The Surprising Burdens of Care

by Ingrid Robeyns on September 1, 2008

I’d like to put an empirical claim on the table for discussion. The claim is that people who have never done a significant amount of informal carework, are extremely likely to underestimate the burdens of care. In this claim I include care for small children, severely disabled people, dependent elderly, or any other human being in need of significant amounts of informal caring. And with burdens of care I mean all sorts of burdens – they can be physical, or psychological, or emotional, or another dimension, or (most likely) a mixture of these.

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. Perhaps in a psychology or sociology of care literature? I have come across plenty of anecdotal evidence, but haven’t come across a study that has investigated this claim in a qualitatively-grounded quantitative way (or a similar claim, perhaps focusing on just one type of care situation). Anyone suggestions for literature? Anyone views on the plausibility of this claim?



Bill Gardner 09.01.08 at 7:35 pm

Is the hypothesis here that someone who is naive about care underestimates the effort required by care more than they underestimate the effort required by other things they are naive about?


Ingrid Robeyns 09.01.08 at 7:42 pm

Bill, good question. Perhaps not greater underestimated than any other activities they are naive about, but I postulate that the underestimating is larger than for most other widely-performed types of work (like working in an office, doing groceries, cleaning a house, etc.). I think that there are plenty of people out there who believe that care is ‘easy’, no work really, just sitting around with some other people (those being cared for), helping them a little bit now and then, or providing them with company and meals. It is only when one does the work, that one starts the experience the myrad other things that a good carer also has to do, and that make caring so burdensome (which, i should stress, of course subtracts nothing from its value or says not about the benefits.)


Ingrid Robeyns 09.01.08 at 7:43 pm

sorry, I meant “all other activities” in the first sentence. Perhaps time to sleep here at this side of the globe…


Bill Harshaw 09.01.08 at 7:52 pm

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.


notsneaky 09.01.08 at 7:53 pm

Isn’t this a staple plot of old sitcoms and cartoons? I’m pretty sure there’s a Flintstones episode where Fred underestimates Wilma’s carework and then to prove it agrees to do it for a day. Of course he can’t, etc. etc. etc.


abb1 09.01.08 at 7:56 pm

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.


bitchphd 09.01.08 at 8:08 pm

I’m sure you’re right, and I think that one of the primary reasons is the gap between our feelings of how much we need to be cared for and how much care we’re actually given. Every caregiver (A) has had an exchange with the person they’re caring for (B) where B says “I’ll do that myself!” or “I can do it!” and A, if A is any good at caregiving, ensures that B *isn’t* doing it him/herself, but gets to think he/she is.

I’ve done this with my child, and I’ve done this with my elderly aunt. Letting the person you’re caring for believe that they’re more independent than they are is one of the most important (and hardest) aspects of caregiving, and the *entire point* is that it should be as invisible as possible.


OneEyedMan 09.01.08 at 8:27 pm

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.


K. Williams 09.01.08 at 8:28 pm

Fascinating — this is exactly the opposite of what I would have thought people would think. As someone who’s never done a significant amount of carework (informal or otherwise), it’s always seemed to me like an incredibly tiring, time-intensive thing to have to do (as well as being extremely boring). That’s precisely why I don’t want to have anything to do with it, and why I dread the (inevitable) day when it’ll become my responsibility. I’m amazed anyone feels otherwise.


tom s. 09.01.08 at 8:28 pm

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.


Phil 09.01.08 at 8:30 pm

A lot will depend on the question asked, obviously different types of care will be easier or harder than others an one person may find a similar type of care harder or easier to carry out than another person. The person being asked will probably try and imagine how hard it would be for them to be a carer and I do not see how this could be tested without them carrying out that care, but then they would no longer be naive about care. I guess it should be possible to compare estimates of the burden of providing a specific type of care for people experienced in providing that care, those experienced in providing other care, and those not experienced in providing care. But I don’t know the relevant literature, sorry.


jayann 09.01.08 at 8:40 pm

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.)


jayann 09.01.08 at 8:41 pm

(Sorry, I don’t know what should follow ‘But the’. I’m sleepy.)


aaron_m 09.01.08 at 8:46 pm

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.


P O'Neill 09.01.08 at 8:56 pm

Well, with anecdote being the singular of data, the ecstatic welcome given to Sarah Palin on conservative websites, with no pause for thought on how exactly care for 5 children, one with Down’s, gets balanced with full time jobs for both parents, is an interesting case study.


Anderson 09.01.08 at 9:08 pm

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.


sg 09.01.08 at 9:29 pm

There is a brilliant but heartbreaking Australian comedy called “Mother and Son” about the amount of work involved in caring. It also pretty accurately describes the attitudes of one type of family member who doesn’t have to do the caring towards those who do.


salient 09.01.08 at 10:00 pm

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.


Matt 09.01.08 at 10:12 pm

I’m not sure what you mean by “informal” here Ingrid- do you just mean people who do care work not as a full-time paid job? As to the hypothesis, I think you’re probably right, though I suspect that there are also lots of cases where people decide it wasn’t as hard as they thought it would be, too.


Laura 09.01.08 at 10:28 pm

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


Clay Shirky 09.01.08 at 11:02 pm

You may want to look at “When a commodity is not exactly a commodity”, about care work, at

Part of Nancy Folbre’s project on the economics of care. More at her page and at the Take Care blog


bianca steele 09.01.08 at 11:43 pm

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.


lARA 09.01.08 at 11:59 pm

I don’t have the statistics, but I imagine they are documented somewhere. I believe the divorce rate for parents of disabled children is higher than those without disabled children.

Not as strong evidence, but I believe the divorce rate for couples with children is higher than couples without children.


Jenny 09.02.08 at 12:03 am

I second the Arlie Hochschild reference, and suggest that the term “emotional labor” might be a good one to search on. 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.)


peter 09.02.08 at 12:15 am

Surely, most people typically under-estimate the amount of time and effort required to do any activities which they themselves do not do.


vivian 09.02.08 at 12:33 am

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?”


Slocum 09.02.08 at 1:36 am

I suspect that the ratings for CEOs and financial managers would be pretty low, less than that for e.g. factory workers.

I suspect that’s true — but only because few people have much of an idea what life as a CEO is like or what life was like paying the dues to get there. I’ve been close enough to that level to have a reasonable idea — and you really couldn’t pay me enough.

Conversely, I did a lot of childcare when my kids were young — more than my wife did, actually. I enjoy little kids and though it was tiring, I found it less stressful than office work. But I think the difficulty of caring varies greatly according to the individuals doing the caring, the individuals being cared for, and the other resources available.


Witt 09.02.08 at 1:55 am

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.


Witt 09.02.08 at 2:04 am

The claim is that people who have never done a significant amount of informal carework, are extremely likely to underestimate the burdens of care.

Sorry for the serial post, but I just realized that a huge variable here is class, economically and otherwise. The burden of caregiving is massively affected by money. Taking care of an infant without an in-home washer/dryer, the ability to breastfeed (due to employer rules) or have “extras” like a functional stroller makes caregiving fundamentally more difficult.

I would bet there are lots of folks who could reliably estimate the burden of informal caregiving based on their own middle-class experience — and yet still not grasp the additional layers of difficulty the same activities can have for a poor or working-poor person.


ScentOfViolets 09.02.08 at 2:53 am

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


vivian 09.02.08 at 3:04 am

Witt@29, Angela’s Ashes did a terrific job of showing this, how mother and young children walked miles across town multiple times to get the parts of a bed from the charity, and how father was eager to help at the house, where he wouldn’t be seen doing house work.


Economics of Contempt 09.02.08 at 5:21 am

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.


magistra 09.02.08 at 10:50 am

One important (but very nebulous) issue is the extent to which you are, practically speaking, ‘on call’. If there is a problem with the person you’re caring for, do you need to drop everything else and go and sort it out? Because that is a very big practical and emotional constraint on people who otherwise may not look as if they’re ‘caring’ for someone at all. If whenever your grandchild gets sick or your elderly father has a confused day, you have to make sure they’re OK that’s a big burden. It also means you can’t book anything far ahead in case there’s a problem and you have to pull out. I found it stressful enough just that I could get charged for cancelling a dental/chiropractic appointment at short notice because my child was suddenly ill and unable to go to daycare.


SamChevre 09.02.08 at 12:53 pm

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?


Glen Tomkins 09.02.08 at 2:17 pm

I don’t know

People sure seem keen enough on avoiding the care of their sick, elderly relations, that I always assumed that it was because they had a healthy respect for what that entails. What is most remarkable about our society, in contrast to more traditional societies, is precisely the wide extent of the shirking of this responsibility, which makes me think that people generally have some grasp of how onerous it is. The professionalization of such care goes way beyond the strictly medical intervention services that actually require professionals, and well into supportive care that lay people could do perfectly well — if they cared to make the time. It is, however, more fair to rephrase that last bit as, “if they weren’t so busy working at making enough money so as to be able to afford to fob off so much of the work of living onto professionals that they had time to do this work themselves.”

To be even more fair to the decisions that individuals have to make in our society as it exists today, we are really past the point where an individual can decide on his or her own, or even the adults in a nuclear family can decide on their own, to take on big chunks of the work of living directly, as opposed to fobbing it off on profesionals. People wring their hands over the social consequences of the impending demise of the nuclear family, but if we’re down to the nuclear family, if we’ve already lost the extended family, we’ve already lost the ability to do any of the heavy lifting that tasks as large as caring for our sick elderly at home would require. It takes a village, or at least an extended household.


Markup 09.02.08 at 2:39 pm

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.”


Colin Danby 09.02.08 at 2:42 pm

3 or 4 possible effects:

1. Simple naivete about the difficulty of something you have not done.

2. An ideology that carework springs from love, is “natural,” and hence cannot be coded as work.

3. The effect BPhD notes, and which Marjorie DeVault (_Feeding the Family_ U Chicago 1991) is brilliant on: that effective carework sometimes entails concealing the work from the cared-for.

4. People who receive more carework than they provide may have an interest in underestimating said work. You can think of this in psychological or structural terms depending on your taste in theory.

I don’t know of the kind of study Ingrid is asking for, though — all the research I can think of is more or less ethnographic. It would be interesting, if someone had the resources, to try and separate some of the above possible effects.


Daniel S. Goldberg 09.02.08 at 4:30 pm


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.


Markup 09.02.08 at 5:15 pm


Ingrid Robeyns 09.02.08 at 7:46 pm

Lots of interesting ideas and comments, thanks!

I’ll check out the specific refefences that people have suggested – perhaps there is more substantive material there that we can discuss at a later stage. Like Colin, the (little) literature that Iv’e read is all etnographic (and hence I’m eager to also learn something from more quantitative research).

Matt, I use the term ‘informal’ in the sense of not officially registered in the economy – often this is also family care, but it could also be care for a neighbour or a friend; and most of hte time it is unpaid, but sometimes siblings pay one of them to do the care for an elderly dependent parent (so it also need not always be unpaid, though I assume in most cases it is).

thanks also to the references to the Ethics of Care and the Economics of Care – both literatures I do in fact know (at least quite a bit of it), and I don’t think they are precisely addressing this question (then, I tend to agree with those of you who think that it would not be that easy to do an empirical study on this question).

SamChevre (@34) – why would that be a contradiction? In contrast, I think the two things could go together: if caring (whether formal or informal) is seen as ‘light’ work, then surely you don’t need to pay a lot for that, do you? Or am I missing the point you are trying to make?


Martha Bridegam 09.03.08 at 4:23 am

The California In-Home Support Services program assigns social workers to determine, according to strict standards, how many hours of care per month to allow each eligible disabled person. I presume by now there have been disputes formal enough to reach the public record over the adequacy of hours allowed to a given recipient. Of course there’s no naive party in IHSS eligibility disputes, but maybe they could give you a baseline to compare with amateurs’ estimates of what it takes.


SamChevre 09.04.08 at 2:20 pm

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.


ingrid robeyns 09.05.08 at 7:00 pm

Sam, thanks for the clarification (the apologies were really not needed).

We know, and employers know, that mothers are more likely to be more absent from work than fathers to take care of ill children or to pick them up from school; so in this sense their care responsibiliteis are more likely to interfere with their work commitments. Of course this doesn’t hold for individual women, yet it is more likely to occur among mothers than among fathers. The implication is that all other things equal, employers will prefer to hire a father (or non-parent who is not likely to become a mother – i.e. an older women or a men) than a mother (or someone likely to become a mother soon); or else they will only hire (potential) mothers if they are happy with lower wages. As the theory says, and I fear practice shows, this is the rationality of statistical discrimination.

Yet I still am not entirely sure that this discrimination against carers would contradict that non-carers underestimate the burdens of care; rather, they know the fact that carers are more often absent from work. That’s not enitrely the same thing. They may, for example, still believe that caring is a leisurely and thus easy or light activity, but one that requires the mum to be home by 4 pm or whenever the child is ill.


Tom Fuller 09.06.08 at 8:44 am

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.

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