Care Paid and Unpaid: Social, Economic and Human Rights Concerns

by Dr Joan Garvanwww.maternalhealthandwellbeing.com

Attempts to achieve gender equity have reached a new high water mark and the recognition and redistribution of care, both paid and unpaid, stands at the centre of this arena. The Australian secretariat – Economic Security 4 Women – have produced landmark reports, both scoping and quantifying the value of the ‘care economy’ and, more recently, Professor Marilyn Waring addressed the topic of care and dignity in the annual Pamela Denoon Lecture Series. Here below are key points from these papers and central messages made by Waring.

Two significant Australian reports on the care economy have been produced over recent years: Scoping the Australian Care Economy A Gender Perspective (2010) and Counting on Care Work in Australia (2012). These projects are concerned with the lifelong economic well-being of women. Though they are particular to Australia and reference local government policies, programs and strategies, they draw from an international body of research and deal with common concerns.

The first report references the importance of data collection and brings attention to landmark work in the Massachusetts case study that used United States Census and Time Use data to measure both paid and unpaid care work [1]. The author Valerie Adams notes tensions between unpaid work, voluntary work and paid work. She draws attention to the ‘relational’ nature of care work, and references the concept of ‘provisioning’ for human need. The report used the notion of ‘care work’ to depict both the paid and unpaid sectors. Adams considers definitions and current issues in the Australian care economy. She surveys relevant government policy and makes numerous recommendations for further research and data collection.

Counting on Care Work in Australia (2012) further develops this arena by quantifying the value of the paid and unpaid care sectors to the Australian economy. In 2009-10 twenty per cent of all paid employment in Australia was in the care sector. Care workers receive 96 cents for every dollar earned by the average Australian worker, and female workers earn on average 84 cents in the dollar to male care workers. The report valued the unpaid care sector at $650 billion with sixty per cent of this contribution being made by women aged 25 to 64. The report furthermore outlined and quantified government investment in the care sector. The authors make recommendations for further work in light of: demographic change; inter-generational concerns; and the continuing economic and life course implications for women.

Marilyn Waring prefaced her recent lecture Care and Dignity: Major challenges to economics and human rights (transcript and video available online: http://pameladenoonlecture.net/) with the proposition that over millennia care has been the primary responsibility of women. She has changed her emphasis since the publication of Counting for Nothing: What men value and what women are worth (1988) [2] and now frames these concerns within a Human Rights perspective.

Waring raised problems for the use of ‘care’ as an analytical category, arguing that most often carers are responsible for a myriad of associated tasks that could be lost through a continuing association with unpaid work. Nevertheless, drawing from studies from British Colombia, New Zealand, Papua New Guinea and the United Kingdom, she sets out a strident case whereby the human rights of care givers are being flouted. She and others set up a questionnaire for a Commonwealth report drawing from Amartya Sen’s capability approach to human rights which references choice, rest, health, meals, work and political involvement, and found multiple breeches.

With governments around the world withdrawing from social and welfare programs these kind of arguments are critical if we aren’t going to ‘throw the baby out with the bathwater’. Care, both paid and unpaid, are clearly significant to the health and well-being of the community, but further to this gender equality will remain allusive if we don’t see transformational change. Unfortunately the issues are complex and though there is increasing reference to the work of unpaid care in terms of achieving gender equity, there is a need to bolster and popularize the debates.

References

[1] Albelda, R., Duffy, M., Folbre, N. (2009), Counting on Care Work: Human Infrastructure in Massachusetts, University of Massachusetts, MA, Massachusetts

[2] In a recent anthology, Counting on Marilyn Waring: New Advances in Feminist Economics, edited by Margunn Bjornholt and Ailsa McKay, 31 authors from nine countries outline the wide ranging impact and resonance of Professor Waring’s work as well as the current frontiers of feminist economics.

 

 

When Caring Goes Wrong: Rehoming Unowned Dogs

By Marie Fox

Those of us who share our lives with dogs know that interspecies relationships are an important and mutually enriching basis for caring practices, yet it is also evident that dogs are often victims of a complete lack of care. These extremes of care are vividly captured in the contrast between the casual cruelty of the 27 year old trainee solicitor sentenced to 18 weeks in prison last month for leaving her boxer dog to starve in a locked kitchen, and the tenacity with which homeless people cling to their relationship with their dogs notwithstanding the difficulties this may pose to them in finding a home. Paradoxical attitudes also characterise media responses to dogs. At the same time that television programmes celebrate The Wonder of Dogs, newspaper reports disproportionately depict dogs as out of control weapons or feral killers. In a familiar litany of reporting of dog attacks on humans, common features are a focus on breed, a desire to impose responsibility and a failure to address the root causes of our problematic relationship with dogs. Over the last few months this is evident in accounts in February 2014 of dog attacks in Blackburn, where an eleven month old girl, Ava-Jane Corless, was savaged as she slept in her bed by an American pit bull type dog owned by her mother’s boyfriend, in Carmarthenshire where Eliza-Mae Mullane, a six day old girl, died having being pulled from her pram and bitten by her family’s Alaskan Malamute who had been acquired from someone in a pub, and in Lincolnshire where in March another pit bull type attacked a 22 year old woman walking near an old quarry.

Malamutes and bull breeds figure disproportionately amongst the sheer numbers of unwanted dogs that are stretching the resources of local authorities, charities and dog rescues. The 2013 Annual Stray Dogs Survey by Dogs Trust reveals that 111,986 stray and abandoned dogs were picked up across the UK over the last 12 months, equating to 307 stray dogs being found every day. Many are bull breeds, victims of a process of media stereotyping fuelled by the 1991 Dangerous Dogs Act which in categorising pit bull terriers as dangerous dogs, has served to make all bull breeds perversely attractive to the wrong sort of owner. One particularly tragic case highlights the potential for well intentioned and caring actions to go wrong in the world of dog rescue. In November 2013 four year old Lexi Branson died after being mauled by her family’s dog Mulan. According to newspaper reports Lexi’s mother, Jody Hudson, fatally stabbed the dog in a frantic attempt to save her daughter when he attacked her on the floor of the lounge in their flat. It transpired that Mulan was an American bulldog type who had been adopted by Lexi’s mother in August 2013 from a Leicestershire rehoming centre. The rehoming reportedly took place after she had seen a picture of the dog in the rehoming section of the rescue’s facebook page. A friend of Ms Hudson reported that the dog had a soft nature and that Ms Hudson had been told he was safe around children. The rescue declined to comment. In the absence of all the facts it is important not to judge actions, as anyone involved in dog rescue will testify.

I volunteer with one of the many small dog rescues struggling to cope with Britain’s unwanted dogs. We work closely with a local authority pound in the North West of England to provide emergency kennel space for dogs who have not been reclaimed, rehomed or offered a rescue space within seven days. At this point they can lawfully be humanely destroyed under s 149 Environmental Protection Act 1990. A key aim of organisations like ours is to place our dogs with bigger and better resourced rescues. However, typically, due to their fear of being overrun with too many unwanted breeds, it falls to smaller rescues to rehome bull breeds – mostly Staffordshire Bull Terrier crosses. We homecheck for our dogs as carefully as possible, requiring prospective owners to complete forms, submit to a home visit, visit the dog in kennels and ensure that dogs are neutered and vaccinated prior to rehoming while dogs are not placed in a home with children under 10 years old. However a consequence of such conditions is that we lose out on good potential homes and in many cases prospective adopters will simply buy a puppy or adopt from a rescue too stretched to impose such conditions. And notwithstanding the care taken and great joy of waving a dog off to a new home, the process is inevitably accompanied with apprehension that things may go wrong, given the difficulties of adequately assessing dogs in a kennel environment.

However in the absence of the full story in most of these cases there are nevertheless a number of conclusions we can draw about media reporting and the reaction it has provoked which serve to highlight our flawed thinking about dogs. Initial media reports of the Branson case pictured Lexi with her uncle’s Dogue de Bordeaux who was erroneously deemed responsible for the attack and wrongly described as a French mastiff. The upshot was that breed specific rescues were reported in dogworld as having been inundated with calls from concerned owners wishing to give up their dogs. When pictures of Mulan were published, the immediate response of bull dog rescues was to deny that Mulan was a ‘British bulldog’, with an editorial in dogworld opining that “After some initial confusion, the dog responsible for this incident is now referred to as a bulldog even though it bears little resemblance to the pedigree Bulldogs bred in this country.” Such responses strike me as reflecting the manifold failures of social attitudes including UK law which casts dogs as disposable commodities and indiscriminately stigmatises certain dogs purely on the basis of their morphology or breed type. Media narratives which reify this focus on breed, and implicitly criticise the irresponsibility of a mother in choosing to allow into her home a dog of uncertain pedigree and origin, or rescues which somehow failed in an ill-defined area, obscure the root causes of indiscriminate breeding which produces unhealthy or ill socialised puppies, dangerous dogs legislation which has compounded the problems of unwanted and often traumatised bull breeds and a legal strategy of ascribing responsibility for stray and unwanted dogs to local authorities which are already struggling to fulfill their core responsibilities and are ill equipped to cope with the complexities of dealing with stray and dangerous dogs. Against this backdrop blaming a mother for her caring action in adopting a dog in need of a home, a not for profit organization struggling to fill the gaps in state provision or even the dog himself is manifestly ill conceived. Until our outdated and paradoxical legal attitudes to dogs are tackled, tragedies such as these unfortunately seem unavoidable, however much well intentioned individuals and dog rescues strive to care.

Workplace personal assistants – what do we need to know?

While I finished my PhD, I worked as a personal assistant (PA) for a physically disabled woman. At first I worked evenings in her home, but later I switched roles and accompanied her to work.

I was surprised to find how different the role was. At home my job had been roughly how you might imagine a more traditional ‘care assistant’ job – largely making food and household chores. But as a ‘workplace PA’ I was taking notes in meetings, filing, and working on complex spreadsheets and reports.

I was always with my employer, of course, and she gave step by step instructions if needed, but the days went more smoothly because I knew how to use a spreadsheet, and could judge what parts of meetings were important enough to write down.

It was an interesting experience, and one I’ve continued to reflect on since.

I was at work, but within my employer’s workplace. My contract and confidentiality agreement were with her, not her employer. If I was late, that made her late through no fault of her own. My behaviour and appearance reflected on her, and if I had been untidy or rude to her colleagues she would have felt responsible.

My employer’s colleagues were used to having her PAs around, but other people seemed unsure about how to react to me. Some would acknowledge my presence, offering me tea (always welcome), asking my name to write in minutes (unnecessary), and trying to include me in discussions in meetings (inappropriate). Others would focus on my employer (good) and act as if I wasn’t there at all (not so good).

I haven’t seen much written about the professional role of workplace PAs who support a physically disabled person. Having spent several years as a workplace PA myself, it seemed to me that my role was very different to someone supporting a learning disabled person or someone with mental health issues at work.

It is likely that more PAs will be needed as people take increasing control over their own support arrangements through both social care and workplace schemes. We need to know more about the current and potential roles of the workplace PA. That’s the only way we can provide appropriate support to workplace PAs themselves, the disabled people who employ them, and to their employers.

What do we already know?

What do we already know about workplace PAs? Not much. The Department of Health’s Social care workforce research initiative (Qureshi and McNay, 2011) acknowledged the current lack of information about PAs more generally, and identified a need to collect routine information such as numbers and levels of pay.

Similarly, the Framework for supporting personal assistants working in adult social care (DH, 2011) recognised the need for a better understanding of personal assistant working, including the range of tasks carried out by PAs, particularly given that they are likely to be working in isolation with little opportunity for reflection and professional development.

There is some mention in such work of supporting people to take an active part in their communities, including access to education and employment. But there is very little, if anything, written specifically about PAs supporting people at work.

Employment rates of disabled people are relatively low. In 2012, only 46.3% of working age disabled people were in employment, compared to 76.4% of working age non-disabled people (Office for Disability Issues). In 2010, young disabled people were twice as likely to be not in employment, education or training as non-disabled people of a similar age (Equality and Human Rights Commission, 2010).

If we are to meet disabled people’s employment aspirations, there must be appropriate support. For some this will include workplace PAs.

The Access to Work scheme is the primary mechanism for supporting disabled people in work at present. A recent review (Department for Work and Pensions, 2011) described this as ‘the government’s best kept secret’, and suggested demand had been kept low by lack of advertising. In April-December 2012, Access to Work granted 11,580 awards (out of a total of 33,180) to pay for support workers, but does not indicate how many of these were to physically disabled people.

Specific questions that need answers

If we are to improve support for workplace PAs, the people who employ them and their employers, then we need some specific information. I suggest some initial questions should include the following.

  • Numbers: How many physically disabled people in employment use a PA at work? How many workplace PAs are there?
  • Roles: What roles do workplace PAs have? If they also work as a home-based PA, what are the differences between the roles?
  • Payment: How much are workplace PAs paid, and where does the money to pay them come from?
  • Recruitment: How are workplace PAs recruited?
  • Career development: What is the employment background of workplace PAs (and do they consider themselves to be part of the ‘social care workforce’)? Do they consider being a workplace PA as a career, or a temporary job?
  • Issues and relationships: What issues have disabled people using PAs experienced at work (with PAs, colleagues, or employers)? How do workplace PAs find relationships with the disabled person, their colleagues, and others in the workplace? How do employers feel about having PAs in their workplace?

For disabled people, particularly those applying for their first jobs, knowing about the role of a workplace PA may encourage them to aspire to a job they may not have otherwise considered. For the organisations who support them, an understanding of the specific requirements of the job will help with recruitment and retention of suitable PAs.

It’s tempting to group workplace PAs with the rest of the social care workforce. But by doing so we risk planning for the recruitment of the same people through the same channels as we have always done. Workplace PAs aren’t necessarily paid with social care money, and while their work may include some personal care, it’s likely to include other specialist skills too. If we think only in terms of social care workers, we risk losing the expertise of people who may be perfect for the job, but who haven’t considered a social care career.

This is my initial attempt to get some of my musings about this written down. I’ll be developing my thoughts further over the next few months, not least about whether ‘workplace PA’ is the appropriate term. I’m interested in anything anyone has to say, either about their own experiences, or just thoughts on reading this. Please get in touch.

Jenni Brooks (jenni.brooks@york.ac.uk), Social Policy Research Unit, University of York

Twitter: @JenniBrooks

References

Department for Work and Pensions (2011) Getting in, staying in and getting on. Disability employment support fit for the future Accessed 1st Feb 2014

Department of Health (2011) Working for personalised care: a framework for supporting personal assistants working in adult social care Accessed 1st Feb 2014

Equality and Human Rights Commission (2010) How fair is Britain? The first triennial review Accessed 1st Feb 2014

Office for Disability Issues Disability facts and figures Accessed 1st Feb 2014

Qureshi, H. and McNay, M. (2011) Overview and synthesis: DH social care workforce research initiative 2007-2011 Accessed 1st Feb 2014

‘Dangerous Care’ by Ann Stewart

Last week, three care workers from Hillcroft nursing home were jailed and a fourth given a community sentence for tormenting and abusing elderly residents with dementia. Their actions were described by the trial judge as “gratuitous sport at the expense of vulnerable victims”.  This high profile case adds to a depressing list of abuse of frail elderly and vulnerable people amounting in many instances to criminal behaviour on the part of care workers.

This blog is a personal reflection on these events although I do have an academic interest in body work and the regulation of care.  My first reaction when I read or see the coverage is to feel sick.  I am taken back instantly to the emotions I experienced in relation to my own parents.  They lived until their late 80s together in their council bungalow in a village until my mum’s physical health deteriorated significantly.  Dad was not able to look after her adequately and I took over responsibility for them.  Eventually they came to live with me and for two years or so I became immersed in the world of ‘care’ – high intensity emotional contexts, exhaustion and persistent low level frustration caused by every day events coupled with constant anxiety about their wellbeing.  I hated to think of their vulnerabilities being exposed.  I wanted everyone around them – care workers, nurses, my friends, neighbours and adult children to see them for what they were – simple ordinary people – nothing special – at the end of their lives.  I wanted people to like them – to see through all the stuff that comes with frailty in old age – and to treat them well and with respect.  I can’t bear to think about what has happened to people like my mum and dad, although neither had the added vulnerability of dementia in the situations described in these cases. I am of course not alone in this – the relatives and friends of those who experienced the abuse say the same: they are angry and feel guilty.  I understand the guilt while recognising that it is inappropriate.

My second reaction focuses on the pictures of the workers, described as bullies, monsters, callous and hard hearted and a disgrace.  I find it difficult to join in the ‘how could they?’ responses.  I was constantly anxious about the demands that my mother in particular presented to those who cared for her.  I worried all the time that they were unreasonable – I often found them unreasonable when I was doing the caring – while at the same resisting this way of thinking about her – why was I expecting her to be reasonable?  What did that mean – complying with my idea of what she wanted or needed?  I would mentally grit my teeth, draw on a joint history (not uncomplicated) and my love for her and find a way through although I would feel furious at times.  I didn’t always stop myself saying and doing callous things or neglecting her.  But how would those who only knew her in this last stage of her life, and through a work relationship, cope?  What did I expect of them?  What was reasonable?

I hoped to manage relationships between care workers and my parents and between the care workers themselves (we always had a minimum of 2 at any one time because of the complex needs of my mother) by throwing as many resources as possible at the situation – decent wages and generous conditions – plenty of substantial and paid breaks away from her during working hours, long holidays, constant attention to individual worker’s needs and pressures,  flexible arrangements between the workers themselves and so on.  I am no saint. I wanted the arrangements to work.  I liked all the people involved.  I could be ‘generous’ because my parents received substantial financial support through direct payments at that time because my dad had been a farmer worker and they had no assets.  I could add to this from my professional salary.  I lived in a very large house with a big garden providing ‘space’ for workers.  It was still far from easy.  Tensions between workers would emerge which had to be sorted out.  But by having a mix of part time postgraduate students, full time directly employed workers and some agency workers coming in at peak times we managed somehow.

I look at the pictures of the ‘homes’ that always seem to accompany the reports of these institutional abuse cases and think about the financial and managerial regimes that underpin them.  The reports provide glimpses of the position of the care workers – often from marginalised groups in society, under pressure, vulnerable, untrained, unsupported and under-resourced – and I can see how the abuse happens quite easily and I find it hard to join in the general condemnation while sharing the anger at what has happened.

It seems to me that we as a society abuse these workers and when they abuse others we send them to prison. We create a ‘moral panic’ about institutional care and put these body workers at its heart.  Labour law seems totally unable to provide an adequate framework for protecting care workers and for managing these really difficult relationships.   The structural problems associated with the commodification of caring particularly in a context of ‘austerity’ are being mis framed as the individual responsibility of marginalised workers within the law. These workers’ (often physically and emotionally exhausted) culturally identified bodies are made invisible for these purposes while increasingly made subject to surveillance by managers and regulators through other forms of regulation deemed necessary to prevent the abuse which results from the means through which such care is provided.  The state punishes them for our collective lack of responsibility.

Ann Stewart, School of Law, University of Warwick, Coventry CV4 7AL, UK