Aging and caring are human conditions. We are all going to get old, and require care. So raising the issues regarding responsibility for care is important. But comments by David Mowat, the parliamentary undersecretary of state for health, on how society should care for the elderly are completely at odds with the findings of the Political Studies Association (PSA) Commission on Care report published in November. In this blog post Commissioners Shirin Rai and Juanita Elias reflect on Mowat’s comments.
Speaking to the House of Commons’ select committee on communities and local government on January 30, Mr Mowat said:
“We need to start thinking as a society about how we deal with care of our own parents.
“One of the things that has struck me as I’ve been doing this role is that nobody ever questions the fact that we look after our children, that’s just obvious. Nobody ever says it is a caring responsibility, it’s just what you do.
“I think some of that logic and some of way we think about that, in terms of the sort of volume of numbers that we are seeing coming down the track, will have to impinge on the way we start thinking about how we look after our parents.
“In a way, it is a responsibility in terms of our life cycle that is similar.”
There are several problems with posing a question about responsibility of care in this way and in this context. As the PSA Commission on Care noted in its report: “The severe financial cuts to the sector are making it difficult for local authorities to meet their statutory duties towards carers and those with care needs. The resourcing gaps in the sector mean that care is increasingly being picked up by unpaid carers”. Put in this context, the suggestion by Mr Mowat reads as: ‘Let us guilt trip people into doing more unpaid work rather than funding social care adequately’.
Of course, adult children do look after their parents – when they can and in different ways. In a mobile society and economy, old bonds of care have inevitably been revised. Indeed some work on households has conceptualised contemporary households as ‘global households’. Migration – intra- or inter-state – is a fact of our lives. For the children of the very old, combining the demands of work, and the need to care for their parents in the context of a crumbling social care system in which profiteering dominates over the provision of high quality care, can be devastating as this recent blog by Beverly Skeggs highlights. So, whose responsibility is it to care for parents? And how can that be delivered?
There are several issues that Mr Mowat’s statement raises. First, this view seems to suggest that parents are a bundle of responsibility that can be carried around without their volition. What do parents want from their adult children? Here is what one contributor (amsams) to the debate that followed on the Guardian newspapers’ report on this story had to say about this: “Looking after children is completely different to looking after parents. Very often the children of the elderly are helping with grandchildren of their own. I for one would not want to live with family members, in many cases it is the cause of much unhappiness”.
Grafton01 said: “I’m not here to be a burden on my children. I would rather take a trip over to Dignitas in Switzerland than force my children to put their lives on hold while I cling to life like a wrinkled old limpet”. The pain and the outrage is clear here; those who have lived independent lives would not want to be seen as dependents – issues of dignity are at stake.
Second, who is the ‘we’ here? Responding to the comments on the Guardian website about this report, muvva77, says: “We all know who will be doing the bulk of the caring, don’t we? All the spoon-feeding of food and dealing with incontinence pads. Women. Those woman who have already given up years of their life, curtailing their careers and earning power to bring up their children. Then perhaps a few precious years of freedom after their kids have left home, and they’re back doing the caring again. What a perfect way to keep women down where many people seem to think they belong.”
Gender roles of caring are deeply entrenched in our society and have been the focus of much academic and activist work. As the PSA Commission report noted, women are more likely to be involved in caring, whether paid or unpaid, and even when men are engaged in this kind of work various forms of gender inequality persist.
Third, caring for older people is not easy – there is often the complexity of need that requires expertise and personalised care, which can only be delivered by trained staff. The problem with Mr Mowatt’s suggestion is it yet again takes the view that ‘anyone can care’. As our report pointed out, the assumption that caring is a ‘natural’ skill means that the need for training often goes unrecognised. The assumption is that ‘someone will step in’ to keep the system going and, more specifically, that women will step in to do unpaid caring. To care for parents without support might need physical strength; currently this is regulated – paid carers have health and safety guidelines and technological support to lift and move adults. So, who will provide this to families who care? Conditions such as dementia, MND and Parkinson’s are increasing health issues for older people – this can lead to both mental, behavioural and physical needs, which family members are generally ill-equipped to deal with.
Fourth, the relationship between parents and children changes over time – adults sharing space have different expectations and histories. muvva77 again: “Some parents are lousy, and to have them in your home, under your care, would prolong a lifetime of emotional or even physical abuse. Some kids are lousy, and if the state defaults on social care, they will have no choice but to go and live with their children, if they’ll even have them”.
Feminist research has long drawn attention to the fact that we need to peer inside the ‘black box’ of the household and expose the power dynamics that mediate family life. The family is not an unproblematic site of affective bonds and altruistic behaviours; As much as we cherish idealised images of the caring family unit. Family relationships can be and sometimes are abusive and unstable, which doesn’t make it the best space of care for older people.
Fifth, our report was concerned with the fact that unpaid family carers also face the stresses and strains of navigating what are often complex bureaucratic systems for accessing care – a burden of ‘co-ordination of care’ that may fall upon other family members who are less directly involved in day-to-day care activities. As one commentator posted on twitter: “Government now asking families to care for elderly; I see families of residents in care homes already do all they can and more!”
This coordination becomes even more stressful if levels of education are low or if the carer does not have a sense of entitlement that often comes with social and economic standing. In the Guardian, a commentator had this to say about their experience of trying to coordinate care for their elderly parent:
“As well as coping with my own chronic health problems, I’m also a (muddling-along-as-best-I-can) carer for my elderly father who as well as being in the early stages of dementia, also has life-long invisible disabilities (that involve challenging behaviour). His GP – who could (potentially) open the door to more help – is obstructive and all-round useless, doubtless partly to do the clinical commissioning group system, as well as being a condescending, undermining, authoritarian, brow-beating middle-class bully. I just feel too worn down to complain atm, probably get nowhere anyway.
“We’re a poor working class family – and in every sense – JAMing. I haven’t even applied for carer’s allowance, being on ESA I don’t want to give them an excuse to persecute me more, ’cause according to Mr Mowat and Co (and his red, yellow and purple friends) I’m just a worthless drain on society.”
Sixth, and as the above passage makes clear, class of course affects all aspects of our daily lives. Those of us who have resources – parents and their adult children – will be better able to arrange a decent life for all concerned. A big house allows space for all to co-exist together and separate and a deep pocket allows for mitigating strategies of buying in labour to help with the essential chores of care. But what of those who cannot? We wonder what image of the ‘home’ Mr Mowat had in mind when he opined that we should all look after our parents.
Seventh, of course, there are social geographies of care where this expectation is well-entrenched, often because the states in these regions have also not provided for their older citizens – the transition to a welfare state has been patchy, necessitating families to come together to care. Indeed, for a long time care provision in this country has assumed not only that women will care, but also, as the PSA report pointed out that ethnicity has played a role in the uneven quality of the care services that older people receive. This is caused in part by issues of access to and information about services as well as stereotyped views concerning the needs of BAME older people (for example, the assumption that BAME communities ‘look after their own’).
During the evidence gathering that we undertook as part of the PSA Commission on Care, we were told that in many BAME communities, there are also problems associated with a lack of awareness or understanding of health conditions affecting older people. Dementia in particular is often misunderstood and highly stigmatised. So, like all British families, BAME families too are not unproblematic sites of care; do not let constructed cultural stereotypes get in the way of the provision of good care for all.
The PSA Commission on Care was particularly concerned about what we have called the domestication of care. The increasing gap between publically financed provision of care and the growing need for care services at home, has seen a transfer of responsibility onto informal, unpaid care by family, friends and neighbours. This is trend that disproportionately impacts women and has implications for the ability of carers to combine paid and unpaid work.
The report argues for, and is part of a growing clamour for, good state funding for decent social care for all who need it.
The report argued that a New Deal for older people will require us to bring together three different aspects of care provision that are often not connected the recognition of issues of care, the importance of redistribution of resources and the representation of the voices of both those that are cared for and those that care. A joined up analysis makes for better policy. A withdrawal of state responsibility from the provision of decent care for those who have contributed all their lives to the country’s economy and society is deplorable.
Our report concluded that what we needed was not a Big Society or Sharing Society but a just society: “Fundamentally, as a society we need to provide for older people – not only for economic reasons but to secure a fair and caring society where everyone gets the support they need, irrespective of their colour, class or creed”.
Mowat would do well to listen to the voices of carers, the cared for and the care workforce. None of the groups that we spoke with during our evidence gathering suggested that families could simply take on this work- however much they were concerned for their loved ones and wanting to help. Indeed, it would seem that Mowat is simply perpetuating the lack of political and economic recognition for caring and care work that came up time and time again in our evidence gathering. Recognizing care as an economically socially and politically valuable activity would be a far more productive starting point.