A proposed scheme to tackle bed shortages in British hospitals has sparked a rash of criticism. This privately-run project, being piloted in Essex by the company CareRooms, places patients who are recovering from surgery away from hospital and into the homes of members of the public.
CareRooms was quickly branded “Airbnb NHS” and lambasted by some in the media, medics and politicians from across the spectrum, for a lack of concern about patient safety. This is of crucial importance. What attracted less commentary, however, is that the scheme is also hugely exploitative, relying on the re-domestication of care to cheapen the labour of carers.
On the CareRooms website care-providers are described as “hosts” who rent out a spare room or annexe. CareRooms explicitly differentiates “hosts” (defined by their provision of space), from carers regulated by the Care Quality Commission who will be on call to provide care in response to various automated alarms. Further examination, however, blurs this divide.
CareRooms claim that all hosts will receive training and resources “for any scenarios that may arise”. Before being accepted, they will be tested on hygiene, food safety, social care law and mental capacity. Hosts are required to prepare and, presumably, clear away three meals a day, provide non-alcoholic refreshments, and engage in conversation. They are also expected to “meet and greet” as well as “discharge” patients, and most likely welcome visitors too.
In addition, there is the cleaning required before and during a stay, to say nothing of help with toileting. The CareRooms website says nothing about this, yet it seems unlikely that an external carer will arrive on the doorstep every time nature calls.
CareRooms presents hosting as “a perfect way to meet others from the area” and characterises the role as being “as simple as providing a cup of tea and some company”. Clearly though, being a host involves considerable work. Importantly, this work is likely to be required across most of the day (and night), even if only sporadically. The £50 room payment does not even cover seven hours at minimum wage.
Care is expensive to provide and difficult to make cheaper. This is partly because of the unpredictability of the biological and social times when we need care. Put simply, to pay for care sufficient to cover the times that it might be needed requires that often carers are employed but not working. At other times there may still be too few carers for the tasks at hand (for instance at breakfast when everyone needs feeding).
Organising care in a capitalist labour market is tricky because labour is typically employed in time-blocks. CareRooms would circumvent this constraint by placing care work in a domestic setting. This obscures the labour involved and redesignates tasks as an extension of familial, and especially women’s, “natural” domestic labour.
Feminists have repeatedly drawn attention to women’s unpaid domestic care work. It is invisible because it occurs in private spaces and, because it is naturalised as a woman’s duty, the work is discounted. This also applies to paid work that occurs in domestic settings. Those who carry it out are categorised as non-workers, beyond the reach of minimum wage and other labour regulation. This can be seen among family carers, au pairs and foster carers.
Family carers are paid a government allowance of £62.70 a week to care for a family member in receipt of health-related benefits for at least 35 hours a week. This is £1.79 per hour for 35 hours of care. Carers working more than 35 hours (anyone providing overnight care) receive a significantly lower hourly rate. Family carers exemplify the ambiguity around domestic care.
The allowance recognises the opportunity costs of care, but the derisory amount and unspecified maximum hours underscore the assumption that family care provision, motivated by love, is limitless.
Au pairs, the UK government states, should be treated as a member of the family, and get “pocket money” of about £70-85 a week. In return, they are expected to work upwards of 25 hours, plus several evenings, per week, performing childcare, cleaning and cooking duties as well as helping with homework, and music or foreign language tutoring. Because they are deemed “family members”, not workers or employees, their work is unregulated. The designation “family-member” goes unscrutinised.
Foster carers are paid better, but a recent survey found that the large majority earn well below minimum wage and some types of care goes unpaid (for example nights). Formally self-employed, foster carers now work for a single provider, but without employment rights, they cannot claim unfair dismissal if dropped. And, like other self-employed workers in the gig economy, foster carers get no holiday or sick pay.
Austerity and local council cuts have led to worsening conditions for foster carers, and prompted them to organise and demand workers’ rights. This has included unionisation, with the GMB and IWGB both establishing foster carer branches, and mounting legal challenges.
In the shadows
These three examples highlight the ways that care performed in domestic settings is made invisible and, by formalising assumptions about family, devalued. In consequence workers performing domestic care work are denied rights, which in the case of foster carers they are now fighting to reclaim.
The language employed by CareRooms suggests that re-domestication is not accidental. Rather, the website seeks to frame hosts as a family-substitute, suggesting that the scheme is intended for people who are “medically fit for discharge but [have] no one to go home to”. The fantasy of familial or home care is evocative and appealing.
But if family becomes a way of enticing poorly-paid and out-of-sight workers to self-exploit, it is time to develop language and practices that more explicitly recognise, and compensate, domestic care work as work. Until that happens, we should remain sceptical of CareRooms, not just because it may provide inadequate and unsafe care, but also because its profitability depends on moving work and workers’ rights into the domestic shadows.