The concept of care is a mixed notion that draws on a number of elements (Twigg & Atkin, 1994), is both ambiguous and contested (Daly & Lewis, 1998), but is a central concept for social policy (Graham, 1983). Twigg (1992) defines informal care as normally occurring “in the context
4 Many of the references in this section are from the 1980s and 1990s, which although some time ago was a formative time in the United Kingdom with regard to policy-making and research on the issue of care.
of family or marital relationships, and … provided on an unpaid basis that draws on feelings of love, obligation and duty”. It can be distinguished from similar care provided in the formal sector on an organised and paid basis. As section 2.2 shows, caring is an activity which extends across public/private boundaries, between care in formal and informal settings, and is both paid and unpaid caring (Daly & Lewis, 1998).
Self-care is one of the three basic types of caring. The second type is kinship or friendship care:
care for those who are similarly capable. The third type is care for dependants, including young children, the frail elderly, the sick and some of the disabled, all of whom cannot survive or function without regular caring personal assistance.5 The three types of caring may combine or co-exist in caring situations. Caring for dependants constitutes the vast proportion of human caring interactions (Jochimsen, 2003), and is the focus of this thesis.
In this thesis the attention falls explicitly on unpaid care work in private homes along the lines suggested by Elson (2000), as outlined in section 1.1. Folbre (2006) suggests moving beyond the term ‘unpaid care’ to a more disaggregated analysis that distinguishes between different forms of care work according to their relationship to the market, characteristics of the labour process, and types of beneficiaries. Here the focus is on the care of a particular type of beneficiary, namely dependent people who are likely to have HIV/AIDS.
What are some of ‘care work’s’ descriptive elements and how does it unfold in practice? A useful starting point is Bubeck’s (1995) reference to four aspects of care which make up women’s part in the sexual division of labour, namely: the gendered nature of care, care as an activity, the psychology of care and the ethic of care. The gendered nature of care has been discussed in
section 2.1. The remaining concepts are explored one by one through the work of various authors.
The second dimension of care is care as an activity. Bubeck (1995) indicates that a key component of care as an activity is that it involves face-to-face interaction between carer and cared-for. Parker and Lawton (1990, as cited in Parker, 1992, p. 10) have developed a ‘typology’
5 There are many people with disabilities who require no care and live independently.
of caring activities, based on the eight tasks defined in the United Kingdom’s 1985 GHS. This typology has been used to develop the questions relating to caring activities for this study and is referred to in Chapter 6. While such a typology focuses on tasks rather than purpose, and in this way may “restrict rather than extend our conceptual horizons” (Nolan, 1994, p. 647), it is nevertheless sufficient for the purposes of this analysis. The typology is as follows:
• Help with personal care, eg. dressing, toileting;
• Physical help, eg. with walking, getting in and out of bed;
• Help with paperwork or financial matters;
• Other practical help, eg. preparing meals, doing shopping;
• Keeping the person company;
• Taking the person out;
• Giving medicine, including giving injections, changing dressings;
• Keeping an eye on the person to see that s/he is all right.
Caring has its own sequence and the tasks of care change over time (Lewis, 2001). Type of care is tied to the different groups in need of care and an equally variable list of care requirements (for example, constant versus periodic caring) within these groups (Means & Smith, 1998).
Jochimsen (2003) refers to three components that make up a caring situation. A resource component is constituted of time and of material and/or financial resources. The latter is necessary to respond to the cared-for’s needs and to sustain the caregiver so that he/she can perform the caring service. Regarding time, the performance of a single caring activity requires more time than is usually allotted for instrumental aspects of the work only, and includes the communicative aspect of care. Moreover, the caring relationship must continue over time in order for the caring activities to be fully effective and to achieve their goal (Jochimsen, 2003).
Parker (1981) defines care work as “tending” and suggests that it has four parts, as outlined in the following equation, figuratively speaking:
Tending = duration + intensity + complexity + prognosis
Parker notes that, firstly, it is necessary to have an idea of the duration of a caring episode, as care of different durations will require different resources. The notion of duration is a key difference between paid care and unpaid care: for a paid caregiver there are ‘hours of work’ that specify a given period, and someone will replace the caregiver should the need arise; for an unpaid caregiver there are no such assumptions or prescriptions. Secondly, the intensity of caring varies according to the dependency of the person receiving care – cared-for’s who are highly dependent may require constant attention, while those who are not very dependent may require help with specific tasks only.
Thirdly, the notion of complexity refers to the extent to which special skill is required in the provision of care. Parker emphasizes that care and treatment have for a long time been regarded as separate activities. Those who offer treatment do not often tend as well, and different
professional and occupational groupings reflect this division. Similarly, Twigg (2003) highlights the boundary that exists between social and medical care. Parker (1981, p. 29) maintains that everyday experience and research findings show that “no sharp line of demarcation can be convincingly maintained”. Instead “good tending is a vital part of successful treatment” and
“under some circumstances tending itself may be the treatment”. Finally, the fourth component of tending is prognosis: “whether more or less care is expected to be required as time passes”
(Parker, 1981, p. 29). By highlighting the labour involved in caring it is possible to quantify the economic contribution of caring (Graham, 1983).
The third dimension of care provision is the psychology of care. Care cannot be understood only as an activity. Rather, the love and duty involved in care are powerful components of care work (Lewis, 2001). Various authors (for instance Folbre & Nelson, 2000; Parker, 1981) refer to a dual meaning of the term ‘care’: the actual work of looking after someone who cannot do so for themselves (‘caring for’), and an affection or concern for the person (‘caring about’). According to Daly and Lewis (1998), care is not like other labour because it is often initiated and provided
under conditions of social and/or familial responsibility. Dalley (1988) also notes that in public discourse the two are not separated, and hence the economic value of ‘caring’ is lost.
Importantly, Bubeck (1995) maintains that care does not require the existence of an emotional bond between carer and cared-for, and that the term ‘care’ does not mean that the work is always done willingly, or with love. In fact the ‘love’ aspect of caring may not always be present.
Whether the work is done willingly depends on the relationship between the caregiver and cared- for and possibly other people in the family or society. In some cases the care is given unwillingly, because the woman feels forced by psychological, social or even physical pressures (Budlender, 2002). In a similar vein, caring can also be an empowering activity because of its other-directed and other-beneficial nature (Bubeck, 1995). Fast, Williamson and Keating (1999) mention the following benefits of caregiving: satisfaction, a greater sense of mastery and self-confidence, and increased knowledge about self. However, this is the ‘best case scenario’, while the opposite may also be true, with care experienced as a burden (Bubeck, 1995). Caring may also give rise to dependency, powerlessness and even poverty (Graham, 1983). The emotional significance of caring has been studied within the field of psychology (Graham, 1983), and the literature on burden and stress in particular has been dominated by psychological methodology (Twigg &
Atkin, 1994).
The fourth dimension of care, the ethic of care, refers to a moral outlook – caring as an attitude – which is part of the activity of care. The attitude of caring involves “a close attention to the feelings, needs, wants, or ideas of others” (Bubeck, 1995, p. 153) but may not always be present in the caring relationship.
Finally it is essential to point to the differentiation that can be made between carers. Caring takes place within relationships of obligation – marriage, parenthood, kinship – in which people feel responsible for and obliged to give care to spouses, children or parents (Twigg & Atkin, 1994).
Co-residence is also a significant marker of who will care, playing an important part in “defining who within a family ends up as the carer, overriding factors such as gender and relationship”
(Twigg & Atkin, 1994, p. 9). There is also differentiation in terms of the circumstances and
expectations of carers. As Twigg (1992) points out, caring for a spouse is different to caring for an elderly parent, and caring for a person involved in a car accident is different to caring for someone with dementia. Furthermore, whether the carer and the cared-for are the same sex or not, and whether the two are kin or not, has implications for the type of support provided (Parker, 1992).
Carers can also be differentiated according to whether the caring task is shared or not, and the extent of involvement in care provision. Sole carers are the only people who have responsibility for the care of a person; main carers may be involved with someone else in the provision of care for the person but they are more involved than others; joint carers are two or more people who are equally involved in providing care to the person; ‘not main carers’ are involved in care provision but others have a greater degree of responsibility than them. A useful way to differentiate between carers who are more or less heavily involved is to distinguish between carers on the basis of the tasks they carry out. Personal and/or physical care may be used as a proxy measure of heavy involvement (Parker, 1992).
Changing focus, importantly a significant aspect of economic life takes place in the household production of non-marketed goods and services (Floro, 1995). The care economy refers to the activities and relationships that are involved in maintaining and developing people, unpaid, within the home and in the community (Glenn, 1992; Ogden et al., 2006). Lund (2006, p. 161) indicates that this work, undertaken almost entirely by women – as family members or as volunteers – makes up the bulk of caring work undertaken in society, while that provided by the state or the formal private system constitutes a tiny part thereof. The concept of the care economy focuses on the economic costs and benefits of care, the sexual division of labour involved in providing different types of care and the contribution of care to economic growth and
development (Ogden et al., 2004). The care economy lens is useful in helping to distinguish the care provided in the home by family members from care provided by trained individuals – paid or volunteer – who are linked to care and support programmes (Ogden et al., 2006, p. 334).
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).