Lessons from the Pandemic: Care is not a Commodity
Updated: Dec 15, 2020
Who Cares for Older People?
More than 50% of Covid-related deaths have occurred in nursing homes in Ireland. Why so many older people died while in care has not yet been fully explained, though it was evident that most people in residential care were Covid-invisible, in Ireland and elsewhere, until the death toll started to rise. The high death rates in nursing homes have shone a light on the care of older people; it raises questions about the type or form of care provided, and who provides it.
There are just over 32,000 people living in nursing homes in Ireland in 2020. Most are over 80 years of age. Many are not only elderly, they are also ill, and/or have age-related disabilities. Of those in nursing homes, 79% are living in private homes; 3.3% are in the voluntary sector and just under 18% are in State-run care homes (HIQA 2020). The great majority of those living in private nursing homes are in places that are run as profit-making businesses, that is to say they are corporatised.
The growing corporatization of nursing home care in Ireland is reflected in the enormous State subvention to private for-profit providers: it has increased from three million euro in 2006 to €176 million in 2019, while funding for the voluntary, and especially the statutory sector, has grown by relatively small amounts. It is time to ask questions as to why we have turned over the care for vulnerable older people, and indeed the care of children in residential care, to profit-making businesses. What are the dangers in care terms?
Care as a Commodity?
The marketisation of care is increasing throughout Europe, the US, and most of the industrialised world. Care of older people in particular is moving systematically from family (unpaid, women-led care), and state-provided, voluntary and community care, to for-profit provision. The size and spread of the markets in home care alone is exponential, reflecting its enormous potential for profit making: The global home healthcare market was valued at US$281.8 billion in 2019.
For-profit providers are not just another player in the care sector in Ireland or elsewhere, however; their size, wealth and political connections makes them a driving force. They are redefining the terms on which other non-profit and state bodies can do care. The concept of care itself is altering under the weight of corporatisation. Business rationalities and the corporate logic of profit-making and cost-cutting (especially labour-cost cutting) now dominates the whole care sector. Care as unpaid labor is gradually being turned into a ‘commodity’.
As care is being corporatised, the person in need of care becomes a ‘consumer’. This is problematic, not least because the logics of care are contrary to the logics of the market in several respects. Care is driven by the logic of nurturing, corporations and businesses are driven by the logic of profit; market logic presumes the speeding up and condensing of time-on-task to increase efficiencies, while care-needs lack boundaries and cannot be time-defined; capitalist logic works through bureaucratic rationalities, operating through explicit hierarchies of power, status and income differentials, while care contradicts scientific and bureaucratic rationalities as it is not career-defined. Also, there is a reciprocal and a voluntary dimension to all care relationships, built on a mutuality of recognition, responsibility, and giving and taking through time, that cannot be supplied to order.
If corporatised, caring is no longer defined as a needs-based relationship, the more person-centred perspectives are pushed out and care becomes measured in units of time and units of money. It is codified, broken down into specific ‘timed tasks’. But love and care labour time is not infinitely condensable; you cannot do it in less and less time. It is not possible to produce ‘fast care’ like fast food in standardised packages. Time-defined care translates often to pre-packaged units of supervision. It becomes less personalized, often poorly paid, based on time-on-task, and less sensitive to the changing needs of the people toward whom it is oriented: it becomes a site of profit-led opportunism.
As the logics of care are antithetical to the logics of capital, and as capitalism is making inroads into caring, imposing an alien market logic on how we nurture and relate to each other, it is time to challenge this. Capitalism has its own morality: it is profit-led. Caring is nurturing-led and person centred. The two are not aligned.
Capitalist businesses cannot be allowed to take over the terms and conditions on which we do caring. To allow this to happen is to hand over the meaning and making of humanity through care relationships to the market, and in so doing to destroy them over time.
Kathleen Lynch’s book Care and Capitalism will be published by Polity Press, Cambridge. Summer 2021
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