Toward a new care settlement (part one)

I said yesterday that I would stay off the subject of care for a while but I was very encouraged by some thoughtful comments* I received. So, over the next couple of posts I’m tentatively laying out aspects of a response to the crisis which I have recently described. I have to decide pretty soon if this is going to be the subject of my 2013 RSA annual lecture so I’m hoping to get some feedback on whether these ideas have promise.

1. Our political leaders need to recognise that care is in crisis and that it is a social crisis not just a policy problem.

I have described in previous posts the overwhelming evidence of a care crisis (in relation both to child care and elder care but the latter more acutely) and, as the House of Lords Select Committee on Public Service and Demographic Change has underlined, there is every reason to believe it will get worse.

It isn’t easy for politicians to admit that we face a major problem and that they don’t have the answers, indeed that Government action alone cannot solve that problem. But the starting point for a long term shift in policy, norms and expectations has to be recognition of the scale of the crisis we face. One of the good things about care as a topic is that it touches all of us, so leaders can connect themselves to the issue, making more possible a type of leadership I have referred to as ‘normative’.

2. A response to the care crisis has to open up deeper questioning about the way contemporary values systematically undervalue care as both a need and an activity.

Joe made the point neatly in this comment. He is in good company. In his recent book ‘The World Until Yesterday’ the esteemed anthropologist and global thinker Jared Diamond compares the more collectivist and less ageist approach to elder care in tribal societies with those in modern America:

‘Care for the elderly goes against interwoven American values of independence, individualism, self- reliance and privacy….American ideas push old Americans to lose self-respect and younger care-givers to lose respect for them’

3. It is, however justifiable and understandable in individual cases, a social system failure that huge amounts of money are transferred from people (in taxes, fees and foregone inheritances) to get strangers to care for their loved ones.

Although care givers and receivers often need professional support, in essence care is an emotional and interpersonal activity. Generally, care based on bonds of recognition and affection is more valuable, fulfilling and efficient than care based on financial incentives and bureaucratic regulations.

Yet the combination of a number of factors including the dominance of individualist values; the reinforcement of expectations and incentives around paid employment; high level of dementia related morbidity among the old and poor support for carers, means that the long term shift towards care being undertaken in largely or wholly transactional contexts (by paid staff) is bound to continue.

4. In a just society, care is a collective responsibility and the risks which result from having care responsibilities should be shared, not just fall on the shoulders of those in need and their loved ones. Our aim should be that people choose to care as part of ‘the economy of regard’ not that they are compelled to by an absence of alternative provision.

5. In essence therefore the goal for a new care settlement should be that families and other loved ones are encouraged to provide care to those who need it but in the context of a state and society which is committed to supporting carers so that their quality of life (income, freedom, and status) is as far as possible protected.

In the next post I will explore some principles and measures which could make this a credible long term goal.

*We’ve had a problem with the Comment facility, now resolved, so many apologies to anyone who posted a comment which then disappeared.