In this final blog in a series of three, Sara Wallin outlines an agenda for change in the regulation of social care for older people in England. In the previous posts (here and here), she outlined how marketization and austerity has led to a fragile social care system – characterised by growing demand, complex regulation and underfunding which leads to the stretching of the formal and informal workforce as well as growing inequalities in who can access local authority-funded care.
As I wrote this post, more news of the care homes crisis had just broken. With Southern Cross collapsing five years ago, this time it is the current largest care homes provider Four Seasons that have reported a £264 m annual loss before tax. The financing problems for care homes are, in part, a knock on effect of the loss of local authority-funding which has not been made up for even by the use of inflated fees for people paying for their own care. However, the care homes crisis also reveals deeper issues in the market-based and financialised care for older people. A report by the insolvency agency Opus for Radio 4s You and Yours showed that not only are 25% of care homes at risk of closure, but 13% of the total 18 000 care homes in the UK pay more in servicing their debts and paying interest than they make in profits. Similarly, recent research by CRESC showed how large care home chains are financial players – placing the provision of care at risk by extracting money, frequent buying and selling of care homes at inflated prices resulting in high levels of company debt, and operating in complex chains to avoid tax.
Feminist scholars have long raised concerns about what happens when essential social goods become incorporated into markets and financialised. Such research has gone beyond showing how financialisation puts the steady provision of care at risk, to examine how social care systems and finance are gendered and imposes conventional family ideals as well as contribute to reshaping inequalities along the lines of race, class and age. For many feminists, a major dilemma is how we can ensure that policymakers understand the value of care to any economy and society, without subjecting care to the same masculine notions of productivity that dominate mainstream economic analysis. On the one hand, care work remains invisible and not prioritised as long as its economic value is perceived as ‘too difficult to measure’. In global terms, being a low-paid care worker or an unpaid carer has been widely recognised to reproduce and entrench women’s economic vulnerabilities and gender inequalities (OECD 2014). On the other hand, free markets are not necessarily the most efficient means to organise care. Several decades of research on neoliberalism and globalisation have shown how gender norms and stereotypes are brought into play when care work becomes marketised – identifying how the benefits are often only available to the few while many are struggling to pay for care or are brought into exploitative working situations.
Adopting a feminist perspective helps us see that a new model for elder care needs to be a part of a wider rethinking of the economy toward one that places care at the centre of any future social and economic model. Adopting a feminist ethic of care also means listening to care workers, informal carers and care receivers and encouraging dialogue and understanding in transforming the social care model. As argued by Sam Smethers at the Fawcett Society, there is surprisingly little research that accounts for the impacts of dementia on women as family or formal care givers – and –even less so that examines the experiences of living with dementia. In turn, older women are particularly exposed to the shortcomings in the provision of care for older people and often suffer from loneliness and lack of formal and informal support. Already, surveys and qualitative research with care workers and carers have identified that the norms surrounding care provision are often different from the masculine ideals of competition and efficiency that are idealised in market discourse. Those providing care often express that ‘they are not in it for the money’ but rather to do good and have a fulfilling working life. However, as a recent report by UNISON made clear, the current system causes emotional harm to care workers as they seek to provide dignified care under impossible conditions. Care slots as short as 15 minutes per person, in which a care worker is for example expected to feed and put to bed an elderly person, is also a contributing factor to the systemic underpayment in the sector – as care workers are forced, or choose to, use their own unpaid time to provide care.
Reform of the care system also means a less bureaucratic and more bottom-up approach, that is based upon stronger partnerships between community groups, local authorities, government and private care providers. In this context, it is pivotal that policy-makers continue to address access to services for members of BAME communities in ways which account for decades of inequality and discrimination and extend the documentation of how key policy agendas such as personalisation impact on these communities. At the same time, it is high time that we move away from commonly held assumptions that BAME communities are homogenous and have static cultural preferences for care provided in the home. Rather, services for BAME communities are increasingly complex – with future financing and regulation especially needing to recognise the key roles played by community organisations as well as carers. At the same time, as the social care sector is becoming more complex and diversified.
With a growing proportion of private and voluntary organisations there is a growing need for a coherent, transparent system of governance in which accountability is clearly laid out. A stronger regulatory framework is also needed to ensure consistency in the delivery of service across different local authorities as well as for different social groups. This means going beyond minimum obligations for local authorities to provide care for those assessed to have ‘substantial’ needs and ensuring a more even process on the integration agenda to make sure that older people with less acute needs do not fall between the cracks of health and social care, or receive inappropriate services. Last but absolutely not least, it is high time that care work is treated as a profession, which has its rights and training requirements strengthened and made consistent.
(photo credit Vince Alonghi ‘My Mother’ via Flickr)