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Costs and Benefits of Caregiving Caregiving and Health Care Reform Creating Better Conditions for Care
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Guidelines for Examining Women, Work and Caring in the New Millennium Pat Armstrong, Department of Sociology, York University and Hugh Armstrong, School of Social Work, Carleton University, the Atlantic Centre of Excellence for Women’s Health and the Nova Scotia Advisory Council on the Status of Women
Care work is women’s work. Paid and unpaid, located at home, in voluntary organizations or in the labour force, the overwhelming majority of care is provided by women. It is often invisible, usually accorded little value and only sometimes recognized as skilled. A new study called Thinking It Through: Women, Work and Caring in the New Millennium draws on Canadian and international literatures to analyse the forces, structures and relationships that construct women as carers and undervalue care work. It is designed as a companion piece to One Hundred Years of Caregiving in Canada, which is based on Canadian research on caregiving among adults. This work outlines kinds of care (e.g, personal care for people with disabilities, skilled home health care for family members discharged from hospital) and kinds of caregivers (e.g., paid and unpaid).[1] The purpose of Thinking It Through is to develop guidelines that will help researchers, policy makers and the general public think about the meaning and consequence of women’s paid and unpaid care work and ultimately help create good conditions for care. To accurately assess women’s care work, guidelines should, first of all, be concerned with both similarities and differences. Because there are so many common patterns in women’s work it is useful to group women together. "Lumping" refers to a way of looking at data, theory and concepts in order to see what women, as women, share. It also helps us to expose the forces that keep these patterns in place and those that change them. But what of the fundamental differences among women related to class, race, culture, age, marital status, sexual orientation and location, as well as variations in patterns for the same women over time? For example, in the last twenty years considerable variations have developed in what has been defined as women’s caring work. Our grandmothers did not clean catheters, insert needles or adjust oxygen masks as part of the care work they did at home. "Slicing" refers to a method for considering different views or "slices" of the same circumstance, research question and evidence in order to create multiple and complex pictures of particular peoples in particular places. In Miriam Glucksmann’s revealing analyses of British women’s work she speaks of "slicing" to look at the various ways work is divided up within what she calls the "total social organization of labour."[2] Slicing a question about women’s work helps expose the complex and contradictory nature of that work and our concepts about it. Slicing allows us to see that there is very little that is natural about women’s work in general or their caring work in particular. Women’s caring can be understood only within unequal relationships, structures and processes that help create women as carers and undervalue this caring work. Slicing assumes that contexts and locations matter. It encompasses the considerable pressures from forces outside of women’s immediate control, as well as women’s active participation in shaping their own lives. It allows that some women resist care work, some embrace it. Our guidelines recommend both lumping and slicing in order to explore what is both common and different among women and among women over time and across space or location. A second guideline is that analyses of women’s work should locate women within both their general and their specific environments. Globalization, changes in the nation state, and the increasing reliance on markets, communities and families to provide care all establish contexts for women’s work. Contexts also include notions about these. For example, notions about the inevitability of globalization and changes in the Canadian state distract us from the fact that these processes and changes result from decisions and practices rather than from forces beyond human control. Canadians still establish many of the conditions for work and for deciding how, when and where care is provided. In providing supports, benefits, services and regulations or in not providing these, state practices establish the conditions for care inside and outside the formal economy. The benefits and negative consequences of these decisions are unevenly distributed between women and men, and among women. In Canada the state still provides most of the financial funding for paid care. But market mechanisms that have become popular with governments increasingly form part of the context of women’s lives and need to be carefully scrutinized for their impact on care and care work. Once defined as public goods largely produced and distributed outside the market, care services are increasingly defined as market goods. What happens when for-profit techniques are applied to care services? For example, consumer purchasing means unequal purchasing because market power is based on resources; as a result, inequality between women and men, as well as among women, will be perpetuated. How is continuity in care across services to be provided if services are competing with each other and are owned by for-profit firms that treat information as trade secrets essential to competition? What is not profitable will be left to individuals or charitable organizations to provide. We have to ask where, when and under what conditions markets are appropriate and what their impact is on care. "Sending care to communities" most often means sending care to families and, within families, to women. But sending care to the community may mean undermining those communities and does not necessarily mean more local participation or control. As Stacey Oliker says, on the basis of her research on welfare, "We might find damage to personal networks and personal relationships, which could threaten families’ capacities to care. The damage might take the form of constriction and greater fragility in networks, the replacement of caregiving support with support for subsistence, and a decline in communal commitments to care."[3] Without time, space, economic resources and other supports, all communities may be at risk. Thus, as a third guideline, it is necessary to examine the ways globalization, states, markets, communities and households penetrate and structure each other, each influencing how the others operate. The blurring of the lines between paid and unpaid work, and public and private sectors of the economy, makes it more difficult to see the links between these sectors and more difficult for women to draw boundaries about and around their work responsibilities. Fourth, critical questions need to be asked about who pays for care and at what cost to whom. Some of the costs of care are financial. Some are in time, some in emotional and social resources and some in lost opportunities. These costs may be borne mainly by individuals, by families, by community organizations or by governments. Sometimes all share in the costs, although they seldom do so in equal portions or in similar ways. Whatever the distribution, the ways costs are borne and shared have significant consequences for women. Each method of funding has an impact on access to care, the nature of care and the costs to the caregiver. Fifth, it is important to explore questions about the time and locations of care. Where, when and for how long is care provided? If we think about where care is given, we can see, for example, that a care recipient may regard the home as a place of quiet comfort. For the caregiver and family, however, home may be a place for entertaining friends. For the paid caregiver, a workplace should be ordered in a manner that meets their standards of care. Each participant may have different, and conflicting, space needs. Time interacts with space and, like space, it is also about social relations. When time is money, care as a relationship may be sacrificed: there may be or may not be time for a hug—an often unmeasured but critical component of care for provider and recipient. A sixth guideline is that the nature of power and the means of enhancing the control women have in providing and receiving care should be explored. Power is primarily about access to resources. Some of these resources are material, like income and services, drugs and diapers. Some are political, like the right to participate fully in decision making in ways that have an impact, or the right to equal pay and other employment protections, or the right to education and information. Some are social, like having time and space for friends and relaxation. Some are symbolic, like having care recognized as work that requires time, space, money, physical capacity, emotional involvement and social support. The more resources are distributed by market mechanisms, the greater the disparities in resources, and thus, in power. Finally, care needs to be understood as the objective, not the problem. Care is a relationship rather than simply a task. We need to recognize the conflicting, often contradictory demands on care providers and determine how to handle these so that women can exercise the right to care in ways that take their needs and capacities into account. This paper is part of a five-year partnership program of
survey and case study research called "A Healthy Balance: A
Community Alliance for Health Research on Women’s
Unpaid Caregiving" led by the Atlantic Centre of Excellence
for Women’s Health and the Nova Scotia Advisory Council
on the Status of Women. For a copy of the full report,
Thinking It Through: Women, Work and Caring in the New
Millennium, contact: NOTES |
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