The Surprising Burdens of Care

I suspect you’d have problems sorting out the impact of other variables: personality (there are martyr-types in the world), fixed versus indefinite care; regenerative versus degenerative situations (i.e., nursing someone back from a broken bone is different than caring for someone who has Alzheimer’s), physical environment (i.e., helping someone who’s in a house with universal design must be very different than someone whose physical environment deteriorated), etc.

Office work can be extremely hard and stressful – or easy and relaxing, depending on the circumstances and attitudes. I suspect the same is true about care work and pretty much any other kind of work. You can put the child in front of the TV and relax.

I could see overestimation of the work required as well. For example, cooking looks much scarier and time consuming than it really is. That’s especially true if you consider that some of cooking is liesure, and if you didn’t care as much you could have a serviceable outcome in less time.
Many non-care-workers would do a worse job (but perhaps still an adequate one) but do it in less time if forced to do the work of care-workers.

You will have a hard time getting empirical evidence because it is very difficult to communicate what is so difficult about care work.

19 years on I still remember the early days of caring for a newborn, being exhausted at the end of the day, but with no idea of what I had done to become so. If anyone had asked me to produce a list of what I did it would have been very unimpressive.

Or maybe I was just crap at childcare.

I’m sure you’re right about this, Ingrid, in part, at least. As for work on it: Arlie Hochschild comes to mind as someone who’d know. (Or someone on the list I cite below should. ) I do think it would be really difficult to do such research well.

I say ‘in part’ because I was someone who’d never been a ‘carer’ till I became my mother’s. I did though know enough about it, totally from the outside, not to want to do it! and looking after friends’ children very briefly had given me a good idea of the immensity of doing that all the time. But the

Also I agree with Bill Henshaw that care is variable. I don’t actually think that invalidates your view at all — i.e. that some carejobs are not only easier than other care jobs but easier than some non-care jobs doesn’t mean non-carers don’t underestimate care work. (Whether someone with no experience of care work who underestimates its demands also underestimates the demands of other work of which they know nothing seems to be irrelevant.)

http://userpages.umbc.edu/~korenman/wmst/wmst-l_index.html

I am also sure you are correct. I tried to overestimated while waiting for the little guy to come out and it still was not enough :)

It is no great difficulty to do a study comparing expecting parents’ expectations of the effort involved in the first year and their assessments afterwards (not sure why Bill sees thinks these would be larger problems here than the usual for social science).

From a quick Google Scholar search I found studies along these lines.

Try G-Scholaring “The transition from expectancy to parenthood: Impact of the firstborn child on men and women” (Feldman and Nash 1984), and check out the articles citing this paper for a start.

Now, I am not entirely sure where to look for empirical evidence which can confirm, refute or help me to refine or revise this claim.

You mean, *besides* the free market? How are care workers paid compared to other jobs?

I think that will tell you pretty quickly how the bearing of those burdens rates in people’s minds.

You mean, besides the free market? How are care workers paid compared to other jobs? I think that will tell you pretty quickly how the bearing of those burdens rates in people’s minds.

No. This isn’t even remotely true. This would imply that, in general, folks believe that everyone is getting paid fairly according to the amount of input labor, concentration, etc. required to do the job.

But that’s clearly not what the free market values. The free market generally allots highest pay to those who are in control of the greatest amount of resources (executives, financial managers, entrepreneurs), or to those working in fields where free-market demand is high relative to the number of individuals who are available to do the job (specialist doctors, trial lawyers w/ successful track records).

None of this has anything to do with how much effort is necessary, or is believed to be necessary, in order to do the job. On a survey asking “which of the following jobs require the most effort?” I suspect that the ratings for CEOs and financial managers would be pretty low, less than that for e.g. factory workers. I don’t know where various caregiving occupations would fall, but I’d bet the results would not correlate well with average pay.

There was a good deal of work on this in the 70s and 80s, when people were trying to figure out whether caring is innate to females – whether women ‘know how’ to care. You might read Dorothy Dinnerstein, Carol Gilligan, Nancy Chodorow and and Emily Abel and Margaret Nelson. Joan Tronto suggested that to develop ‘an ethic of care’ people must experience caring for and being cared for by others. I have worked on this vis-a-vis migrants who are employed to do caring labour in informal markets (see ‘A Migrant World of Services’ in Social Politics, 10,3, 2003. Informality is a major aspect of my own work on migration.

Best, Laura
http://www.nodo50.org/Laura_Agustin/

I’d second the idea that people who haven’t experienced something will probably underestimate its burdens. (Caring for very small babies may be a partial exception because everybody expects it to be very difficult.) I don’t think the studies I’ve seen reported consider the kinds of variables I’ve noticed as factors: one thing that can make a difference in my opinion is being able to stop and think once in a while. Then, one thing that can make it difficult to do this, other than sheer busyness, is fatigue — and I’ve found it can be surprising what is going to be especially fatiguing.

I second the Arlie Hochschild reference, and suggest that the term “emotional labor” might be a good one to search on. http://en.wikipedia.org/wiki/Emotional_labor There seem to be a number of scholarly studies linked to from here.

Also, you might check ergonomic research done in hospitals and by medical device manufacturers to learn more about the physical demands of caregiving, as there are so many labor/back-saving devices in use to help caregivers bathe or lift heavy patients, for example.

You might also find some interesting directions for hidden costs of caregiving if you look at the economic burdens of care, and also the environmental costs (disposable vs. cloth ADULT diapers, for example.)

Ingrid, I think you’re right but it’s not just people naive about caring underestimating its effort. People who do care work can also minimize what is required, or overestimate their emotional/physical reserves. Especially when they suddenly get a break. For example, about ten minutes after the crying baby finally falls asleep, the stress of the previous hour starts to fade. As soon as the elderly parent dies, the caregiving children start to revise the story they tell themselves about the decline.

It’s what people do. The same problem as making a dentist appointment in advance, underestimating how hard it will be to drag oneself to the office (at least if you read utilitarians like Parfit). Or, think about how within the first few hours after labor and successful delivery the pain starts to fade.

If we didn’t underestimate the hardship, we’d never get into it, we’d have trouble being compassionate enough to care. Like the people who say “I wasn’t a hero, just ran into the building and didn’t think about the danger.” The downside, of course, is carers, firefighters, etc. get paid crap, because so many of us think “well, how much extra work is it to pick up after two kids?”

There are different ways to underestimate what caregiving entails. You can underestimate logistically — as in, not believing that it really does take THAT LONG to get a two-year-old bathed, fed, and in a clean diaper. This is easier to counteract with logic and/or firsthand experience. Once you’ve gotten a toddler out the door a couple of days, you know what’s entailed, and most folks can get a partial grasp just by hearing a detailed narration.

But people can also underestimate emotionally, partly because the emotional requirements of the job can be tremendously hard to communicate. They’re hard because they’re harder to measure (I can check to make sure my elderly uncle doesn’t have bruises, but I have no idea if you read him the paper and talked about politics the way he likes, or just trapped him in front of a game show he hates).

They’re hard because they’re harder to agree on. Is “good” caregiving for a toddler just keeping them safe, clean, and fed? Or is it having conversations with them using stimulating vocabulary, playing directly with them, socializing them into the ways that we expect people to behave?

They’re hard because we have different fantasies about what kind of caregiving was available in the past, and what kind of standard we are trying to live up to now. It’s easy to romanticize how great it was for elders to die at home, without acknowledging how exhausting (and sometimes dangerous) it can be to be around someone with severe dementia. It’s easy to prioritize family care over paid care, without acknowledging the fact that broader social forces like who has the “real” job are going to affect which family member(s) provide the care.

It’s hard because mental caregiving time can be invisible. The person providing X hours of coverage may be supplemented by another person doing the emotional work of “Do we have enough nursing staff for this weekend? Has anyone refilled the prescription? She likes her compression socks on at night — are those clean?” and all the related management.

And finally, it’s hard because the default expectations are different across genders (and other variables). My father remains convinced that he did a lot of caregiving for my grandmother when she was dying. In number of hours and amount of mental space devoted to her, I’m sure he devoted an unprecedented amount with respect to anything he had done before. But it was still only about 15% of what she needed. My mother provided another 35% and my aunt the remaining 50%. To this day, I think my father thinks that he and his sister “shared” the burden.

From a slightly different angle, think about all the people who have never owned a pet like a dog, and who _drastically_ underestimate the amount of commitment in time and energy that is necessary for a healthy animal. We have three dogs, three cats, and a rabbit (plus numerous other smaller creatures over time, not all of the mammalian taxa.) At each acquisition we have been assured by our daughter that _this_ time she really will be completely responsible for the new member of our family. I’m sitting here with a three-legged chihuahua in my lap as I type, the youngest member of our family ;-)

Sorry for the ramble, but I guess I’m saying I agree with the observation above, that misunderestimation, much as we despise it in our leaders, is a very human attribute. Perhaps for evolutionarily significant reasons.

ObSF: “When the Bough Breaks”, by Padgett

Guardianship is where you want to look. When an elderly person is adjudicated incapacitated and becomes a ward of the state, a “guardian of the person” is appointed to provide precisely the kind of informal care you’re talking about. There are generally three types of guardians: (1) professional guardians; (2) public guardians (i.e., employed by the state); and (3) family members.

Family members who serve as guardians are notoriously underprepared, and most do, in fact, underestimate the difficulty of taking care of the ward. I’ve done quite a bit of pro bono work in guardianship law (mostly for the guardianship division of probate courts), and there is NO QUESTION that, in general, family members who serve as guardians not only underestimate the burdens of care, but also tend to consistently provide inadequate care. Of course, professional and public guardians aren’t great either, but they’re infinitely more prepared and reliable than family members. Guardianship experts universally acknowledge that family guardians tend to underestimate the burdens of caring for the ward.

Here’s a good empirical study of professional guardians: Reynolds & Carson, Dependent on the kindness of strangers: professional guardians for older adults who lack decisional capacity (1999). It’s not exactly on the topic you need (family members as guardians), but it’s at least a starting place for research in that area.

It seems to me reasonable at first thought that your claim would be true.

However, wouldn’t the idea that there is discrimination against care-givers in the formal labor market contradict the idea that non-carers underestimate the effort of caring?

How many “I”‘s are in “me?”

Is the “surprise” really the burden, or rather the disassociation to that has occurred over the past few decades and a new, re-revelation of it? Proper estimating takes experience, without which one is likely to run head first into, “They misunderestimated me.”

Ingrid,

There is a burgeoning literature on the burdens of caregiving. Carol Levine does some excellent work on this, both theoretically grounded and rooted in the narratives of her own experience as a LTC-caregiver. One caution is that apparently “care” means very different things to different people, so it might be a difficult concept to investigate in a manner that controls for relevant confounders. There is a good 2006 article on this in, I believe, soc. of health & illness (in context of the therapeutic misconception, not in context of caregiving).

In addition, we have a plethora of evidence that able-bodied persons dramatically underestimate the reported QOL enjoyed by even severely impaired persons; perhaps an analogy can be drawn to experiences of caregiving adduced by non-caregivers? I think that there are some relatively recent think-tank reports on this subject as well; it actually made some news in the most recent congressional session as well, so there may be some government reports on this.

If you’re really interested, email me, and I’ll see what sources I can turn up quickly.

Ingrid Robeyns,

I apologize for not putting my thoughts more clearly.

I was not thinking of discrimination in the field of pay for care work. My thought was that if mothers in general are paid less, for jobs that are filled by both mothers and non-mothers (a result that seems to be fairly well-supported by salary studies), the people setting pay apparently observe and/or believe that the care work requires significant effort.

Given the huge amount the state spends on those who end up in their care, I should think that it would be fairly simple to show the burden that falls on those who handle the task privately. I remember Elaine Morgan writing about this in The Descent of Women back in the 70’s. It would probably be quite convincing as a proxy.