CREATING VALUE IN THE CARE ECONOMY
The pandemic has forced society to recognize that care work is inextricably linked to social and economic outcomes. Prioritizing it will help us all in future crises.
— the economic sectors that involve paid and THE CARE ECONOMY unpaid care, including childcare, elder care and long-term care — is one of the fastest expanding economic sectors globally. A 2015 study of 45 countries by the International Labour Organization (ILO) found that there were 206 million people in care jobs such as early childhood education and long-term care, and they estimated that this figure would rise to 248 million by 2030.
The COVID-19 pandemic has brought an increased focus on how the lack of support for care sectors and the increasing trend of financializing access to care have placed equality and health on fragile grounds. In Canada, COVID has highlighted the poor conditions in long-term care homes and the dearth of affordable and high-quality early childhood education options — in part due to for-profit organizational models that have turned caring into a business that only some can afford.
The pandemic has forced many to think about a new ‘ethics of care,’ where we see ourselves not as a collection of autonomous individuals but as many interconnected and interdependent relationships and communities. As society emerges into a recovery economy, questions about the future of care emerge: What organizational and policy changes are needed to ensure that care work and caregiving is more equitable and sustainable? What do we know and what still remains to be discovered through future research?
To explore these questions, the Institute for Gender and the Economy convened a virtual research roundtable early in 2022 with support from Women and Gender Equality Canada and the Social Sciences and Humanities Research Council of Canada (SSHRC). The workshop hosted over 60 scholars and practitioners from around the world who presented their research, identified research agendas and discussed policy implications for the future of care. In this article we will highlight five of the key insights that emerged from this discussion.
Care work includes the diINSIGHT 1: CARE WORK IS MULTIFACETED. rect work of providing face-to-face services that develop the capabilities of the recipient, including mental and physical health as well as physical, cognitive and emotional skills. Providing
such care includes emotional work to assure the care recipient’s welfare. It also involves dependency, as caregivers usually provide labour to meet needs that care recipients cannot meet themselves. This type of caregiving has been conceptualized as ‘direct care’ or ‘nurturant care.’
But, care work also includes many activities that are not direct care but are still necessary for providing care. This work — which includes food preparation, laundry and cleaning — is sometimes called ‘indirect’ or ‘non-nurturant’ care. Based on such definitions, the unpaid care that parents or other caregivers provide for their family members are a significant part of the care economy, as are employment sectors such as childcare, education, long-term care, healthcare and home care work.
Finally, care work also involves advocacy work. For example, parents need to get their children into childcare centres, or ensure their neurodiverse children get the services they need. Adult children help their elderly parents to search for quality care and to receive benefits from long-term care insurance. This advocacy work is often very time consuming and can even crowd out the ability to provide the other forms of care.
Care work may therefore take on many different forms, both paid and unpaid, and many people are involved in multiple ways. Being attentive to this complexity in research and policy making will allow for policies to be tailored to different groups and achieve better outcomes.
Globally, womINSIGHT 2: CARE WORK IS GENDERED AND RACIALIZED. en and girls are estimated to be responsible for three-quarters of unpaid care and domestic work in homes and communities. Even as women have joined the paid labour market in increasing numbers, their time spent on care and domestic labour has not commensurately decreased or become shared among men partners, a phenomenon that has been referred to as the ‘second shift.’
Recent research from both East Asian and Western countries suggests that women carry out 30 minutes to two hours more total work than men each day — where total work includes work for pay and unpaid work for households. This second shift has escalated in importance throughout the COVID-19 pandemic, resulting in trends in which women — especially single mothers — have faced employment loss out of the necessity to meet heavier caregiving loads.
On the other hand, higher-income women have historically had the option to outsource labour to paid care workers, of which women (especially women of colour) are also the majority. In Canada, women represent three-quarters of all paid care workers, including nurses, elementary and kindergarten teachers, personal support workers (PSWS) and early childhood educators (ECES).
Researchers have theorized how such work is often viewed as ‘dirty’ and servile and therefore sits at the bottom of occupational hierarchies. It is frequently relegated to people of colour and other marginalized groups such as immigrants. This is not a new phenomenon: As paid service sectors have expanded, white women have become well-represented in higher-paid, publicfacing caring roles such as nursing, while women of colour disproportionately fill low-wage, precarious, less regulated, and less visible care work, including as PSWS (also known as nursing aides and nursing attendants) and home care workers. Men of colour also tend to be overrepresented in indirect care jobs such as cleaning.
The transnational movement of care workers from the Global South to the Global North has been enabled by aging populations, decreasing birth rates, women’s increased labour market participation and immigration policies facilitating the entrance of temporary workers in the Global North. Notably, high-income countries host nearly 80 per cent of all migrant domestic workers. These migrant flows have created ‘global care chains’ or ‘international reproductive labour divisions’ as migrant workers leave their dependents in the care of other family or community members in their home countries.
In Canada, migrant care workers tend to be disproportionately represented in home care and personal support work. Over one-third of nursing aides, orderlies, patient service associates and PSWS are immigrants. These care jobs require less time in formal education, have less oversight by professional regulatory bodies, pay relatively little and create precarious work conditions such as no paid time off and no benefits.
Migrant care workers are often internationally educated but face barriers to finding jobs commensurate with their education level due to barriers to foreign credential recognition. One study of migrant caregivers in Canada found that over 70 per cent had post-secondary degrees prior to emigrating but had trouble finding higher-paying and more secure work.
Even before the pandemic, providINSIGHT 3: CARE WORK IS TOUGH. ing care has always been tough work. The difficulty comes not only because of the personal and emotional labour involved, but also because systemic issues — such as the devaluation of care work — hinder caregivers and care workers from working effectively, providing high-quality services and maintaining their own health and well-being.
Paid care workers endured high stress even prior to the pandemic. For example, in Canada prior to 2020, nurses showed higher rates of work stress and job strain compared to other occupations. Since COVID, the stress levels of both physicians and nurses have risen significantly: 70 per cent of health care workers have reported worsened mental health and feelings of burnout, with women showing higher rates. Similarly, in 2021, a survey of the early childhood education workforce in Ontario showed an 89 per cent increase in their job-related stress and a 54 per cent decrease in job satisfaction since the pandemic began. Qualitative data revealed experiences of exhaustion, anxiety, depression and hopelessness.
This burnout and psychological distress is connected to care workers’ conditions of work. For instance, paid care jobs tend to offer significantly lower wages than jobs with similar education and experience requirements (which then directly contributes to the gender wage gap.) Women face an expectation to provide care out of ‘love and obligation’ rather than for money, and this stereotype is an implicit justification for low wages. There is a tension here because keeping wages low may keep costs lower for families who need care services — yet this perspective can be problematic as low wages in care can create greater instability in care quality.
Early Childhood Educators (ECES) are one example of care workers who continue to face issues such as workplace discrimination, lower wages and gender stereotypes. An Ontario survey of ECES found that during the pandemic, 20 per cent reported an increase in work hours, yet only nine per cent reported an increase in wages.
Depending on their education level and province of work, Canadian ECES earn on average between $24,000 and $36,000 one year after graduation. Their experiences point to impending problems in retention and recruitment even as childcare in Canada is subsidized by the government to be more affordable: Many people trained as ECES have already left the sector due to low wages and poor working conditions.
Poor working conditions are detrimental not only for those giving care but also for those receiving it. This became evident in Canada during the early stages of the pandemic when residents and PSWS in long-term care homes saw outbreaks of COVID-19 due to factors such as poor treatment and protection of workers, who often did not have access to paid sick leave. Many were working in multiple facilities — which were already experiencing overcrowding and substandard conditions — to make ends meet. As the healthcare system was put under strain, the demand for PSWS increased and many had to work long hours in facilities that were chronically understaffed. These conditions resulted in widespread illness and death that may otherwise have been prevented.
INSIGHT 4: TECHNOLOGY PRESENTS BOTH OPPORTUNITIES AND RISKS. New technologies — including digital communication, automation, artificial intelligence, digital assistants, telepresence and robotics — are increasingly playing a greater role in care to either relieve care shortages or improve quality of care. The pandemic has showcased the potential benefits of this technology use, from digital health appointments that reduce human contact to socially aware robots in long-term care homes. In certain care settings, technology is assisting with managing demands for care. For example, in Japan, care robots have been used to ease the chronic care needs of an aging population.
Some people thus see technology as a solution to shortages of care workers and care facilities. But technology cannot be a catchall solution for gaps in the care economy. Research shows that care work is not ‘replaceable’ by technologies because it is highly relational and involves recognizing the humanity of both the caregiver and the cared-for through their essential interdependence.
A risk in the use of robotics and artificial intelligence is that it may bring about a loss of dignity as well as place further demands on caregivers who must both meet the emotional or relational needs of care recipients and manage how the technologies deliver practical aspects of care. As a result, researchers have noted that care technologies are more likely to improve care interactions by assisting with certain duties rather than replacing them.
Some technologies that enable greater digital communication between care workers, caregivers and care receivers can
serve to shift the responsibility of care to others, and can ease concerns about safety and security for caregivers who have charged others with care responsibilities. Digital care platforms such as Staffy or care.com are examples of how the sharing of care duties — ranging from childcare and elder care to household duties — might be made more accessible through technology. A benefit of these labour platforms is that they facilitate trust between care workers and care receivers.
However, such platforms can be embedded with traditional norms and structures of inequality. Although these platforms help care workers to find work, workers still bear unequal safety risks and poor working conditions due to a lack of employment protection. And because platform arrangements are usually informally negotiated between the care worker and care recipient, research has shown that these technologies may reinforce or exacerbate asymmetries of power.
For example, during the pandemic, some digital care platforms surveilled the health of care workers to ensure families were protected from COVID, but did not provide measures to ensure care workers had similar protections while they were working. Technologies have also blurred lines between personal and professional lives: Flexible or remote work technologies can help caregivers such as working parents to work and care for dependants simultaneously, but having this ability can also disrupt the time that caregivers intended to spend with families.
The pandemic INSIGHT 5: NEW ORGANIZATIONAL MODELS ARE NEEDED. has highlighted problems with profit-driven models for care, as seen in the management and health outcomes of for-profit longterm care homes and the marketized childcare sector in Canada. During the pandemic, evidence emerged that for-profit longterm care homes provided inferior care and resulted in higher death rates compared with non-profit homes. Market-based childcare provision has also meant that childcare has been costprohibitive for many families, precluding parents and especially mothers from engaging in paid work.
These models financialize care, turning it into a service that is bought and sold while ignoring its necessity for the economy and for all people’s well-being. Researchers and advocates have recommended prioritizing alternative business models and nonprofit care to build more sustainable systems, create decent jobs and assure quality of care.
To address economic and job insecurity faced by care workers, some are arguing for an ‘intimate community unionism’ in which universal government funding is strengthened by a democratic alliance between unions, labour movements, caregivers and care receivers, to decide who and what should be funded and what should be recognized as care. This also extends to conversations about care in developing countries where there is a true dearth of funding for care work and advocates are pushing to integrate a care analysis into existing international development programs.
A Recovery Based in the Care Economy
Governments and organizations face an opportunity to transition to policies and practices that function on the understanding that the care economy is deeply connected to all of society — shaping lives, careers and economic prosperity. Following are 11 important considerations.
1. One of the key gaps in developing effective government and organizational policy is the lack of data. Intersectional perspectives in data collection and analysis on the care economy will allow for more nuanced and complex understandings of care. People experience care and caring differently based on income, gender, race and many other factors.
2. Data collection and analysis should capture the complexity of the care economy by focusing on historically neglected care activities. This may include data on the value of unpaid care, on less direct forms of care work (e.g., care advocacy), and on temporary and migrant care workers and their transitions in and out of care work.
3. Including paid and unpaid care workers’ voices in policymaking rather than making policy for them may result in more effective outcomes. Engaging communities and care workers in policy design and implementation should achieve more equitable results.
4. The toll of the pandemic on care workers raises the importance of making their physical and mental well-being a policy and research priority. Ensuring high-quality working conditions with labour protections would avoid a ‘zero sum’ approach
in which affordability of care for families is seen as a trade-off with job conditions for workers.
5. Care policy should not be seen as independent of other government policy-making. For example, integrating care policies with immigration policy would help protect care workers, including temporary workers, from precarity. Linking care policies to policies for supporting women’s entrepreneurship and women’s representation in organizations will help fill a missing gap in those strategies.
6. Policies have both direct impacts on outcomes as well as ‘expressive’ impacts that shape the culture and norms about what is acceptable. Government and organizational policymaking should take both forms of potential impact into account.
7. The value of care is not just financial. Measuring the value of care accurately means measuring not only economic growth and gain (e.g., GDP), but also the less visible, yet foundational, benefits of care to society, such as physical and mental well-being, capabilities and inclusion.
8. Without stability and resilience of care systems, care responsibilities are hard to manage. Instability of care can disadvantage caregivers’ careers, exacerbate gender inequity, and lead to overwork and stress.
9. Technological ‘solutionism’ and other short-term fixes alone will likely not lead to a sustainable care economy. Instead, technology can be oriented towards specific goals within the care economy; for example, policymakers and researchers can focus on what technology’s role may be in reducing women’s overburden of unpaid care work.
10. For-profit models have not historically resulted in highquality and affordable care. Non-profit and cooperative models may be better options for a higher-quality care system in developed economies. In developing economies, creative public-private partnerships may be the most agile in meeting care needs.
11. Care work takes many different forms, both paid and unpaid, and is connected to all sectors. People are involved in the care economy in many ways, both as givers, receivers and advocates. Understanding ‘chains of care’ at the micro level of families and the macro level of global care migration is important to understand who might benefit or be disadvantaged.
In closing
The pandemic has revealed gaps in policy, infrastructure and systems for care work both in and outside of the home. It has also exacerbated the impacts of other ongoing crises such as the climate crisis, which has its own implications for the availability and mobility of care workers in addition to the physical and mental health of caregivers and receivers. Hearing from those who perform the essential work of care is a necessary first step to achieving equality in both paid and unpaid care work. This must be matched with new measures to track the impact of care on well-being — and on the economy.
As our society recovers or moves into the endemic phase of COVID-19, how can care be valued and prioritized in policy decisions? The pandemic and the climate crisis have highlighted the importance of ensuring that the care economy is resilient to future crises. What would a model of resilience in the care economy look like? Many questions remain for how care can achieve quality, affordability and scale — and these connect to questions of whose caring labour is valued.