3 LITERATURE REVIEW – MEASURING AND VALUING UNPAID CARE WORK TIME
The previous literature review highlighted the unpaid care work that women undertake within the home. Ogden, Esim and Grown (2006, p. 334) argue that making this unpaid work and the unpaid workers visible is of value to governments and policy makers “in order to … capture the benefits of these activities, but also to … enumerate their costs – so that the unpaid contributions of women to the productive economy can be acknowledged and compensated”. The most obvious way to make this work more visible is to measure the time spent undertaking it so that a monetary value can be placed on it. This chapter reviews the literature on methods used to measure and value time-use.
waged time, move from full-time to part-time work, or give up their entire job (Netten, 1996).
This applies similarly to caregivers involved in other types of income earning. Some women have to leave the labour market to care, while others’ employment is curtailed (by taking up part-time employment, for example), and these women will experience reduced earnings, but also reduced benefits (Rimmer, 1983). In a United States study, Robinson (1997) found that uncompensated care to the frail elderly resulted in nine percent of home-based caregivers who left the labour force to provide care, 29 percent who adjusted their work schedules, and 18 percent who took time off without pay. It is not only current, but also future earnings and benefits, such as occupational pensions, which are affected (Glendinning, 1992; Graham, 1983).
Giving up work may also mean an early retirement if the carer is older, since re-employment is often difficult at older ages, and this may in turn increase the risk of poverty in old age (Rimmer, 1983). According to Joshi (1992) the degree to which caring work interferes with a woman’s capacity to earn depends on the helplessness of those she cares for, on the extent to which the care is shared by other people, and on expenditures on commodities which make multiple roles easier – such as domestic machinery. Moreover, opportunity costs will differ depending on the stage of the individual in the life cycle, and on other determinants of their potential earnings (such as their occupation or education level) (Rimmer, 1983). All aspects of costs increase with disease severity and problembehaviour (Moore, Zhu, & Clipp, 2001).
Further costs include giving up non-waged time. Care for others can be displaced, also opportunities for leisure and self-fulfilment (Netten, 1996), other unpaid work, domestic and subsistence work (Chen et al., 2005). A caregiver may also give up accommodation – the loss of a room used for the cared-for could mean the lost opportunity to earn a market rent (Netten, 1996).
The value of the unpaid work of carers is often a major component of the total cost of care
provision within the home. Ancona-Berk and Chalmers (1986, as cited in Fast & Frederick, 1999, p. 2) argue that: “community based care is less costly than hospital care only when kin care is assigned no value”. Rice et al. (1993), for instance, find the costs of care for a patient with
Alzheimer’s disease in northern California to be about the same whether the patient lives at home or in a nursing home. Yet the break down of costs varies. For patients at home, three-quarters of the total cost is the imputed value of the labour of unpaid carers compared with 12 percent of the cost for institutionalized patients. Similarly Stommel, Given and Given (1994) in the United States calculate the costs of cancer home care to families. Monetary costs assigned to family labour are either equated with income losses to the carer or are based on a putative market value of the expended labour time. The authors find that when family labour is included in the cost calculations, average cancer home care costs are not much lower than the costs of nursing home care.
Direct financial expenditure on goods and services as a result of caregiving also constitutes noteworthy costs. Netten (1993) defines the financial costs of care to include those goods and services which would not have been purchased in the absence of disability. She gives the
following examples: higher costs of heating, laundry, special foods and travel. Netten goes on to distinguish between two principal types of good: consumption goods, which are consumed or used in the process of production (e.g. actual expenditure on food, heating and laundry which is directly attributable to disability), and capital goods, which are manufactured goods that are used to produce commodities (e.g. adaptations such as ramps for a disabled person). Further out-of- pocket expenditures include buying time to care by purchasing other services (such as child care services or garden services) and purchasing respite care (Fast et al., 1999), and the direct costs of unreimbursed health care expenses (Arno et al., 1999). McDaid (2001) reminds us of the
importance of identifying whether income is being received by the person being cared for as this may be used for these direct costs, which then cannot be considered a household expense on care provision. However, in developing countries where money tends not to be received for
caregiving, this would not be a concern.
Other consequences for caregivers of shifting the responsibility for care from paid to unpaid caregivers include stress, burden, guilt and deteriorating health (Fast & Frederick, 1999, p. 4). A literature on the caregiver’s burden (see for instance Pakenham, Dadds, & Terry, 1995) focuses on the social, physical and emotional problems associated with providing care. Emotional
wellbeing costs include psychological stress, poorer morale and loss of control and independence, while social wellbeing costs relate to interpersonal relationships and social activities (Fast et al., 1999).
Many of the factors stated thus far lead to lowered standards of living among households in which care is being given, which are closely linked to lowered standards of living in old age (Graham, 1983). Evandron (1990, as cited in Glendinning, 1992, p. 171) finds that carers are consistently worse off than non-carers. Especially disadvantaged are carers living in the same household as the cared-for, female carers, carers who have sole responsibility for providing care and carers who are not economically active.
Some of the costs described above are easier to count than others. Direct financial costs as well as accommodation have a monetary value attached to them, which makes it easier to cost these. The same applies to accommodation if it is being rented, but not if it is owned or has been built.
In order to understand more about the costs borne by family caregivers, this thesis estimates the costs of the unpaid care provision undertaken for ill people within the home. This is done by estimating the labour costs of family caregivers and the financial costs of households.