The COVID-19 crisis has highlighted the inadequacy of current societal and governmental approaches to providing support for those with care needs and their caregivers. Crucially, in many countries, this means the near-total reliance on unpaid and untrained family carers to meet care and support needs. With smaller families and increasing need for care support as populations age, the heavy reliance on unsupported family carers is not adequate or sustainable. It is crucial that policymakers remember that there is always a cost to care. If it is provided by unpaid family members, these costs can include loss of income or educational opportunity, impacts on savings, assets or pensions, access to health insurance and health care, reduced social connection, stress and emotional strain, physical injuries and other health consequences. Additionally, the family member receiving care may not receive the best quality care if their family carer is not trained, does not have access to needed resources or simply does not have sufficient time to provide adequate support.
The costs of care are heavily gendered as UN Women highlights in their new policy brief, COVID-19 and the Care Economy: Immediate action and structural transformation for a gender-responsive recovery (Policy Brief No. 16). It is women who provide the vast majority of both paid and unpaid care work. Paid care workers and domestic workers providing care support are often ill-remunerated and have poor working conditions. Those who provide unpaid care largely do so without any support from government systems or services. The UN estimates that unpaid contributions of women to health and care are equivalent to 11 trillion USD (about 17% of global GDP). The brief makes a compelling case for the need to rectify the gender inequality in the care economy.
Women of all ages provide care. The UN Women brief recognizes that women are over-represented among those with care and support, largely because they live longer. It also recognizes that while older men with care needs are more likely to have a spouse who provides care, a larger group of older women with care needs are single or widowed and are more likely to live alone. However, the brief overlooks the role older women often play as caregivers for their own parents, spouse or other family members. It is important that data collection include people of all ages and that age and sex disaggregation be done to better understand the care workforce.
The brief suggests key actions to transform care systems now and for the future with a view that ultimately what is needed are robust, resilient and gender-responsive care systems. It promotes the 5R approach: “recognizing, reducing and redistributing unpaid care;ensuring adequate reward systems for paid care workers and prioritizing representation of caregivers and care recipients from policy to evaluation’. A complete shift is needed in the way care and care economies are thought of by policy makers and the public. There are opportunities to rethink macroeconomic policies which enable the growth of the care sector, creating paid jobs where they do not currently exist. Investing in accessible technology to reduce the care burden will have the advantage of freeing up time for family carers and increasing independence and autonomy on the part of those with care needs.
At HelpAge International, we believe that developing comprehensive, integrated, universal long-term care systems is an essential part of any society in the 21st century. Though formal long-term care systems are not yet in place in most low- and middle-income countries, action in this area is essential to achieve progress on the Sustainable Development Goals including on social protection floors, universal health coverage and gender equality. Even if considered from a purely economic standpoint, inaction will be disastrous as female labour force participation and female educational achievement will be sidelined in the face of growing need for care and support.
To learn more about HelpAge’s work during COVID-19, including rapid needs assessments of older people, bi-monthly reports monitoring the situation of older people in Asia Pacific during this crisis, and guidance and tools on COVID-19 access our website here.