. We work hard for long hours. And now the government has turned around and said: ‘Your skills aren’t good enough.’”
This post-Brexit migration strategy looks likely to exacerbate the staff shortages in the social care sector. According to the Health Foundation, the UK will need an extra 140,000 fulltime social care staff in the next five years. About 1.4 million adults live without adequate social care support, and there are more than 120,000 vacancies for social care staff. The government has pledged to reform the social care system, but Idriss questions whether these measures will be a far-reaching intervention to meet the needs of our ageing population, or mere tinkering under the bonnet. “It’s not just reform that’s needed. There needs to be proper funding attached to it,” he says.
A staggering 22% of all NHS and social care staff deaths have been British Filipinos. The community is traumatised and grieving. “We Filipinos, we are like a big family,” says Cueva. “Every death in the community is devastating. It’s had a strong effect on us because we know that, as migrants in the UK, we have to support each other. So when someone dies, you feel connected to that person.”
Joven’s car is still parked outside the family home. The sight of it upsets Aurora. “He always gave me lifts to work,” she says. “When I see it, I become very sad. I control myself, not to cry, because when I start crying it’s very difficult to stop. I think of happy moments in my life and try to fight it.” In front of the children, she holds it together. But when she’s alone in her room, she sobs. “If I am sad and alone,” Aurora says, “I pretend God is with me. God is my friend. My comforter. I talk to him.”
It’s hard for Jehtro, too. He has to work at the hospital where his father died. “Whenever I pass critical care, I feel sad,” he says. The house feels empty. His father’s death means that Jehtro has had to step up into his role. Every month he gives Mely money to support her in the Philippines. It’s what Filipino people the world over do. Love each other, support each other – and send money back home.
He never complained that he was working too hard. That was his way of showing love to us