ourEconomy: Feature

Cheap labour and AI won’t fix our care crisis. Here’s a real solution

People are living longer, with more care needs. We must rebalance our relationship to work, the planet and each other

Emily Kenway
3 July 2023, 8.00am

Getty Images. Collage by Daniel Norman. All rights reserved.

  • This article is part of openDemocracy’s new series on the care crisis that explores the roots of the problem and inspiring alternatives.

  • Emily Kenway will be discussing solutions to the care crisis at a parliamentary event co-sponsored by openDemocracy on 11 July from 6-8pm. You can register for free here.

I’d like to introduce you to some people I’ve met recently.

When Ulla was in her 60s, her husband had a stroke. When Line was 29, her son was born with Down’s syndrome. When Safa* was 12, she began helping to care for her little sister who has physical and cognitive impairments. When Ayesha was 27, her mother got cancer. When Katy was in her 40s, she became the full-time carer of her husband, who has a motor neurone disease. When Tracy was in her 50s, her dad got dementia. When Eric was 35, his husband got cancer. When Carlyle was 71, his wife had a stroke. When Josie was 31, her son was diagnosed with Asperger’s. When Karen was in her 50s, both her parents got dementia.

None of these people expected the care crisis to come to their own front doors. Perhaps you didn’t either, if you’ve experienced something similar – or perhaps you still don’t.

But the care crisis is here, and it affects us all.

That’s why openDemocracy is launching ‘The care crisis is failing us all – here’s how to fix it’, a new series on how we got into this crisis, and the possible ways out of it.

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Today, people are living longer, but with more care needs. Meanwhile, we’re having fewer children. The care industry makes huge profits globally, yet unpaid caregiving still makes up the bulk of care provision in the UK. In fact, an estimated 12,000 new people are becoming unpaid caregivers each day.

What’s more, the work of caregiving is not evenly distributed. Women remain the majority carers for our species around the world, both in the family realm and the paid care sector. In the UK, paid carers must shoulder poor wages and working conditions. Unpaid carers are given paltry support from the state – just £76.75 a week at current rates.

The toll is immense. One in five residential care workers is living in poverty. Unpaid carers experience severe financial strain and are more likely than average to use food banks, since caring responsibilities restrict the number of hours they are able to work. They lose savings, careers, social relationships and even their own health: horrifically, they have higher mortality rates too.

It’s clear: we are living in a care crisis. At root is our society’s chronic undervaluing of care, both materially and culturally. And it will take more than a sticking plaster to solve.

It’s common to point towards government services as the solution to this dire situation. But today, they’re plainly insufficient: there are nearly 300,000 people on social care waiting lists in England alone. Even when support is assigned, it relies on the poorly paid, high-intensity labour of migrant women. Migrants are overrepresented in the care sector by a factor of two compared with their proportion of the general population, racialised migrants from poorer countries above all. What kind of global justice is it that relies on low-income migrants to service the care-free lives of the rich?

Technology is another flawed solution – especially the forms that exploit or even attempt to ‘replace’ carers. ‘Carebots’ have received billions in investment from governments and businesses around the world. Japan has introduced Pepper, a white humanoid bot designed to lead exercises and games in residential care homes, while Israeli firm Intuition Robotics has brought an AI-driven ‘social companion’ to market, providing conversation as well as health-related reminders.

Well-designed tools can make care easier. Yet recent ethnographic research from Japan has found that the carebots are failing to live up to their promise, merely creating more work for caregivers who have to monitor and maintain them. And even if these issues were resolved, it’s not clear how we can meet the intensive resource usage that automation demands without deepening the climate crisis. The communities on the front line of environmental disaster have care needs, too.

There are sensible options, of course. Investment in paid care work, with performance measured by quality and not profitability, would significantly address care needs as well as the injustices of care labour. Estimates of the amount required vary, from around £7bn suggested by Care England to £13bn according to the Local Government Association. Better ways of working could be popularised too, like not-for-profit care cooperatives that enable care receivers and family carers to participate in governance and delivery, and give employees control of their terms and conditions.

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But we need to go further. For one thing, we need to be more imaginative about the role of governments in solving the care crisis. The amount of care we’ll need in future years is unsustainable if we’re all too busy working to support loved ones. We must rebalance work and care time, dethroning the former through policies like a four-day working week and paid, job-protected care leave.

And we’ll need new social infrastructure to cope. Our living arrangements must shift from the narrow confines of the traditional family to more porous, care-friendly arrangements, such as co-housing projects where people live in private spaces but share common areas and collective endeavours.

We should all be afraid of what’ll happen without these radical new pathways. We can’t chart those paths without making care as personal as it is political. Because while we need government investment, a rebalancing of work and care time, and many more changes, at the crux of it, this is a crisis of our own vulnerability.

Care is often talked about as if it’s solely about birth, parenting and reproduction. But it’s also about frailty and death. We’re taught to revere our freedom and independence, or at least to aim past the things that tie us to drudgery and dependency. As Oscar Wilde wrote in his 1891 essay on socialism, “it is mentally and morally injurious to man to do anything in which he does not find pleasure”.

We must be wary of how deeply this idea reaches into our lives, because to reject unpleasant tasks is also to relinquish love. Care teaches us this, showing us that, if we love anyone, there will be hard things to do; toil and heartbreak. It’s the price we pay for love and community. This doesn’t mean accepting care on the terms dictated by capitalism, but it does mean accepting that our freedoms are subject to the vagaries of the universe: sooner or later, we’ll discover that today’s liberty was but a fleeting condition.

Fear of mortality makes us stigmatise and withdraw from the sick and impaired. There is a dissonance at the core of us humans; we are capable of charting the stars and mapping our interior helix, yet tethered to tumours and toilets. That knowledge of our own vulnerability, the eventual demise of our minds and bodies, makes us fearful of confronting care, but a confrontation is what we need. If we fail to do it by choice, it’ll be forced upon us, just as it was upon Ulla, Line, Safa and everyone else we met earlier.

We talk of care as a ‘sector’, something sectioned off from a larger whole. Consequently, we don’t think about it until the unthinkable happens. But care is not a sector like legal advice, or hairdressing, or podiatry. Rather, care is what feminist theorists Joan Tronto and Berenice Fisher have termed a ‘species activity’, a fundamental task embedded in the very facts of life and love. Seen this way, it is a continuous presence, involving us all.

If we fight for change from this foundation – rooted in the reality of the human condition, connected in our mutual vulnerability, understanding that with love comes necessity but not under the terms that capitalism requires – then we just might get somewhere better. Maybe, if you’re lucky, it’ll be in time for you.

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