Bakker (1994) points to the need for the resources in reproduction to be ascribed a proper value.
Indeed, the value of the time, energy and resources in the care economy is generally
unrecognized and remains almost entirely unaccounted for in most systems of national accounts (Ogden et al., 2004). Caring activities were and are mainly considered “pre- or post-economic activities”, and “standard economic theory is unable to represent the context of reproduction … which is so essential to human beings” (Jochimsen, 2003, p. 5). While market rationality assumes that individuals are independent and competitive, the rationality of care assumes connection, relationship and interdependence. In this way neo-classical economic explanatory models face difficulties (Lewis, 2001).
Community care is justified in terms of its low-cost to government and in terms of the quality of life it lends when compared to institutional provision (Rimmer, 1983). However, it is argued that not enough resources have been made available for its implementation (Dalley, 1988). In the United Kingdom, long-stay hospital provision was reduced at a significant rate but local authority community-based services were not expanded sufficiently rapidly to offset this reduction
(Ungerson, 1987). The professional services which were defined as comprising community care (such as home nursing, day care, respite care, group homes etc.) have in practice been found to be insufficient (Dalley, 1988). Community care in this sense is understood as “essentially cost- cutting rather than liberalizing and liberating” (Ungerson, 1987, p. 53).
According to Dalley (1988, p. 18), community care is “a form of care that is largely uncosted and unmeasured, which can be invoked by planners and politicians without its cost being borne by official resources”. In community care the tasks that were performed by residential workers are performed unpaid by family members or friends. The cost effectiveness of community care depends on “not putting a financial value on the contribution of informal carers, who may in fact shoulder considerable financial, social and emotional burdens” (DHSS, 1981, as cited in Rimmer, 1983, p. 135). The main reason that the cost of community care has been considered to be lower than other alternatives is that in public expenditure terms community care policies are lower cost than their institutional alternatives. It is only the public expenditure costs of community care that are considered – the costs to caregivers within the home are ignored (Fast & Frederick, 1999;
Rimmer, 1983). Fast and Frederick (1999, p. 4) explain that “any redistribution of responsibility for care from the formal to the informal sector also represents a redistribution of costs such that reductions in public expenditures are off-set by increases in costs to informal caregivers.”
Community care is not a cheap option if the unpaid labour of caregivers is included in the financial calculations (Glendinning, 1992, p. 162).
Therefore while the effect for those concerned with public spending will be reduced costs and improved efficiency, costs will in effect be shifted from the paid economy to the unpaid economy of the household, or rather, of women (Bakker, 1994; Chen et al., 2005; Elson, 1991b). This is linked to a second set of criticisms of community care. Although voluntary organizations, friends
and neighbours may play a role in community care, this help tends to be sporadic and irregular (Dalley, 1988), and community care is “in most cases family care, and within the family it is women who bear the main brunt of caring” (Rimmer, 1983, p. 135). Most often care provision falls onto wives, mothers and daughters, who tend to be women of middle age, middle
generation, between children and their own parents (Dalley, 1988). Parker (1981) argues that the availability of a community care system and the position of women has been taken for granted.
Some (for instance Ungerson, 1987) maintain that policies for community care are, within a context of public expenditure cuts, incompatible with policies for equal opportunity for women.
Cuts in social spending have been met by pressure from the feminist movement to recognize unpaid care work, and this has in turn resulted in more attention being focused on this work, and on legitimizing such work (Standing, 2001).
Other criticisms of community care also relate to “the substance of the policies themselves and the principles upon which they are based” (Dalley, 1988, p. 5). The third broad criticism concerns the belief that the family is the appropriate location for care, the dependent person can best
achieve privacy and independence in their own home, and that the family has a moral duty to care. Linked to this, the fourth set of criticisms relate to the fact that community care policies are based on premises which do not always correspond to the needs or wishes of all dependent people. That is, the assumption is that community care is “appropriate to all categories of dependency. Just as all forms of institutional and residential care are perceived as unacceptable, so all forms and conditions of dependency are regarded as being amenable to care in the
community” (Dalley, 1988, p. 6).
Ogden et al. (2004) also point to problems arising from the general terminology used to describe care that takes place in the home. The terms ‘home-based care’, ‘homecare’ and ‘community home-based care’ are usually used interchangeably to refer to “both that universe of care (clinical and non-clinical) that is provided by lay, volunteer or professional providers who are linked to programmes and care (generally non-clinical) that is provided by family members who are not linked to programmes”. Yet by using these terms to refer to what is actually a variety of types of
care means that the specific benefits and costs of unlinked care – where caregivers are not linked to or supported by any formal HIV/AIDS care programmes – are missed.
In both developed and developing countries, governments are concerned with different groups in need of care. In developed countries the concern of social policy makers is with the growing number of elderly people requiring care. Many of these governments have therefore attempted to
“strengthen the family’s capacity to care” (Daly & Standing, 2001, p. 8). In some developing countries, chiefly those in sub-Saharan Africa, the concern of governments has been with the increasing numbers of people with HIV/AIDS who require care, and community care policies have been placed centre-stage to this end. Almost all AIDS care in sub-Saharan Africa is home- based, and women are disproportionately responsible for this care (Urdang, 2006, p. 173). Yet, as noted in section 2.2, for the vast majority of AIDS-affected families care is ‘unlinked’ (Ogden et al., 2004). Urdang (2006, p. 177) argues for the valuation of the unpaid care work which
underpins the HIV/AIDS epidemic, and notes that if this is not done “governments will simply continue to allow this work to subsidise the national economy”, which is able to limit expenditure on care provision more generally as a result.
2.5 HOUSEHOLD STRUCTURE AND UNEMPLOYMENT IN SOUTH