When it comes to long-term care, the personal is political
In long-term care, the majority of those who seek care and those who provide care, are women.
It is women, many of whom are racialized and/or newcomers, who spend their professional and personal lives caring for others. They provide the majority of the direct paid care for older people and then often go home to provide unpaid care. It is women who are the spouses, daughters and volunteers who provide most of the unpaid labour to residents and family members in care homes.
Care work has typically been seen as women’s work. This long association contributes to the notion that care work just comes naturally to women and as a result requires little skill, little or no training, and little effort. The physical and emotional demands of the work are too often rendered invisible.
Before the pandemic, those in health service assisting occupations, such as personal support workers, had the highest number of accepted days lost claims due to illness and injury.
Women doing this work have made gains through equity legislation and union contracts but their lack of supports, such as child care, home care, shift choices and fulltime employment in single sites, limits their power.
The low value attached to care work directly relates to the low value placed on those who need care, especially if these older people are women. Compared with men, women generally live longer and have more chronic conditions. According
to Statistics Canada, there are nearly two women for every man over the age of 85.
Women are also more likely to provide the direct unpaid care at home. They often outlive their partners and although the majority live independently, when older women require care there may be no one to provide it.
Compounding this is the fact that women often don’t have enough income to support their care and stay in their homes, as historically they have been less likely to work outside the home and are typically paid less.
These factors in part explain why more than two-thirds of Canadian long-term-care residents are women.
Yet little research or policy attention has been paid to the needs of women residents, let alone of women from different cultures and racialized groups who are a growing segment of this population.
In the wake of COVID-19, we need to recognize that our understanding of both care work and of older women, has created a health system that disproportionately disadvantages women.
Ignoring these facts will not lead to improvements in long-term care. Instead, we need to shape a long-term-care system that recognizes the importance of women. Pat Armstrong is distinguished research professor of sociology at York University and a Fellow of the Royal Society of Canada.
Paula Rochon is a senior scientist at Women’s College Hospital, a professor of medicine and the RTOERO chair in geriatric medicine at the University of Toronto.