Caring For/Caring About: Women, Home Care, and Unpaid Caregiving PDF
Preview Caring For/Caring About: Women, Home Care, and Unpaid Caregiving
Caring For/Caring About Women, Home Care and Unpaid Caregiving This page intentionally left blank Caring For/Caring About Women, Home Care and Unpaid Caregiving Edited by Karen R. Grant Carol Amaratunga Pat Armstrong Madeline Boscoe Ann Pederson KayWillson A volume in the Health Care in Canada Series. General Editor: Pat Armstrong, York University Garamond Press Aurora, Ontario © The authors, 2004 No part of this book may be reproduced or transmitted in any form, by any means, electronic or mechanical, without permission of the publisher, except by a reviewer who may quote brief passages in a review. Printed and bound in Canada Garamond Press Ltd, 63 Mahogany Court, Aurora, Ontario L4G 6M8 National Library of Canada Cataloguing in Publication Caring for/caring about : women, home care, and unpaid caregiving / edited by Karen R. Grant... [et al.]. (Health care in Canada series) Includes bibliographical references and index. ISBN 1-55193-048-X I. Caregivers—Canada. 2. Women—Employment—Canada. 3. Women—Social conditions. 4. Home care services—Canada. 5. Sexual division of labor—Canada. I. Grant, Karen R. (Karen Ruth), 1957- II. Series: Health care in Canada (Aurora, Ont.) RA645.37.C3C37 2004 649.8'0971 C2004-901140-5 This project was financially supported by the Women's Health Contribution Program, Women's Health Bureau, Health Canada. The views expressed herein do not necessarily represent the views or official policy of Health Canada. Garamond Press gratefully acknowledges the support of the Department of Canadian Heritage, Government of Canada, and the support of the Ontario Media Development Corporation of the Government of Ontario. Contents Acknowledgements vii Introduction 1 Thinking It Through: Women, Work and Caring in the New Millennium by Pat Armstrong and Hugh Armstrong 5 One Hundred Years of Caregiving by Pat Armstrong and Olga Kits 45 Designing Home and Community Care for the Future: Who Needs to Care? by Nancy Guberman 75 What Research Reveals about Gender, Home Care and Caregiving: Overview and Policy Implications by Marika Morris 91 Redefining Home Care for Women with Disabilities: A Call for Citizenship by Kari Krogh 115 Aboriginal Women and Home Care by Shelley Thomas Prokop, Erika Haug, Michelle Hogan, Jason McCarthy and Lorraine McDonald 147 "Just Fed and Watered": Women's Experiences of the Gutting of Home Care in Ontario by Jane Aronson 167 Conclusions 185 About the Contributors 189 Index 191 The Health Care in Canada Series General Editor: Pat Armstrong Caring For/Caring About: Women, Home Care and Unpaid Caregiving Exposing Privatization: Women and Health Care Reform in Canada Medical Alert: Afew Work Organizations in Health Care Take Care: Warning Signals for Canada's Health Care System Vital Signs: Nursing in Transition Acknowledgements Many individuals contributed to the production of this book. We are particu- larly indebted to those who attended the National Think Tank on Women on Unpaid Caregiving in November 2001 and who shared their expertise on how to address research and policy on women, home care and unpaid caregiving. Their insights and analyses reaffirmed that the right to care for those providing care and for those receiving care must acknowledge women's vital role within the system. The Think Tank would not have been possible without the financial support provided by Health Canada's Women's Health Contribution Program, and the other sponsors including Veterans Affairs, the CIHR Institute of Gender and Health, and the Prince Edward Island Health Research Institute. We are grateful to all of the contributors, particularly those who persevered through multiple revisions of their work. Finally, we thank Lesley Cameron for her sensitive editing of this work. This page intentionally left blank Introduction We typically think of care in personal rather than social terms. Many authors have argued that the organization and delivery of care continues to be based upon the assumption that caring about someone naturally leads to caring for them (Noddings 1984; Tronto 1993). This way of thinking reinforces current patterns of family caregiving in which women are estimated to comprise nearly 80 percent of those providing unpaid, direct personal care in Canada and are the majority of workers providing paid home care. Current trends in health care reform in recent years reinforced the vision that care is a "private trouble," rather than a "public issue" (Mills 1959) as the state reduced its investment in care and support for both paid and unpaid caregivers. Recent discussions in Canada, however, suggest that policy makers are beginning to recognize the burden of caregiving on women and are investigating strategies to improve the situation of women and families (Romanow 2002). We hope this book provides support to this counter trend and increases the options for providing care in our society. This monograph examines care work, both paid and unpaid, and the current conditions for such work. These conditions arise in a context of globalization and changes to the nation state, families and communities, as well as ideological trends and evolving conceptualizations of women, race, culture, sexuality, age and social justice. Closer to home, federal and provincial/territorial policies structure the conditions of care, setting the terms for who provides and who pays for care to whom, where and when. Finally, individual preferences and personal circumstances affect both the possibilities and limits of caring. This book builds on a National Think Tank on Gender and Unpaid Caregiving held in Charlottetown, Prince Edward Island, in November 2001.[ The Think Tank brought together academic and community researchers, paid and unpaid caregivers, policy makers and advocates for three days to discuss the gendered nature of caregiving, to hear about research and identify areas for additional investigation and to examine the experiences of caregiving in the current context. That the Think Tank participants were deeply committed to action became evident with the preparation during the final hours of the Think Tank of what came to be called "The Charlottetown Declaration on the Right to Care." This book is a further product of our commitment to action as we, the A. Caring For/Caring About National Coordinating Group on Health Care Reform and Women, work to make the effort and concerns of the participants visible to a wider audience. The National Coordinating Group on Health Care Reform and Women came together in 1998 with representatives from the four federally funded Centres of Excellence for Women's Health, the Canadian Women's Health Network, and the Women's Health Bureau of Health Canada. Our mandate is to coordinate research on health care reform, to identify gaps in research and take steps to fill those gaps, and to translate research into policies and practices. While home and community care have been on the public policy agenda for many years in Canada, the establishment of the Commission on the Future of Health Care in Canada in April 2001 provided a vital opportunity to raise our voices with respect to this pressing issue. We were fortunate to have the opportunity to share the results of the Think Tank, on behalf of the participants, with the Commission in the spring of 2002. In its Final Report (Romanow 2002) the Commission stressed the fact that Canadians want and need a comprehen- sive health care system that encompasses home and community-based care. Little recognition was given, however, to the fact that care is primarily women's work and women's responsibility. We hope, therefore, that this book encourages further discussion of the current practices and policies regarding care work, changing trends and possible futures. The book includes all the papers presented during the Think Tank- several of which have been revised and updated - as well as some papers commissioned by the editors, based upon discussions at the Think Tank. For example, participants identified the need for greater visibility and research into home care as it concerns women with disabilities and Aboriginal women. We are pleased to have enlarged this monograph with chapters on both topics. In addition, chapters include an analysis of the historical context of care work in Canada, a companion piece on care in the new millennium, a review of home care research and policy from the perspective of gender, and two papers that discuss how we might design home and community care to serve the needs of people for active citizenship and human dignity. The overriding question behind this book is: How do we make care possible in the current fiscal, political and social context? Each of the contributions offers us some guidelines that will help make it possible for women to continue to care about others in their lives and to have greater choice in when, where and how to care for them.
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