tag:theconversation.com,2011:/global/topics/unpaid-care-4116/articlesUnpaid care – The Conversation2024-02-12T13:26:57Ztag:theconversation.com,2011:article/2199532024-02-12T13:26:57Z2024-02-12T13:26:57ZFamily caregivers face financial burdens, isolation and limited resources − a social worker explains how to improve quality of life for this growing population<figure><img src="https://images.theconversation.com/files/574183/original/file-20240207-27-pcczxx.jpg?ixlib=rb-1.1.0&rect=30%2C30%2C5061%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Family caregivers may be less likely to turn to others when they need their own support. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-pushing-father-in-wheelchair-royalty-free-image/494327497?phrase=caring+for+the+elderly&adppopup=true">Terry Vine/DigitalVision via Getty Images</a></span></figcaption></figure><p>Millions of Americans have <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">become informal family caregivers</a>: people who provide family members or friends with unpaid assistance in accomplishing daily tasks such as bathing, eating, transportation and managing medications. </p>
<p>Driven in part by a <a href="https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">preference for home-based care</a> rather than long-term care options such as assisted living facilities, and the <a href="https://doi.org/10.1155/2012/680265">limited availability and high cost</a> of formal care services, family caregivers play a pivotal role in the safety and well-being of their loved ones.</p>
<p>Approximately 34.2 million people in the United States <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">provide unpaid assistance</a> to adults age 50 or above, according to the Family Caregiver Alliance. Among them, about 15.7 million adult family caregivers care for someone with dementia.</p>
<p>I am a licensed clinical social worker and an assistant professor of social work <a href="https://scholar.google.com/citations?user=AikbrQ4AAAAJ&hl=en">studying disparities in health and health care systems</a>. I focus on underrepresented populations in the field of aging. </p>
<h2>Challenges for family caregivers</h2>
<p>In my research focusing on <a href="https://doi.org/10.1093/geront/gnad086">East Asian family caregivers</a> for people with Alzheimer’s and related dementia, I discovered that <a href="https://doi.org/10.1177/07334648221142600">Chinese American</a> and <a href="https://doi.org/10.1080/13607863.2022.2122932">Korean American caregivers</a> often encounter challenging situations. These include discrimination from health care facilities or providers, feelings of loneliness and financial issues. Some of these caregivers even find themselves <a href="https://doi.org/10.1080/13607863.2022.2122932">having to retire early</a> because they struggle to balance both work and caregiving responsibilities. </p>
<p>My findings join a growing body of research showing that <a href="https://doi.org/10.1111/scs.12463">family caregivers</a> commonly <a href="https://doi.org/10.1177/0733464818813466">encounter five specific challenges</a>: financial burdens, limited use of home- and community-based services, difficulties accessing resources, a lack of knowledge about existing educational programs, and physical and emotional challenges, such as feelings of helplessness and caregiver burnout. </p>
<p>However, researchers are also finding that family caregivers feel more capable of managing these challenges when they can tap into formal services that offer practical guidance and insights for their situations, as well as assistance with some unique challenges involved with family caregiving.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/dskLxMc2MW0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How to find your way back if you feel that you’ve lost yourself in a caregiving role.</span></figcaption>
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<h2>The demographics of informal caregivers</h2>
<p>More than 6 in 10 family caregivers are women. </p>
<p>Society has always expected <a href="https://doi.org/10.1093/geront/32.5.607">women to take on caregiving responsibilities</a>. Women also usually earn less money or rely on other family members for financial support. This is because equal pay in the workplace <a href="https://iwpr.org/wp-content/uploads/2020/09/C455.pdf">has been slow to happen</a>, and women often take on roles like becoming the primary caregiver for their own children as well as their aging relatives, which can drastically affect their earnings. </p>
<p>While nearly half of care recipients live in their own homes, 1 in 3 live <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">with their caregivers</a>.</p>
<p>Sometimes termed “resident caregivers,” these individuals are less likely to turn to others outside the family for caregiving support, often because they feel that it’s important to keep caregiving within the family. These caregivers <a href="https://doi.org/10.1080/13607863.2021.1935460">are typically older, retired or unemployed</a> and have lower income than caregivers who live separately.</p>
<p>According to a 2020 report from the AARP Public Policy Institute, about 1 in 3 family caregivers <a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">provide more than 21 hours of care a week</a> to a loved one. </p>
<p><iframe id="4L0re" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4L0re/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Juggling caregiving with everyday life</h2>
<p>Caregiving often creates financial burdens because it <a href="https://doi.org/10.1093/geronb/gbv095">makes it harder to hold a full-time or part-time job</a>, or to <a href="https://doi.org/10.1093/geronb/gbv095">return to work</a> after taking time off, particularly for spouses who are caregivers.</p>
<p>Often, community-based organizations such as nonprofits that serve older adults offer a variety of in-home services and educational programs. These can help family caregivers <a href="https://www.cdc.gov/aging/caregiving/caregiver-brief.html">manage or reduce</a> the physical and emotional strains of their responsibilities. However, these demands also can make it difficult for some caregivers to even learn that these resources exist, or take advantage of them, particularly as the care recipient’s condition progresses. </p>
<p>These challenges <a href="https://doi.org/10.23750/abm.v93iS2.12979">worsened at the height of the COVID-19 pandemic</a>. Many support programs were canceled, and it was hard to access health care, which made things even more stressful and tiring for caregivers. </p>
<p>Research shows that those who are new to family caregiving often take care of their loved ones <a href="https://www.ncbi.nlm.nih.gov/books/NBK2665/">without any formal support initially</a>. As a result, they may face increased emotional burdens. And caregivers age 70 and above face particular challenges, since they may be navigating their own health issues at the same time. These individuals are less likely to receive informal support, which can lead to social isolation and burnout.</p>
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<a href="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="Mature woman places a cardigan on an elderly adult." src="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Caregivers age 70 and above may be navigating their own health challenges with little support.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-caring-for-her-elderly-mother-royalty-free-image/1390975112?phrase=family+caregivers&adppopup=true">Alistair Berg/DigitalVision via Getty Images</a></span>
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<h2>Support for family caregivers</h2>
<p>There are numerous programs and services available for family caregivers and their loved ones, whether they reside at home or in a residential facility. These resources include government health and disability programs, legal assistance and disease-specific organizations, some of which are <a href="https://www.caregiver.org/connecting-caregivers/services-by-state/">specific to certain states</a>.</p>
<p>In addition, research has found that providing appropriate <a href="https://doi.org/10.1046/j.1532-5415.2001.49090.x">education and training</a> to people in the early stages of caregiving enables them to better balance their own health and well-being with successfully fulfilling their responsibilities. Many community-based organizations, such as local nonprofits focused on aging, as well as government programs or senior centers, <a href="https://doi.org/10.1111/jgs.14259">may offer case management services</a> for older adults, which can be beneficial for learning about existing resources and services. </p>
<p>For family caregivers of people with dementia, formal support services are particularly crucial to their <a href="https://doi.org/10.1590/1809-98232016019.150117">ability to cope and navigate the challenges</a> they face.</p>
<h2>The role of Medicaid</h2>
<p>Formal support may also be helpful in finding affordable home-based and community resources that can help compensate for a lack of informal support. These include <a href="https://www.medicare.gov/coverage/home-health-services">home health services</a> funded by Medicare and <a href="https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html">Medicaid-funded providers</a> of medical and nonmedical services, including transportation.</p>
<p>Medicaid, which targets low-income Americans, seniors, people with disabilities and a few select other groups, has certain income requirements. Determine the eligibility requirements first to find out whether your loved one qualifies for Medicaid.</p>
<p>The <a href="http://www.thescanfoundation.org/sites/default/files/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-aarp-ppi-ltc.pdf">services and support covered by Medicaid may vary</a> <a href="https://www.payingforseniorcare.com/medicaid-waivers/home-care">based on a number of factors</a>, such as timing of care, the specific needs of caregivers and their loved ones, the care plan in place for the loved one and the location or state in which the caregiver and their loved one reside. </p>
<p>Each state also has its own Medicaid program with unique rules, regulations and eligibility criteria. This can result in variations in the types of services covered, the extent of coverage and the specific requirements for <a href="https://www.medicaidplanningassistance.org/getting-paid-as-caregiver/">accessing Medicaid-funded support</a>.</p>
<p>If so, <a href="https://www.medicaid.gov/about-us/contact-us/index.html">contact your state’s Medicaid office</a> to get more information about self-directed services and whether you can become a paid family caregiver.</p>
<h2>Medicare might help</h2>
<p>Medicare may <a href="https://www.medicare.gov/coverage/home-health-services">help pay for certain home health services</a> if an older adult needs skilled services part time and is considered homebound.</p>
<p>This assistance can alleviate some of the caregiving responsibilities and financial burdens on the family caregiver, allowing them to focus on providing care and support to their loved ones without worrying about the cost of essential medical services. </p>
<p>Peer-to-peer support is also crucial. Family caregivers who join support groups tend to <a href="https://doi.org/10.1080/13607863.2016.1231169">manage their stress more effectively</a> and <a href="https://doi.org/10.3389/fpubh.2019.00122">experience an overall better</a> <a href="https://doi.org/10.1111/j.1532-5415.1990.tb03544.x">quality of life</a>.</p><img src="https://counter.theconversation.com/content/219953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Lee has received funding from the Alzheimer's Association - New to the Field (AARG-NTF-20-678171). </span></em></p>Family caregivers who have stronger support networks and positive communication with loved ones tend to be more resilient.Kathy L. Lee, Assistant Professor of Gerontological Social Work, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1854882022-06-28T01:50:13Z2022-06-28T01:50:13ZYet again, the census shows women are doing more housework. Now is the time to invest in interventions<figure><img src="https://images.theconversation.com/files/470187/original/file-20220622-15-5wmsss.jpg?ixlib=rb-1.1.0&rect=0%2C30%2C6720%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The Australian Census numbers have been released, showing women typically do <a href="https://www.abs.gov.au/census/find-census-data/community-profiles/2021/AUS/download/GCP_AUS.xlsx">many more hours of unpaid housework</a> per week compared to men.</p>
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<p>It’s not a new development. In <a href="https://www.abs.gov.au/websitedbs/D3310114.nsf/home/2016+Census+National">2016</a>, the “typical” Australian man spent less than five hours a week on domestic work, while the “typical” Australian woman spent between five and 14 hours a week on domestic work. Before that, the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/7d12b0f6763c78caca257061001cc588/c0e6e1069c8d24e9ca257306000d5b04!OpenDocument">2006 census</a> showed, again, that more of the domestic workload is shouldered by women.</p>
<p>So, in the 15 years since the Australian Census <a href="https://www.theage.com.au/national/census-to-count-unpaid-work-20060226-ge1ty0.html">started collecting</a> unpaid housework time, women are shown to do more than men. Every. Single. Time.</p>
<p>What is unique about these latest census numbers is Australians filled out their surveys during one of the greatest disruptors to work and home life – the COVID pandemic.</p>
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Read more:
<a href="https://theconversation.com/planning-stress-and-worry-put-the-mental-load-on-mothers-will-2022-be-the-year-they-share-the-burden-172599">Planning, stress and worry put the mental load on mothers – will 2022 be the year they share the burden?</a>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470186/original/file-20220622-13-9gh2n6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">In the 15 years since the Australian Census started collecting unpaid housework time in 2006, women are shown to do more than men.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Pandemic pressures</h2>
<p>We have a breadth of <a href="https://scholar.google.com.au/citations?hl=en&user=EHPbrxgAAAAJ&view_op=list_works&sortby=pubdate">research</a> showing the pandemic disrupted women’s – especially mothers’ – work and family lives, in catastrophic ways. </p>
<p>Economic closures knocked women out of employment at <a href="https://arts.unimelb.edu.au/the-policy-lab/projects/projects/worsening">higher rates to men</a>, forcing them to rely more heavily on their savings and stimulus payments to make ends meet. All this while managing intensified housework, childcare and homeschooling.</p>
<p>The <a href="https://read.dukeupress.edu/demography/article/59/1/1/286878/Research-Note-School-Reopenings-During-the-COVID">transition</a> to remote and hybrid learning meant mothers, not fathers, reduced their workloads to meet these newfound demands. </p>
<p>Fathers picked up the slack in the home – doing <a href="https://theconversation.com/covid-forced-australian-fathers-to-do-more-at-home-but-at-the-same-cost-mothers-have-long-endured-154834">more housework</a> at the start of the pandemic and <a href="https://journals.sagepub.com/doi/full/10.1177/1097184X21990737">holding it</a> over time.</p>
<p>Yet, as my colleagues Brendan Churchill and Lyn Craig <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/gwao.12497">show</a>, fathers increased their housework but so did mothers, meaning the gender gap in that time remained. </p>
<p>So, while men should be applauded for doing more during the unique strains of the pandemic, we <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/gwao.12727">show</a> mothers were the true heroes of the pandemic, stepping into added labour at the expense of their health and well-being.</p>
<p>Quite simply, the pandemic placed unparalleled pressures on Australian families. So it is perhaps no surprise our surveys are showing <a href="https://www.theage.com.au/national/victoria/the-juggle-is-real-parents-want-greater-flexibility-in-return-to-office-20220325-p5a820.html">Australians are burnt out</a>.</p>
<p>(As discussed in <a href="https://theconversation.com/dont-give-mum-chocolates-for-mothers-day-take-on-more-housework-share-the-mental-load-and-advocate-for-equality-instead-182330">previous articles</a>, the chore divide in same-sex relationships is generally found to be more equal. But some critiques suggests even then, equality may suffer <a href="https://www.nytimes.com/2018/05/16/upshot/same-sex-couples-divide-chores-much-more-evenly-until-they-become-parents.html">once kids are involved</a>.)</p>
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<a href="https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469967/original/file-20220621-23-bv1i02.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">In general, fathers increased their housework during the pandemic – but so did mothers, meaning the gender gap remained.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<em>
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Read more:
<a href="https://theconversation.com/covid-forced-australian-fathers-to-do-more-at-home-but-at-the-same-cost-mothers-have-long-endured-154834">COVID forced Australian fathers to do more at home, but at the same cost mothers have long endured</a>
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<h2>Time for action</h2>
<p>So, where to now? </p>
<p>We pay upwards of <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/mediareleasesbyReleaseDate/1B9C46E8DBFC05FFCA25847D0080F9A2?OpenDocument">$640 million dollars</a> every five years to document Australia through the census. </p>
<p>And, in each of these surveys we find the same result – women are doing more housework than men. </p>
<p>This <a href="https://theconversation.com/sorry-men-theres-no-such-thing-as-dirt-blindness-you-just-need-to-do-more-housework-100883">parallels decades of research</a> showing women do more housework, even when they are employed full-time, earn more money and especially <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1741-3737.2008.00479.x">once kids hit</a> the scene.</p>
<p>Men have increased their <a href="https://link.springer.com/chapter/10.1007/978-3-319-21635-5_2">housework</a> and <a href="https://aifs.gov.au/aifs-conference/fathers-and-work">childcare contributions</a> over time and <a href="https://journals.sagepub.com/doi/abs/10.1177/00113921211012737?journalCode=csia&fbclid=IwAR0Vgrre91fTarMY_EFLmDl1iJk7hPms6p3FhfM0E0y52Bbe9bZqmJ7Gs1A">younger men want</a> to be more present, active and attentive in the home.</p>
<p>Simply put: men want to step into greater care giving and women are suffering from “doing it all”.</p>
<p>We have documented these trends for decades – enough. Now it is time for action.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469968/original/file-20220621-19-qr3c2h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pandemic intensified housework, childcare and homeschooling demands on women.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flexible-work-arrangements-help-women-but-only-if-they-are-also-offered-to-men-155882">Flexible work arrangements help women, but only if they are also offered to men</a>
</strong>
</em>
</p>
<hr>
<h2>Creating a fair future</h2>
<p>These are the critical questions we are asking through <a href="https://www.unimelb.edu.au/futureofwork">The Future of Work Lab</a> at the University of Melbourne – how do we create a future that is fair to everyone, including women and mothers? </p>
<p>A few key projects illuminate some of the next steps towards clear interventions. The first is to provide Australian families with a comprehensive safety net to support their care-giving lives.</p>
<p>All of us will be, at some point, called upon to care for a loved one, friend, family member or colleague. At these moments, work becomes difficult and housework demands soar. </p>
<p>So, providing <a href="https://theconversation.com/if-were-serious-about-supporting-working-families-here-are-three-policies-we-need-to-enact-now-105490">care-giving resources</a> beyond just paid time off is critical. This underscores the need for </p>
<ul>
<li>universal free high-quality childcare</li>
<li>paid caregiver leave, and/or </li>
<li>better and longer term cash payments for caregivers.</li>
</ul>
<p>Second, we need comprehensive policies that allow <a href="https://pursuit.unimelb.edu.au/articles/flexible-families-workplace-equality">men to step</a> into care-giving roles without fear of retribution and penalty at work.</p>
<p>Australians work more <a href="https://stats.oecd.org/Index.aspx?DataSetCode=AVE_HRS#">annual hours</a>, on average, than their Canadian and United Kingdom counterparts, working hours more similar to the overwork culture of the United States. And, only <a href="https://www.theguardian.com/lifeandstyle/2019/may/28/only-one-in-20-fathers-take-primary-parental-leave-in-australia">one in 20 Australian fathers</a> take paid parental leave following childbirth, an abysmal rate relative to other high-income countries. </p>
<p>We can do better. </p>
<p>The pandemic created the space for many men to step into larger care-giving roles with great pleasure and showed workplaces that flexible work is feasible.</p>
<p>Next, the Australian workplace must become more supportive of men’s right to care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469969/original/file-20220621-11-q6rxsk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australian workplaces must become more supportive of men’s right to care.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Unpaid domestic work and the mental load</h2>
<p>Finally, we must redress the challenges of unpaid domestic work and the <a href="https://theconversation.com/planning-stress-and-worry-put-the-mental-load-on-mothers-will-2022-be-the-year-they-share-the-burden-172599">mental load</a> on women’s physical, mental and <a href="https://www.tandfonline.com/doi/abs/10.1080/13668803.2021.2002813">economic health and well-being</a>.</p>
<p>Perhaps tech holds some solutions. </p>
<p>The demand is clearly there with some super impressive women building out concrete tech solutions to reduce the mental load and unpaid domestic work - like <a href="https://getmelo.app/">Melo’s mental load app</a> or <a href="https://www.yohana.com/">Yohana’s virtual concierges</a>. </p>
<p>Others are using old tech solutions – like <a href="https://www.fairplaylife.com/the-cards">Eve Rodsky’s Fair Play</a> cards – to help couples equalise the often unseen, and undervalued household chores. We are working on a research project to understand the impact of these different resources on families’ unpaid domestic loads and lives more broadly. </p>
<p>The census is valuable in showing us we remain unchanged. </p>
<p>But, now, is a time to invest in intervention and innovation to make us better versions of ourselves into the future.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-give-mum-chocolates-for-mothers-day-take-on-more-housework-share-the-mental-load-and-advocate-for-equality-instead-182330">Don't give mum chocolates for Mother's Day. Take on more housework, share the mental load and advocate for equality instead</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/185488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leah Ruppanner receives funding from the Australian Research Council and is working on a research project with Melo to understand how to share the mental load. </span></em></p>We must redress the challenges of unpaid domestic work and the mental load on women’s physical, mental and economic health and well-being.Leah Ruppanner, Professor of Sociology and Founding Director of The Future of Work Lab, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1590292021-05-10T12:34:38Z2021-05-10T12:34:38ZWomen-dominated child and home care work is critical infrastructure that has long been devalued<figure><img src="https://images.theconversation.com/files/399607/original/file-20210509-13-175ac9c.jpg?ixlib=rb-1.1.0&rect=122%2C89%2C5309%2C3526&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many mothers struggled without child care during the pandemic.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChildCare/48245e1a12d34b3ea114fd9c2437a775/photo?Query=child%20AND%20care&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=1582&currentItemNo=129">AP Photo/Ted S. Warren</a></span></figcaption></figure><p>A <a href="https://www.nytimes.com/2021/04/29/us/politics/joe-biden-speech-transcript.html">fiery debate has erupted</a> over the definition of “infrastructure.” </p>
<p>Does it mean roads, broadband and other physical structures included in the <a href="https://www.buildingsolutions.com/industry-insights/infrastructure-what-is-it-why-do-we-need-it-why-does-it-cost-so-much">traditional meaning of infrastructure</a>? Or should it have a broader definition that includes other important parts of the economy, such as workers who care for children, older adults and people with disabilities? </p>
<p>President Joe Biden prefers the latter meaning and wants to use <a href="https://www.wsj.com/articles/bidens-infrastructure-plan-how-the-2-3-trillion-would-be-allocated-11617234178">nearly one-fifth</a> of the US$2.25 trillion of spending in his jobs and infrastructure plan <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan">to expand and strengthen child care and home-based long-term care</a>.</p>
<p>As a <a href="https://scholar.google.com/citations?user=7chEaMgAAAAJ&hl=en&oi=ao">sociologist who has studied the paid-care workforce</a> for over 15 years, I know how critical it is to the U.S. economy – as the COVID-19 <a href="https://www.brookings.edu/research/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/">pandemic has made quite plain</a>. The problem is, these workers have long been undervalued, primarily because of who they are. </p>
<h2>Who’s in the caring economy</h2>
<p>A <a href="https://www.rutgersuniversitypress.org/making-care-count/9780813549613">broad definition of the care economy</a> includes health care, child care, education and care for older adults and people with disabilities. </p>
<p>The number of people doing this type of work has exploded over the past 70 years, driven by an aging population, expanding medical technologies and the large-scale entrance of women into the paid labor force. My calculations show that in 2018 <a href="https://usa.ipums.org/usa/">more than 23 million workers</a> – almost 15% of the U.S. labor force – worked in the care sector, up from just under 3 million in 1950. </p>
<p>While the overall care economy is dominated by women, the two areas that are the focus of Biden’s plan – child care and home care – are even more so. I found that over 85% of the <a href="https://usa.ipums.org/usa">3.6 million people employed as home health workers</a>, personal care aides and nursing assistants are women. These people meet the health care needs of older adults and disabled individuals and also provide <a href="http://phinational.org/policy-research/key-facts-faq/">assistance with daily living activities</a> like bathing, dressing and eating. </p>
<p>The share of the 1.3 million child care workers who are women is even higher, at about 93%. </p>
<p>Both job categories are also disproportionately made up of people of color and immigrants. For example, 30% of home health and personal care aides are Black and 26% are immigrants. Among child care workers, 24% are Hispanic and 22% are immigrants. </p>
<h2>Why care work is ‘essential’</h2>
<p>The pandemic has shown just how essential this workforce is to the U.S. economy, as well as to families and communities. </p>
<p>Care workers, broadly speaking, made up <a href="https://www.doi.org/10.1080/13545701.2020.1828602">fully half</a> of all those deemed “essential critical infrastructure workers” at the beginning of the pandemic by the <a href="https://www.cisa.gov/sites/default/files/publications/ECIW_4.0_Guidance_on_Essential_Critical_Infrastructure_Workers_Final3_508_0.pdf">Department of Homeland Security</a>. This designation was used to identify workers who “protect their communities, while ensuring continuity of functions critical to public health and safety, as well as economic and national security.” </p>
<p>In effect, it meant they could continue to go to work despite state lockdowns, risking their own health and that of their families. </p>
<p>But Americans also saw their importance in their absence. The pandemic <a href="https://www.americanprogress.org/issues/women/reports/2020/10/30/492582/covid-19-sent-womens-workforce-progress-backward/">forced many child care centers across the country to shut down</a>, while many home-based nannies and personal care aides <a href="https://www.domesticworkers.org/6-months-crisis-impact-covid-19-domestic-workers">were let go</a> because of COVID-19 concerns and precautions.</p>
<p>In the absence of these care workers, the media was full of stories about the <a href="https://www.nytimes.com/interactive/2021/02/04/parenting/working-moms-coronavirus.html">crushing burdens faced by working parents</a> – mostly mothers – trying to simultaneously manage caring for children at home. And older adults isolated at home <a href="https://www.doi.org/10.1001/jamainternmed.2020.1661">suffered from lack of access to formal home care support</a> as families struggled to meet their needs.</p>
<p>Perhaps the most striking indication that not just families but economic activity depends on paid care is the <a href="https://www.nytimes.com/2021/02/18/us/politics/women-pandemic-harris.html?fbclid=IwAR2vYEfbszrIBypzb1yHFHAVRwWLWgCik3fSl_bHLBdUyp8X5ztEo7wegjc">millions of women</a>, particularly mothers of young children, <a href="https://www.americanprogress.org/issues/women/reports/2020/10/30/492582/covid-19-sent-womens-workforce-progress-backward">who have dropped out the labor force</a> because they had to care for a child or someone else.</p>
<p>This is why government officials and policymakers recognized reopening schools to in-person learning and <a href="https://www.wbur.org/cognoscenti/2020/12/10/child-care-workers-economy-covid-19-marty-walsh-annissa-essaibi-george">supporting child care centers</a> as critical to enabling the opening of the rest of the economy. </p>
<p>In other words, just as businesses and communities cannot function without bridges and broadband, the same can be said about having a solid paid care infrastructure in place. </p>
<h2>The devaluation of care work</h2>
<p>But this workforce has long been devalued, perhaps most clearly demonstrated by their wages. </p>
<p>My own research shows that the historical development of the paid-care sector <a href="https://www.rutgersuniversitypress.org/making-care-count/9780813549613">has relied on a gendered narrative of care</a> as a “natural” characteristic of women that has created and justified low wages.</p>
<p>Care workers overall <a href="https://doi.org/10.1080/13545701.2020.1828602">earn 18% less than other essential workers</a>, such as police officers, bus drivers and sanitation workers, after controlling for the usual factors that depress wages, such as gender, years of education and depth of work experience. </p>
<p>And the workers targeted by Biden’s plan are at the low end of this devalued sector, with some of the lowest wages in the U.S. labor market. In 2020, the average annual salary for home health care and personal care aides, for example, <a href="https://www.bls.gov/news.release/ocwage.t01.htm">was $28,060</a>, and for child care workers it was $26,790. These are near poverty wages, <a href="https://aspe.hhs.gov/2020-poverty-guidelines">barely exceeding the federal poverty threshold of $26,200</a> for a household of four. </p>
<figure class="align-center ">
<img alt="An elderly woman lies in a bed as a home care aide prepares some food." src="https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399761/original/file-20210510-18-15g95k7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people depend on home care aides.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AgingAmericaHomeHealthWorkers/969cca9263d4411a8b1e3bfe14605d33/photo?Query=home%20care%20aide&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=55&currentItemNo=45">AP Photo/Tony Dejak</a></span>
</figcaption>
</figure>
<h2>Care as a public good</h2>
<p>There’s another reason to think about paid care work as a part of infrastructure: <a href="https://doi.org/10.1525/sp.2013.60.2.145">Both are what economists call a public good</a>. </p>
<p><a href="https://www.cbpp.org/research/state-budget-and-tax/its-time-for-states-to-invest-in-infrastructure">Every business and worker gains</a> when there are good roads and public transportation to ferry people around. But the benefits are so dispersed that the private market usually can’t cover the costs to maintain them. <a href="https://courses.lumenlearning.com/ushistory2americanyawp/chapter/introduction-28/">This has negative impacts on the economy</a> as a whole if not offset by public investment. </p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Similarly, when children receive high-quality child care, they benefit – but so do their families, their parents’ employers, their own future employers and their future partner or children. The <a href="https://www.doi.org/10.1177/000271629956100103">benefits are significant but dispersed</a>.</p>
<p>But unlike traditional infrastructure, there has been little government support for this kind of work, reflecting its economic and societal devaluation – and on top of that, <a href="https://www.unwomen.org/en/digital-library/publications/2020/04/policy-brief-the-impact-of-covid-19-on-women">women often fill in any gaps in paid care infrastructure with unpaid work</a>. </p>
<p>If Biden’s plan becomes law, the invisible human infrastructure that supports America’s families, communities and economic activity would finally be valued for what it is.</p><img src="https://counter.theconversation.com/content/159029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mignon Duffy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Biden wants to use his $2.25 trillion infrastructure plan to shore up child and home care. A scholar explains why that kind of care is just as critical as roads and bridges.Mignon Duffy, Associate Professor of Sociology, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/968072018-06-11T11:35:32Z2018-06-11T11:35:32ZAutomation has the potential to improve gender equality at work<figure><img src="https://images.theconversation.com/files/222003/original/file-20180606-137309-jub94v.jpg?ixlib=rb-1.1.0&rect=707%2C1026%2C4268%2C2828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are considerable differences in pay, employment levels, and the types of activities that men and women perform in the workplace</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1102690298?src=YeF9fTKeTocIiMT8xrR0cA-2-32&size=huge_jpg">shutterstock</a></span></figcaption></figure><p>If <a href="https://theconversation.com/the-new-industrial-revolution-robots-are-an-opportunity-not-a-threat-81792">predictions are right</a>, automation will transform work as we know it. But it’s difficult to know exactly which – and how many – jobs will be affected. Although there is <a href="https://theconversation.com/machines-on-the-march-threaten-almost-half-of-modern-jobs-18485">a huge debate</a> over just these questions, one area frequently overlooked is how automation will affect the prospect of gender equality.</p>
<p>Right now, there are considerable differences in pay, employment levels, and the types of activities that men and <a href="https://theconversation.com/made-in-britain-how-the-uk-became-a-worse-place-for-women-to-work-36794">women perform in the workplace</a>. As women are often expected to take more responsibility for care at home, there are fewer job opportunities. This is because the current job market lacks the flexibility needed by women who are expected to juggle caring and working responsibilities. These biases will lead to a future of work that remains unequal. Where bias goes in, bias comes out. </p>
<p>But this doesn’t have to be the case. Male and female roles and identities are constructed – not fixed – and so the future distribution of work is not fixed either. If jobs get scarcer while productivity increases, we need to ask how the rewards are going to be shared and we need to rethink the structures of employment and the forms of work before it’s too late. Here are some alternatives for shaping a more gender equal society. </p>
<h2>Less working time</h2>
<p><a href="https://www.oxfordmartin.ox.ac.uk/downloads/academic/The_Future_of_Employment.pdf">While studies</a> paint a fairly dismal picture of a world where there is less demand for workers, they don’t consider working time. If automation increases productivity, the average working week could be radically reduced, creating more free time for all. Of course, if we are to enjoy increased leisure time, we still need to earn a decent wage. So any reduction in working hours shouldn’t mean a reduction in salary.</p>
<p>Given that part-time and low-paid workers are <a href="https://policy-practice.oxfam.org.uk/publications/why-is-womens-work-low-paid-establishing-a-framework-for-understanding-the-caus-620379">predominantly female</a> a reduced working week with a decent salary could enable a more equal distribution of wage work. Rather than revert to the norm of men earning a family wage while women care for family members, more free time for both women and men could create the conditions necessary for a more equal sharing of care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-three-day-weekends-can-help-save-the-world-and-us-too-64503">How three-day weekends can help save the world (and us too)</a>
</strong>
</em>
</p>
<hr>
<h2>Equalise unpaid labour</h2>
<p>A woman’s position in the labour market is inextricably linked to the home. In the UK, 42% of carers are men and <a href="https://carers.org/key-facts-about-carers-and-people-they-care">58% are women</a>. If we are able to reduce the working week, thanks to advances in automation, then we could support more innovative approaches towards domestic and care arrangements. </p>
<p>New forms of flexible working that are no longer subject to the whim of employers but give workers control over hours, remote working, breaks and time off could help equalise household roles so that women and men can share earning and caring. </p>
<p>If men and women became equal participants in domestic and work roles this would challenge expectations about who is responsible for paid and unpaid labour. Women would no longer be perceived as primary carers and low earners.</p>
<h2>We must begin valuing care work</h2>
<p>If automation increases productivity and creates more wealth, while reducing the number of jobs, we’ll need to find some way of redistributing that wealth in a way that benefits society. One constructive approach would be to more highly reward those undervalued jobs, such as care work, that are crucial for our society.</p>
<p>At the moment, the jobs that are profitable for capital, such as working in finance, gain high status while care work remains sidelined. All the while, many western countries face <a href="https://theconversation.com/japan-is-not-the-only-country-worrying-about-population-decline-get-used-to-a-two-speed-world-56106">demographic time bombs</a>. We’re in dire need of more care workers to look after the growing number of elderly people. But our social, economic and political system is structured in a way that doesn’t value care work properly.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222145/original/file-20180607-137315-1t0dcgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The majority of carers in the UK are women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUyODM4ODc1NiwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTA4NTc2ODQ1MCIsImsiOiJwaG90by8xMDg1NzY4NDUwL2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJRZzZiWGE5UFFHYXhGQTArb0pRdVB5dHAvUm8iXQ%2Fshutterstock_1085768450.jpg&pi=33421636&m=1085768450&src=diQd1F66_lYSQbjVuemuYg-2-62">Shutterstock</a></span>
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<p><a href="http://journals.sagepub.com.manchester.idm.oclc.org/doi/10.1177/0950017014556412">Women dominate the care sector</a>. So when we recognise that some forms of work should be fairly rewarded for their social value, rather than an ability to generate profit, gender equity will be improved. </p>
<p>Technology can also improve the care industry through new innovations. Assistive technologies, such as the <a href="http://www.parorobots.com">therapeutic robot seal</a>, which is used to help care those with dementia, have the potential to address some of the challenges of the care sector. But this requires substantial investment in technology rather than defaulting to the norm of zero-hours contracts and low-cost labour. Instead of investing only the bare minimum in care, the government needs to direct wealth created through automation towards the care sector. This includes socially and financially recognising the value care workers better and investing more heavily in technological solutions that can help the care sector.</p>
<h2>End gender segregation at work</h2>
<p>If job losses affect lower-skilled workers, who often tend to be women, we need to focus on upskilling and retraining. A more inclusive and ambitious education system could open up possibilities for those pursuing a career change or needing second chances. </p>
<p>Challenging gender segregation at work also requires a radical reorientation of STEM (science, technology, engineering, and medicine) occupations, given the growing demand for technical knowledge and skills. In the UK, levels of female employment in the IT industry are decreasing and women make up only <a href="https://www.wisecampaign.org.uk/resources/2017/10/women-in-stem-workforce-2017">17% of the workforce</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222143/original/file-20180607-137298-1bivk1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Women are seriously underrepresented in the STEM industry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concept-architects-hand-asian-young-woman-1106740043?src=crWuxqogvcTD_4MNPbx_UQ-1-0">Shutterstock</a></span>
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<p>Various government initiatives have failed to make the STEM industry more gender equal. This is because they are based on the assumption that increasing female participation will miraculously transform the industry – an “add women and stir” approach. “<a href="https://www.penguinrandomhouse.com/books/547571/brotopia-by-emily-chang/9780735213531/">Brotopia</a>” and frat house culture, particularly in Silicon Valley companies means that those women who are employed in high-tech firms tend to vote with their feet, with <a href="https://www.ncwit.org/sites/default/files/resources/womenintech_facts_fullreport_05132016.pdf">more leaving than are being recruited</a>.</p>
<p>Reports that <a href="https://www.sfchronicle.com/business/article/Uber-to-settle-discrimination-case-for-10-million-12785437.php">Uber have just paid $10m</a> to settle a class action concerning discrimination suggest that much work needs to be done to tackle discriminatory work practices. If the sector is to become more inclusive, a radical reorientation of working culture is needed. The absence of women workers is particularly problematic if they have practically no voice in the development of major technological innovations that might transform our future.</p>
<p>Although much of the discussion on automation focuses on dystopian outcomes, this is far from certain. Debating the future of work can actually provide us an opportunity to map out a more equal society.</p><img src="https://counter.theconversation.com/content/96807/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jill Rubery is affiliated with The Labour Party</span></em></p><p class="fine-print"><em><span>Debra Howcroft does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Automation could transform our working world. Here’s what we can do to ensure it is a more gender equal one.Debra Howcroft, Professor of Technology and Organisation, University of ManchesterJill Rubery, Professor of Comparative Employment Systems, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/927292018-06-03T17:22:57Z2018-06-03T17:22:57ZConsider this advice before travelling abroad for health care<figure><img src="https://images.theconversation.com/files/218571/original/file-20180511-52177-sixmya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This photo was taken at a resort just outside Chennai, India that caters to medical tourists following discharge from hospital.</span> <span class="attribution"><span class="source">(V.A. Crooks)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>I will never forget the first Canadian medical tourist I interviewed. I was gripped when this person told me about travelling abroad for invasive surgery, accompanied by their spouse. While in India, this spouse required emergency surgery to address a chronic condition that had worsened. </p>
<p>This situation sounded so distressing and the researcher in me wondered: Could the mental and physical stress of caregiving in an unfamiliar, international context have negatively impacted the spouse’s health to the point that surgery was required? </p>
<p>There are <a href="https://doi.org/10.1108/TR-04-2014-0015">many reasons why patients opt to seek health care abroad</a>. In some cases it is because they cannot access timely surgery locally. In others, they are seeking an experimental procedure that is not available at home, such as an unapproved stem cell therapy. </p>
<p>For most of the last decade I have been involved in extensively studying medical tourism. I have spoken with patients, policy-makers, doctors, nurses, tourism officials, travel operators and many others in well over a dozen countries. Much of this research has examined <a href="http://dx.doi.org/10.1136/bmjopen-2012-002302">ethical</a> and <a href="https://doi.org/10.1186/1475-9276-9-24">equity</a> questions related to medical tourism. For example, trying to understand if and how <a href="http://www.dx.doi.org/10.1186/s12939-015-0147-1">local patients</a>, <a href="https://doi.org/10.1186/1475-9276-12-2">health-care providers</a> and <a href="https://doi.org/10.1186/s12992-015-0113-0">health systems</a> can benefit from medical tourism in the Caribbean.</p>
<p>One thing I have learned is that many medical tourists do not travel on their own. Many travel with a friend or family member. </p>
<p>Friends and family provide support and companionship. They serve as a source of familiarity and comfort. They can assist with very practical matters, such as confirming travel plans and keeping people at home informed about the medical tourists’ health status. My own research has found that these <a href="https://equityhealthj.biomedcentral.com/track/pdf/10.1186/1475-9276-12-94?site=equityhealthj.biomedcentral.com">roles and responsibilities</a> can be quite extensive. </p>
<p>I would like to take a step back and offer a more critical perspective on this practice of informal caregiving by friends and family members in the context of medical tourism. </p>
<h2>‘Shadow workers’ in a multi-billion dollar industry</h2>
<p>It is <a href="http://medicaltourismassociation.com/blog/medical-tourism-a-multibillion-dollar-industry-at-your-disposal/">often reported</a> that medical tourism is a multi-billion dollar global industry. (Though, let’s be careful not to rely too much on the numbers that are reported because, <a href="http://www.dx.doi.org/10.1016/j.socscimed.2015.11.019">most of the quantitative figures that exist are wrong</a>.) </p>
<p>Clinics, hospitals and entire countries are actively trying to attract medical tourists through costly advertisement campaigns and other promotional efforts. But what about the friends and family who accompany them?</p>
<p>I rarely see mention about friends and family in the brochures, websites, e-mails and trade shows that advertise medical tourism services. </p>
<p>There is no formal guidance on what they can expect while they are abroad. No formal resources to prepare them to do things like change wound dressings in hotel rooms or navigate airports with someone recovering from surgery. </p>
<p>These friends and family are, in many ways, “shadow workers” in a multi-billion dollar global industry. </p>
<p>The <a href="https://doi.org/10.1186/1744-8603-9-31">unpaid care work they provide to medical tourists is invaluable</a>. And I have no doubt that many patients would not even consider medical tourism without someone to accompany them on what can be a painful and challenging journey. </p>
<p>Yet, in my opinion, the industry does little to protect them.</p>
<h2>Nine factors to consider</h2>
<p>I think there are many things that can be done to transition these friends and family members from unpaid “shadow workers” to prepared members of medical tourists’ support networks. </p>
<p>My collaborative research shows that <a href="https://doi.org/10.1186/s12889-017-4442-1">one tangible action is to develop resources to help these individuals make informed decisions</a>, become prepared travellers and caregivers and stay safe and healthy. </p>
<p>I was recently involved, with a research team, in interviewing Canadians who had accompanied a family member or friend abroad for medical tourism. Their stories contained very important pieces of advice for people considering taking on this role. We gathered this advice together and published it in an academic article. </p>
<p>We also put together a simple, one-page information sheet that offers <a href="http://www.sfu.ca/medicaltourism/Caregiver-Info-Sheet_c.pdf">nine specific factors that I strongly urge friends and family to carefully consider before accompanying a medical tourist abroad</a>.</p>
<h2>Read, share, discuss</h2>
<p>The information sheet we developed can be shared widely. The text can be copied and pasted freely onto the websites or promotional materials of clinics and hospitals seeking to treat medical tourists. </p>
<p>I invite people to read it, share it and talk about the content. </p>
<p>This sheet also serves as companion to another information sheet we developed —for <a href="http://www.sfu.ca/medicaltourism/ThinkingAboutMT.pdf">Canadians thinking about participating in medical tourism</a>.</p>
<p>The global medical tourism industry relies on the unpaid labour provided by patients’ friends and family members. Their unpaid labour needs to be acknowledged. Their needs must be assessed. Their health and safety needs to be protected. </p>
<p>I push for these things to happen when I meet with medical tourism sector representatives, and I call on others to push for the same.</p><img src="https://counter.theconversation.com/content/92729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valorie A. Crooks receives funding from the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, and the Canada Research Chair Secretariat. </span></em></p>Informal caregivers play a vital role in medical tourism yet find themselves unprotected as “shadow workers” in a multi-billion dollar industry.Valorie A. Crooks, Full Professor, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/939532018-04-02T19:58:14Z2018-04-02T19:58:14ZDisability workers are facing longer days with less pay<figure><img src="https://images.theconversation.com/files/212351/original/file-20180328-109204-z6rntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The study found that the disability support workers regularly spent unpaid time on two types of work activities.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Disability support workers are being significantly underpaid as some core tasks and activities do not get counted as work, <a href="http://journals.sagepub.com/doi/full/10.1177/1035304618758252">our research finds</a>.</p>
<p>We investigated disability support workers’ working time patterns and pay by analysing 30 self-completed work diaries kept by 10 workers over three consecutive work days. We also interviewed the workers. </p>
<p>Like most frontline care workers, the disability support workers in our research are low-paid and work part-time hours only. Employed to provide support to people in their own homes and the community, their working time is highly fragmented, with multiple short periods of paid work spread out over long working days. This means that many also have to work six or seven days a week to earn a living.</p>
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Read more:
<a href="https://theconversation.com/the-ndis-costs-are-on-track-but-that-doesnt-mean-all-participants-are-getting-the-support-they-need-79424">The NDIS costs are on track, but that doesn't mean all participants are getting the support they need</a>
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<p>It’s not unusual for the businesses who employ care workers to limit employees’ paid work time. However, under the tight pricing arrangements of the National Disability Insurance Scheme (NDIS), this appears to be leading to excessive unpaid overtime and unfair pay. For low-paid workers this can mean their actual pay rates are being pushed well below minimum award rates.</p>
<h2>What workers are spending unpaid time on</h2>
<p>We found that the disability support workers regularly spent unpaid time on two types of work activities.</p>
<p>Workers travelled directly between different locations to provide support and care and were not paid for this travel time as each incidence of support was treated as a separate work shift. </p>
<p>As a typical example, one woman provided support to four people in four separate locations on one day and she was paid for a total of 3.5 hours’ work for the four separate work shifts. However, she also spent an additional unpaid 55 minutes, 20% of her total work time, travelling directly from one work location to the next. </p>
<p>The workers we studied also regularly spent unpaid time providing direct support, completing mandatory or essential paperwork, and communicating with support recipients, families or supervisors. While the periods of unpaid work were mostly short, say 10 minutes or so, they occurred several times a day. </p>
<p>This type of unpaid overtime amounted to an additional 10% or more on top of paid time over three days, for half the workers we studied.</p>
<p>The financial cost of these two forms of unpaid work combined was significant for these part-time and low-paid employees. Over the three days, for five of the workers, unpaid work made up between 2% and 6% of total work time. We estimate this cost them between around A$9 and A$30 in unpaid wages over the three days. </p>
<p>For the other five employees unpaid work time was between 12% and 21% of total work time. The estimated to cost in unpaid wages for three days was between $25 and $182. These are significant amounts for workers whose earnings for the three days ranged from around $150 to $600. </p>
<h2>Why are workers forced to work for free?</h2>
<p>Underpayment of social care workers is often invisible and ambiguous.</p>
<p>Under the NDIS personal support and care provided by disability support workers is funded on the basis of a set hourly price. In 2017 <a href="https://www.sprc.unsw.edu.au/media/SPRCFile/NDIS_Pricing_Report.pdf">research highlighted problems with the NDIS pricing model</a>, including: inadequate allowance for workers’ time spent travelling between clients, for tasks other than face-to-face support and inadequate provision for supervision and training. All of these are essential to workers’ ability to provide safe, personalised support.</p>
<p>The recently released <a href="https://www.ndis.gov.au/providers/independent-pricing-review">review of NDIS pricing undertaken for the National Disability Insurance Agency</a> acknowledged that many service providers are unable to operate profitably under current NDIS pricing arrangements. The report describes the providers that are “working economically” as those operating with more casualised workforces or utilising sole trader care workers.</p>
<p>In contrast, providers that weren’t considered to be working economically were those that offered greater supervision of workers, had more experienced workforces or had enterprise agreements that paid wages above the award minimum.</p>
<p>A strong theme running through the report is that these service providers should be able to reduce their labour costs. Yet, our research suggests low-paid disability support workers may already be subsidising the system and bearing the consequences of inadequate prices for disability support, through wages underpayments and unfair pay practices.</p>
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Read more:
<a href="https://theconversation.com/ndis-needs-the-market-to-help-make-up-at-least-60-shortfall-in-specialist-disability-housing-93479">NDIS needs the market to help make up at least 60% shortfall in specialist disability housing</a>
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<p>Disability care is a female-dominated industry and the undervaluing of women’s work underpins <a href="http://search.ror.unisa.edu.au/record/UNISA_ALMA51109762080001831/media/digital/open/9915914124201831/12142958410001831/13142954800001831/pdf">inferior minimum employment conditions</a>in the industry. This includes an absence of minimum shift times for part-time employees and lack of an explicit provision for payment for time travelling between work assignments. </p>
<p><a href="http://www.pc.gov.au/inquiries/completed/ndis-costs/report/ndis-costs-overview.pdf">The NDIS is expected to generate about one in five of all new jobs in Australia in the next few years</a> with many of these jobs likely to be frontline disability support jobs. The nature of these jobs is not only critical to the working lives of many employees, now and in the future, but also to the quality of support provided to people with disability and others requiring care.</p><img src="https://counter.theconversation.com/content/93953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Macdonald receives funding from the Australian Research Council. She is affiliated with the Brotherhood of St Laurence as an unpaid member of the Board of Directors.</span></em></p><p class="fine-print"><em><span>Eleanor Bentham and Jenny Malone do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While disability carers are employed to work part-time hours, they often have long work days with short periods of work interspersed with non-work periods.Fiona Macdonald, Senior Research Fellow in Work & Employment Relations, RMIT UniversityEleanor Bentham, Researcher, Work of Social Care Research Program, Centre for People, Organisation & Work, RMIT UniversityJenny Malone, Researcher, Work of Social Care Research Program, Centre for People, Organisation and Work, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/760082017-04-11T02:46:13Z2017-04-11T02:46:13ZCensus 2016: Women are still disadvantaged by the amount of unpaid housework they do<figure><img src="https://images.theconversation.com/files/164756/original/image-20170411-31886-1yx7bvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows women consistently trade time in employment for greater time in domestic work even when their resources are on par with men. </span> <span class="attribution"><span class="source">f1uffster (Jeanie)/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The <a href="http://www.abs.gov.au/websitedbs/D3310114.nsf/home/2016+Census+National">first release of data from the 2016 Census</a> shows the typical Australian woman spends between five and 14 hours a week doing unpaid domestic housework. For the typical Australian man it’s less than five hours a week, suggesting women still assume the lions’ share of the housework.</p>
<p><a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features40March%202009">National statistics from 2006</a> showed that women account for the majority of unpaid domestic work time, spending 33 hours a week in domestic work. Before we write these off as the bemoans of well-resourced first world problems, it is important to note that housework and the mental labour associated with its organisation have real and long-term economic consequences, particularly for women’s employment. </p>
<p>Economists often factor in housework as one dimension of a person’s total amount of time in a day. People weigh all of their time demands – work, family and leisure – and make rational trades between these to maximise resources and efficiency. The problem with this rational-choice approach, <a href="http://www.journals.uchicago.edu/doi/abs/10.1086/230577">research shows</a>, is women consistently trade time in employment for greater time in domestic work even when their resources are on par with men. This is in a society that equates femininity with domesticity. </p>
<p>Women spend more time in housework even when they are single and working full-time. Although single women do slightly more housework than single men, it’s during singlehood that housework time is most equal by gender. When women start to cohabit, their <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1741-3737.2008.00479.x/full">housework time goes up while men’s goes down</a>, regardless of their employment status. These gender gaps in housework linger over time and widen even further when children enter the picture. </p>
<p><a href="https://books.google.com.au/books?hl=en&lr=&id=Vnr8w6HwiAAC&oi=fnd&pg=PR7&dq=becker&ots=B3Ifre1Vg3&sig=bE4XbE3vTPir2SCyZtJFetM-6YQ#v=onepage&q=becker&f=false">Some economists have argued</a> that the traditional division of housework and employment maximises each partners’ skills and increases efficiency within a marriage. Feminists have spent decades challenging this argument by pointing out being a <a href="http://search.proquest.com/openview/dd0061f9909b9804f40e0bca440d047d/1?pq-origsite=gscholar&cbl=25922">woman does not make one more skilled in scrubbing toilets</a>.</p>
<p>And, the fact that women remain intimately tethered to the home based on gender role expectations, means women lose out on economic resources, a deficit that compounds over the life course. Australian women have <a href="https://data.oecd.org/emp/part-time-employment-rate.htm">some of the highest part-time work rates in the world</a>, often reducing work time to part-time when children are born. A second child could knock a woman out of the labour force for close to a decade.</p>
<p>This means women’s total lifetime earnings are reduced, it also shortens their career ladders and results in superannuation earnings that are significantly less than their male counterparts. In fact, one in three Australian women <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Economics/Economic_security_for_women_in_retirement/Report">retire with nothing in their superannuation</a>.</p>
<p>The lessons from these relatively small daily housework numbers – 43 to 120 minutes – are major, showing deep and persistent mechanisms of inequality. The challenge is not housework alone but the way in which <a href="https://books.google.com.au/books?hl=en&lr=&id=x1SsBgAAQBAJ&oi=fnd&pg=PA1&dq=gender+factories+fenstermaker+berk&ots=qQtaof7l2H&sig=oGPfyDNQn3mvaiFoBshYWNUnTek#v=onepage&q=gender%20factories%20fenstermaker%20berk&f=false">housework is embedded within broader care responsibilities</a>. </p>
<p>Women are expected to stay home with young children and, while they are home, they might <a href="https://books.google.com.au/books?hl=en&lr=&id=JuQuoPKMPF4C&oi=fnd&pg=PP1&dq=lareau&ots=up66wIaDqW&sig=A7_jmQoMSfIwqYHYn9XXEbiK9N4#v=onepage&q=lareau&f=false">as well put on a load of washing</a>. Women who work full-time are not absolved of this guilt as they remain responsible for organising the childcare and reminding family members to pick up their socks and wipe down the benches. </p>
<p>All of this labour requires mental energy to ensure the hamster is alive and the dishes are unloaded. It is no wonder Australian women are increasingly feeling <a href="http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12300/full">time pressed, stressed and depressed</a>. </p>
<p>One way to tackle this time squeeze is to create institutional structures that encourage men and women to share domestic work more equally. Because children often bring a mountain of laundry, providing extended parental leaves that are required to be shared by both parents is a start. </p>
<p>Sweden has a use-it-or-lose-it approach to parental leave requiring men to take a portion of the paid leave or the family loses this leave. The result is that men <a href="https://academic.oup.com/esr/article-abstract/18/4/433/551572/Gender-Division-of-Childcare-and-the-Sharing-of">share housework more equally over the life course</a>. Men today are <a href="http://journals.sagepub.com/doi/abs/10.1177/0003122414564008">more interested in sharing childcare responsibilities</a> so the economic benefits to maternal employment from this equal sharing is a win-win for all.</p><img src="https://counter.theconversation.com/content/76008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leah Ruppanner receives funding from the Australian Research Council. </span></em></p>The latest Census shows Australians spend between five and 14 hours a week on unpaid domestic work, but it’s women who suffer the most from this.Leah Ruppanner, Senior Lecturer in Sociology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/124202013-03-01T03:29:00Z2013-03-01T03:29:00ZThe thorny issue of home care in Michael Haneke’s Amour<figure><img src="https://images.theconversation.com/files/20558/original/n2r68jbf-1361744845.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ageing couple Gorges and Ann Laurant (Jean-Louis Trintignant and Emmanuelle Riva) negotiate illness and death in Amour.</span> <span class="attribution"><span class="source">EPA Claudio Onorati</span></span></figcaption></figure><p>During our lifetime, we face a series of <a href="http://psychology.about.com/library/bl_psychosocial_summary.htm">developmental tasks</a> that are universal to the human condition. The last of these stages comes in our final years, when we face our mortality, reflect back upon our life’s achievements, and either reach a position where we can come to a calm acceptance of our inevitable death, or fall into ruin.</p>
<p>The French film <a href="http://miff.com.au/films/view?film_id=124089">Amour</a> – which won the Academy Award for best foreign film and was nominated for best picture, best actress, best screenplay and best director – shows an ageing couple, Georges and Ann Laurent, painfully negotiating that final developmental task together.</p>
<p>Anne is a retired piano teacher of some renown. Our first real sight of her is at a Parisian concert given by a successful former pupil, now a rising star. She appears to be ageing gracefully but a stroke the following morning changes all that. The audience becomes acutely aware of her disability following that event, and of the loss of dignity that accompanies it.</p>
<p>Early on, she extracts a promise from her husband to never return her to hospital. Anne appears to lose hope early on, seemingly prescient as to the path her life will inevitably take from that point. She is conscious of the burden she will pose her husband, and takes a morbid interest in the details of a mutual friend’s funeral, no doubt imagining her own. She doesn’t want to go on, but presents as more demoralised than depressed.</p>
<p>A second stroke leaves her incontinent, intermittently confused, and barely able to speak. Tellingly, one of the few words she regularly repeats is “hurts”. Keeping his promise to her, Georges resists the urging of his daughter to have Anne placed in a nursing home, to the admiration of his neighbours.</p>
<p>The story is gruelling and relentless. It is clear from the start that this is not going to end well. Art, this may be. Entertainment, it is not. But George’s struggles will be familiar to many.</p>
<p>Roughly 85% of the elderly in Australia reside within their own homes, and receive care from a variety of paid and unpaid (usually family) carers. The increased availability of home supports and <a href="https://theconversation.com/aged-care-reform-experts-respond-6576">community care packages</a> has enabled those with even significant disability to continue to remain at home in accordance with their wishes.</p>
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<span class="caption">Burnout and depression is common among carers.</span>
<span class="attribution"><span class="source">Image from shutterstock.</span></span>
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<p>While this is arguably a good thing for the elderly, the reality is that it’s a virtue born of necessity. The ageing population is upon us, and no government could hope to fund residential aged care to the point where all those who require care can receive it in a subsidised facility.</p>
<p>Governments promote home care for the elderly as being respectful of the choices of elderly patients and their families, but is this another case of economic rationalism dressed up in the language of consumerism and “choice?” Is home care really “better” for the elderly, and for those who provide their care at home, or just better for the governments who would otherwise have to fund institutional care as the alternative?</p>
<p>The burden of care thus often falls on untrained, elderly and ailing spouses who are ill-equipped to manage the complex medical, functional, cognitive and behavioural challenges that the care for their loved one poses.</p>
<p>Over a quarter of such carers <a href="http://newoldage.blogs.nytimes.com/2012/12/28/united-states-lags-in-alzheimers-support/">provide</a> more than 20 hours of direct care per week, resulting in enormous levels of carer burden and burnout. <a href="http://www.priory.com/psych/carerdep.htm">Up to half</a> of family carers of those with Alzheimer’s disease, for example, show significant symptoms of depression.</p>
<p>Those who assert their right to be cared for at home often do so without due regard for the consequences of that choice for themselves, their family, and the quality of care they will ultimately receive.</p>
<p>While it is true that staff within aged care facilities are <a href="https://theconversation.com/aged-care-reform-experts-respond-6576">often poorly trained</a> to provide care to residents with complex needs, at least care can be provided in three shifts across 24 hours, within an administrative framework that guarantees that certain minimum standards of care will be met.</p>
<p>Family carers at home will generally have no training, and are accountable to no one for the care they provide which, while well-meaning, is usually destined to be suboptimal at best, and frankly abusive at worst. As many as <a href="http://ageing.oxfordjournals.org/content/37/2/151">one in four</a> elderly people are at risk of abuse by family carers, with most of this going unreported.</p>
<p>Sometimes abuse occurs without intent on the part of the abuser. We see this in Amour in a number of scenes. Anne is clearly delirious at one point, and subsequently may well be clinically depressed, yet her access to medical care consists of a weekly visit from her general practitioner; Georges slaps her in another scene for refusing to drink, and his actions seems clouded by his own at-risk mental state. </p>
<p>There is clearly a place for home-based care of our elders across a spectrum of diseases and disabilities. But there is a threshold beyond which it is objectively clear that the demands of care cannot be reasonably met by a sole carer, no matter how well-meaning or well-trained. </p>
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<img alt="" src="https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/20725/original/hsbx5jdj-1362004924.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Home care can sometimes be worse than the alternative.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
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<p>To address this issue, we need an objective framework to monitor the safety and quality of care provided at home to ensure the best interests of vulnerable elders are served. Such a framework could be government-led, with input from ageing, caring, nursing and medical stakeholders. The choices of our elders need to be supported, but such choices need to be informed. And home care can sometimes be worse than the alternative.</p>
<p>The audience of Amour is encouraged to empathise with Georges’ choices via director Michael Haneke’s unremitting chronicling of Anne’s deterioration. But had Anne entered residential care, albeit against her express wishes, her quality of life was likely to have been significantly superior to that she experienced in her final months.</p>
<p>The principles of human rights are often invoked as defences against perceived medical paternalism, but when the poor choices of a proxy decision-maker objectively place a vulnerable party at risk, society needs to examine how it weighs the risks and benefits of those choices. </p><img src="https://counter.theconversation.com/content/12420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steve Macfarlane does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During our lifetime, we face a series of developmental tasks that are universal to the human condition. The last of these stages comes in our final years, when we face our mortality, reflect back upon…Steve Macfarlane, Director of Aged Psychiatry, Caulfield Hospital (Alfred Health) & Associate Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/99462012-10-21T19:21:57Z2012-10-21T19:21:57ZCounting the cost of Australia’s care economy<figure><img src="https://images.theconversation.com/files/16724/original/g48rrtzy-1350619498.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mapping the scope of Australia's care economy — both paid and unpaid — has been challenging.</span> <span class="attribution"><span class="source">Flickr\Wunkai</span></span></figcaption></figure><p>It is easy to measure the national economic value of primary industry production, of manufacturing, and of the wholesale and retail sectors. But many Australians don’t work in profit-focused enterprises, so how do we measure and recognise their contribution to the economy and the contribution of those who provide the paid and unpaid care that supports our society? Does care work count?</p>
<p><strong>The care economy vs the market economy</strong></p>
<p>Mainstream economics has traditionally only considered goods and services in the market as productive. This ignores the fact that markets could not continue to operate without an ongoing workforce, which is supplied by social reproduction in families. The care economy provides a new vision of economic life that counts unpaid work in statistics, explains the role of care (as well as commodities) in the working of economies, and integrates the care economy into policy.</p>
<p><strong>The scope of the care economy</strong></p>
<p>The care economy is comprised of paid care, unpaid care, and government investment in the care sector. It is <a href="http://www.countingcare.org">defined</a> as:</p>
<p>“The total (paid and unpaid) labour required to meet the needs of children to be cared for and educated, everybody’s physical and mental health that requires attention, and the needs of individuals who require assistance with the activities of daily living because of illness, age or disability”.</p>
<p>“Care work” provides assistance and support to community members suffering from mental illness, chronic ill-health, terminal illness, disability and frailty associated with ageing. The volunteer sector is a key component of the care economy. The care economy therefore operates in a wide range of care settings, including: paid care in childcare, schools, hospitals and other health care facilities, and disability and aged care facilities; and unpaid care of children, elderly people and people with disabilities in homes and community settings and by volunteers in formal health, disability and aged-care facilities.</p>
<p>Paid care is provided usually by qualified professionals and trained assistants. Unpaid care is provided by families, friends and neighbours, by members of non-government organisations, and by community volunteers.</p>
<p><strong>The value of the care economy</strong></p>
<p>Although there is vast literature on different aspects of the Australian care economy, until recently there has been no comprehensive mapping of it. Given the complexity of care work and its profound social and economic implications for our nation, it is crucial that this sector is defined and valued as a distinct segment of economic activity. The recent research reports [2010 and 2012] commissioned by economicSecurity4Women (eS4W), a national women’s alliance under the Australian Government’s Office for Women, draw attention to the worth of the care economy and the risk to Australia of ignoring its economic value in these changing times.</p>
<p>The <a href="http://www.security4women.org.au/wp-content/uploads/Scoping-the-care-economy-report-FINAL2.pdf">Scoping the Australian Care Economy report</a>, published in 2010, was the first research in Australia to examine the size and significance of the care economy. The recently released report, Counting on Care Work in Australia, built upon this scoping data and has quantified the Australian care economy for the first time.</p>
<p>The Counting on Care Work in Australia <a href="http://www.security4women.org.au/projects/the-australian-care-economy/counting-on-care-work-in-australia">report</a> examined the three intersecting spheres of paid care work, unpaid care work and government investment in the care sector and sought to measure the labour and resources devoted to the daily care of Australians including: care of children and those who are elderly or disabled; education of children from kindergarten to year 12; and delivery of health care to both well and sick citizens regardless of age.</p>
<p>This seminal report reveals that in 2009-2010, the care economy in Australia was worth an estimated $762.5 billion.</p>
<p>While paid care was worth $112.4 billion - 8.8% of GDP - providing nearly 20% of all paid employment, unpaid care was imputed at a staggering $650.1 billion. The 21.4 billion hours of annual unpaid care work (60% of which is undertaken by women) equates to 50.6% of gross domestic product (GDP); 11.1 million FTE workers and 1.2 times the total Australian full-time employed work force.</p>
<p>In addition, in 2009-10, local, state/territory and Commonwealth governments invested a total of $135.9 billion in the care sector (excluding wages, salaries and social security payments) equivalent to 10.6% of GDP.</p>
<p><strong>Unpaid care</strong></p>
<p>The report acknowledges that the value of unpaid care is likely to be underestimated since it does not account for the opportunity costs of providing unpaid care, the value placed on emotional wellbeing and the financial cost of caring. Undertaking unpaid care work can restrict a carer’s ability to change jobs, accept job promotions, or take on new job opportunities, and unpaid care providers may need to reduce their working hours or resign to meet care needs. The research indicates higher rates of poverty among carers than in the general population.</p>
<p>The report presents a snapshot of the caring load on families in a single year, but it will enable future trends to be monitored and modelled. As carers age and become consumers rather than providers of care, replacing the significant amounts of unpaid care provided each day with formal paid care will be impossible. When unpaid carers enter the labour force, this reduces the total availability of unpaid care and places higher reliance on the paid care sector. As women’s role in the formal workforce expands, men will be required to provide a greater share of unpaid care. More data is needed to assess the future impacts of an ageing population and shifts in employment patterns of current carers, and the unmet need for respite for carers providing disability or aged care.</p>
<p><strong>What do the findings mean for Australian families?</strong></p>
<p>The Counting on Care Work in Australia report describes the scope and value of the care economy in 2009-10. The authors relied extensively on ABS census data collected every five years [especially for paid care] and time-use data collected at less regular intervals [especially for unpaid care]. It is essential that the care economy should be regularly monitored to inform government planning for childcare, health care, disability care and aged care.</p>
<p>Given our ageing population and the rising expectations of Australians, we can expect that a population shift in the proportions of children and older people will impact significantly on the resources available in the formal and informal sectors to care for our more vulnerable citizens. Shortfalls in formal care services will inevitably be picked up by families providing unpaid care.</p>
<p>Other factors need to be taken into account. For a start, the aged care workforce itself is ageing and less able to take on the heavy manual handling and emotional support the role requires. The report also highlights the need to monitor trends in housing costs (that now require two wages per household), in the demand for aged care (as carers become those cared for), in costs of living that prevent carers from choosing to combine caring with part-time work, and in lifestyle demands and expectations that limit women’s ability to continue their unpaid roles.</p>
<p><a href="http://www.asu.asn.au/data_man/sacs/payup/20110516-interim-fwa-decision-equalpaycase.pdf">Fair Work Australia recently recognised</a> the low value placed on care work in the social, community and disability services industry that has resulted in poor recruitment and retention rates as workers seek better paid work. The care load borne predominantly by women – both paid and unpaid – reduces both their incomes and retirement savings. Unpaid care work restricts the capacity of carers to earn a living in general and to save for retirement in particular.</p>
<p><strong>What should happen next?</strong></p>
<p>We know that countries with higher levels of government investment in the paid care sectors tend to have a more equitable split of unpaid care work](http://www.oecd-ilibrary.org/social-issues-migration-health/society-at-a-glance-2011_soc_glance-2011-en), and that Australia is not one of those countries.</p>
<p>As a nation, we need to recognise care work as a public good and count the contribution to productivity of carers, acknowledging the need to retain workers and maintain the supply of care. EconomicSecurity4Women <a href="http://www.security4women.org.au/wp-%20content/uploads/eS4WPolicyRoundtableCareEconomy2012.pdf">recommends</a> increasing government investment in care work by improving the wages and conditions of paid care workers and supporting the rights of unpaid carers to secure and flexible work arrangements that accommodate their caring responsibilities and protect their retirement incomes. That, at least, would be a good start.</p><img src="https://counter.theconversation.com/content/9946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jean Murray is a member of BPW Australia which is an organisation affiliated with economicSecurity4Women.</span></em></p><p class="fine-print"><em><span>Valerie Adams was contracted on a short-term basis in 2010 by economic Security4Women to do the reseach and write the report 'Scoping the Care Economy: A Gender Equity Perspective'.</span></em></p>It is easy to measure the national economic value of primary industry production, of manufacturing, and of the wholesale and retail sectors. But many Australians don’t work in profit-focused enterprises…Jean Murray, Adjunct Academic teaching health and aged care policy, Flinders UniversityValerie Adams, Research Associate, Hawke Research Institute, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.