Baby's hand over mother's hand

In our project, we aim to promote and advocate for gender and socioeconomic equalities. We do this by working to reduce gender gaps in economic outcomes and by showing and properly valuing social and economic contributions of caregivers; and integrating care into macroeconomic policy making toolkits.

In this era of demographic shifts, economic change and chronic underinvestment in care provisioning, innovative policy solutions are desperately needed, now more than ever. Sustainable and inclusive development requires gender-sensitive policy tools that integrate new understandings of care work and its connections with labor market supply and economic and welfare outcomes.

The Care Work and the Economy Project, currently based at the Economics Department of American University and co-led by Maria S. Floro and Elizabeth King, includes more than 30 scholars around the globe, working closely together to provide policy makers, scholars, researchers and advocacy groups with gender-aware data, empirical evidence and analytical tools needed to promote creative macroeconomic and social policy solutions. In the next phase of the project, Care Economies in Context, we will be scaling up our project to include 8 different countries, in 4 global regions. I will be leading this next phase of the project, which will be based at the University of Toronto.

I define Care work is defined broadly as work and relationships that are necessary for the health, welfare, maintenance and protection of all people – young and old, able bodied, disabled, and frail. This definition may seem broad – but care– at its core is a very basic human need and a necessity. Whether we know it or now, we all participate in providing care work – paid or unpaid, and in receiving care every day.

By care economy, I am referring to the sector of economy that is responsible for the provision of care and services that contribute to the nurturing and reproduction of current and future populations. More specifically, it involves child care, elder care, education, healthcare, and personal social and domestic services that are provided in both paid and unpaid forms and within formal and informal sectors.

Care work is important because it is important work that sustains life. It is also important now in particular because it is one of the fastest expanding economic sectors and a major driver of employment growth and economic development around the world. For example, across the OCED, the service sector economy now accounts for over 70 percent of total employment and GDP. In lower- and middle-income countries, it is estimated to comprise nearly 60 percent of GDP. Within the service sector economy, care services is one of the fastest growing subsectors.

The International Labour Organization (ILO) estimates that the global employment in care jobs is expected to grow from 206 million to 358 million by 2030 simply based on sociodemographic changes. The figure will be even more dramatic to 475 million if governments invest resources to meet the UN sustainable development goal targets on education, health, long-term care and gender equality.

In Canada, the service sector already makes up for 75 percent of employment and 78 percent of GDP. Within this sector, healthcare, social assistance and education services are key drivers of economic and employment growth. In the U.S., healthcare is already the largest employer, larger than steel and auto industries put together. In short, our current and future economy is and will be increasing dominated by care services and care work.

However, at the same time, much of the care work continues to be performed for no pay, by families and friends, at home and in communities. This unpaid care work is not including in in our national GDP because GDP only takes into account work that is done for pay in the formal market. Therefore, if we only look at the GDP as a measure of the economy and economy growth, we miss a huge segment of the economy and economic activities. As the pandemic has shown, without both paid or unpaid care work, our economy will not be able to function effectively, nor would it be able to sustain itself.

What we are trying to do in our project is to make the care economy clearer and more visible by measuring and mapping out the size and shape of the economy, and to develop macroeconomic models that would help policymakers and civil society actors to develop better policies and better strategies to ensure more sustainable and equality inducing economic growth.

Listen to the full talk “The Care Work and the Economy Project” to learn about what the care economy is and why we should know more about it, particularly now.

 

 

The blog was authored by Ito Peng, contributing researcher for the Understanding and Measuring Care research cluster

 

Faculti, an organization that presents digital media from leading experts and academics outlining their work, recently released a digital presentation by the Care Work and the Economy Principal Investigator Dr. Maria S. Floro entitled “Macroeconomic Policies, Care and Gender in the Post-COVID Era.” The discussion describes the interconnections between the crisis of care, the deepening ecological crisis and growth and accumulation processes.

There are many common threads with the climate and ecological crisis and the care crisis. Significantly, the idea that economic growth is overall beneficial. The type of economic growth generally pursued worldwide has not only increased stresses put upon the earth’s resource base but also on care labor capacity, which is similarly but wrongly perceived to be of infinite supply. Moreover, arguments that equate economic growth with overall improvement fail to recognize the distributional element of rising income inequality, which is far more nuanced. In fact, among countries that are higher income, gains from economic growth within those nations do not trickle down to everyone. When looking at care, the widening income equality gaps has shifted distribution of care givers across social classes and national boundaries. As a result, the quality and adequacy of care within a single nation can be very different, which exacerbates differences in social reproduction.

At the same time, income inequality has created a solution for the care needs of those that have the means to hire care for children and elderly, because care workers in those sectors are often paid low wages. But for the working poor, hiring care work help is inaccessible due to financial constraints, therefore they rely on their kinship networks to help provide this care. Furthermore, much of the care work burden still falls on women even as they enter to labor force. Economics and social policy in many parts of the world continue to neglect the heavy work burden put upon women and the necessity to balance household care activities and market work. What can also be observed is a global care supply chain, with the migration of women and girls to urban areas to provide care for wealthier families. Care itself is becoming one of the drivers of income inequality.

The economy is not all about material production; it is really about human vision and social provisions. However, an illusion has been created that unpaid care work is a natural resource that serves as an input for market production to promote GDP growth. However, this idea does not take into account that the wellbeing of people, especially the elderly, the sick and children should be an end in and of itself, to achieve sustainable growth. There is much work to be done to address these issues. To begin, economists must envision long term horizons that look forward to future generations while also taking into account the interdependence of life and moral responsibility. They must also integrate care and environmental consequences into our economic policy tools. Overall a new economic paradigm that includes green ecology and feminist economic concerns is needed.

Link to Part 1 of this blog here.

Photograph of multiple hands, palms up joining

Faculti, an organization that presents digital media from leading experts and academics outlining their work, recently released a digital presentation by the Care Work and the Economy Principal Investigator Dr. Maria S. Floro entitled “Macroeconomic Policies, Care and Gender in the Post-COVID Era.” This discussion delves into the foundation of project itself, its context, the analytical tools utilized in the research, as well as the external factors that have served as the catalyst for the work being done.

The Care Work and the Economy Project was developed after a group of feminist economists observed that in the effort to reduce gender gaps in economic outcomes, as laid out within the United Nations Sustainable Development Goals, there were aspects of care work that needed to be addressed. The project includes 35 scholars from all around the world that are working to develop innovative analytical tools. The research has been applying and testing these tools in South Korea, a country that quickly industrialized in the 70s and 80s and therefore witnessed a very rapid demographic change in fertility and life expectancy.

The care economy, which is inclusive of caring for those that cannot care for themselves, underpins the production of all economies within society. This begins with the fact that if people stopped having children, which require care, then the economy would come to a halt due to lack of labor force. Generally, care work has a tendency to be undermined through a lack of gender awareness in macroeconomic modeling, which does not address care needs in any adequate manner. This aspect is also neglected within the policy making discourse, with the current economic paradigm failing to take into account the necessity for care work to achieve economic growth.

Economic models that display growth also fail to take into consideration social elements, making the assumptions that, for example, children will be cared for despite the lack of social investment into care. However, with care work there comes social, political and economic significance.  The Care Work and the Economy project is working to demonstrate what a care focused macroeconomic model can reveal through the implementation of the analytic tools being developed and implemented through the research.

The absence of the care economy within macroeconomic models is in large part due to it being “invisible” since the work often unpaid. This has led to the neglect of care needs despite unpaid care work providing indispensable services in terms of economic activity and growth. The result is an emerging care crisis that has manifested itself in terms of uncared for elderly, sick and children. Furthermore, the crisis has provoked a form of silent protest against long unpaid work hours performed by women, leading to a decline in marriage and fertility rates. This in turn has resulted in a reproduction crisis.

The Care Work and the Economy project researchers are developing and using innovative analytical tools to bring care to the forefront, along with a deeper understanding of the nature of care work, while illustrating the intersectionality between care provisioning, economic growth and distribution. Although these analytical modeling tools are currently being applied in South Korea, the project believes they can be adopted and implemented into other countries as long as the provision of care is taken into context of those countries. The project research shows that governments have an important role and duty to invest in care provisions as well as comprehensive national care plans.  One of the key findings is that it is important to take into account demographic change and climate change along with economic and structural changes taking place in policy making. This is a tall order but necessary to sustain economies and provide a future for next generation.

 

Link to Part 2 of this blog here.

A Narrative on Care

In 2018, the Care Work and the Economy (CWE-GAM) Project’s Understanding and Measuring Care (UMC) Working Group set out to gain a deeper understanding of the nature of care work and the well-being of caregivers in the context of South Korea. The group used a unique qualitative method combining in-depth interview and oral historical approach to investigate care as a continuously recurring activity throughout one’s life course and a necessary part of human existence. As part of the project’s qualitative field work and with the help of Gallup Korea, the UMC Working Group conducted 96 interviews between May – December 2018, bringing together 96 comprehensive narratives of care work in the South Korea context.

The CWE-GAM Project’s qualitative field work in South Korea conducted 96 in-depth interviews of paid and unpaid caregivers to provide useful care narratives based on the Korean context to inform macro-modelling. The qualitative research team interviewed 25 family caregivers of the elderly, 20 family caregivers of children, 20 paid care workers for elderly, and 31 paid care workers for children. The interviews of family caregivers focused on the decision-making process and evaluation of care arrangements for the elderly and children. In-depth interviews were combined with an oral historical approach to gain a deeper understanding of care work, emphasizing active listening to gain a more holistic understanding of the narrator’s life story on care. Interviewees were also asked about their experiences with caregiving. The interviews of paid caregivers focused on dual care burdens in terms of paid care work in addition to unpaid care work in the home. To learn more about the CWE-GAM Project’s qualitative field work in South Korea, read the Qualitative Methodology Report by the Care Work and the Economy UMC Working Group.

The following is one of the 96 stories. The respondent, Sung, lives with and cares for her mother, who was diagnosed with dementia about ten years ago.

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Date: May 29, 2018

Seocho-gu, Seoul

Interviewer: Hyuna Moon

Interviewee: Sung (pseudonym)

Sung, born in 1968, is 50 years old. She has a son and a daughter. They are both over 19 years old. One is attending college, and the other is studying for the college entrance exam. She is currently living with her children and her mother. As for siblings, she has one younger brother who is married. About ten years ago, Sung’s mother was diagnosed with dementia. Sung’s dad cared for her mom in the beginning, but her dad was also later diagnosed with Parkinson’s disease. Sung thus decided to move into her parents’ house to live together. It was by the time her first child entered middle school and her second child reached the upper grades in primary school. Her dad died four years ago, and she now looks after her mother. Her mother became a grade 3 beneficiary of the Long-Term Care Insurance (LTC) in her initial stage.

When Sung found out that her parents were ill, she didn’t think about passing the care duty to her brother. The siblings first considered making living arrangements so that each of them would live with one of their parents, for instance, Sung living with their dad and her brother living their mom, but their parents did not want this; they wanted to live together, not separately. Sung also felt that she ought to take care of her mother because of her ten years of experience living abroad, away from her parents. Sung has never thought that taking care of her frail parents is a son’s or a daughter-in-law’s duty. She didn’t think it was her brother’s duty to live with their parents and provide support. Nonetheless, her brother has taken up the role of financially supporting their parents. According to Sung, this was not negotiated but naturally happened. Sung and her brother also tried having their parents stay at her brother’s house during weekends, but it was always troublesome because he was not familiar with the situation, thus constantly calling up Sung for help. This weekday/weekend division of care duty did not work for them. Sung’s mother started going to the elderly daycare center from 2015 after her husband died. Her mother moved to a different center once because the center was located too far away from Sung’s place. Sung’s mother attended the first center for two years. When the center stopped running its shuttle bus to Sung’s house, Sung had to drive her mother to and from the center for a year. During that time, she had to hire a private caregiver who was responsible for driving Sung’s mother home in the evenings.

The hired caregiver also prepared meals and did some simple house chores for Sung. Sung paid her 1,000,000 KRW ($850 USD) every month, in addition to the monthly senior center fee of 300,000~400,000 KRW ( $250 – $335 USD). Other care-related expenses include Sung’s mother’s caregiver’s wage and other care services such as home-visit bathing service on weekends, food, medical bills and daily necessities such as diapers and etc., totaling about 2,000,000 KRW ($1,700 USD) per month. Sung’s brother helped to cover their mother’s care-related expenses, as Sung’s own income also had to cover her children’s education and living costs.

Description of Care Arrangement

Sung’s mother goes to the senior daycare center on weekdays and receives a home-visit bathing service every Saturday morning. The current elderly care center runs a shuttle that arrives at Sung’s house at 8:20 am to pick up her mother and to ride her back home at 9 pm. Sung’s mother is using the center service fully, spending the whole day at the center. Sung takes care of her mother after 9 pm until she goes to bed. When her mother comes back home, Sung helps her take medicine and changes her clothes and diapers. Her mother sleeps before 10 pm. Sung said her mother usually gets home tired after engaging in a variety of programs and activities offered all day long at the center.

Sung thinks her mother’s enrollment at the day care center is better than her staying at home and being bored. Sung said the most difficult part in caring for her mother happens at night, when her mother wakes up due to defecation. In such instances, Sung has to respond quickly to avoid what would otherwise become an even longer night, with her having to clean up the remains that will be all over the place. It got worse since last year and called for the most attention when caring for her mother. Nevertheless, Sung said her mother’s situation of dementia is not too bad, considering that some people with dementia can be very aggressive and easily agitated. Sung’s mother is relatively well-behaved, but she has this stubbornness which makes it difficult for Sung to help her get washed and change her underwear for she finds these to be a shame.

 

Sung said weekend care is tougher than weekday care because she needs to prepare food for every meal. The LTC-funded caregiver visits every Saturday to provide bath support, which is of great help, but Sung also needs to partake in the bathing assistance, requiring her presence.

 

 

 

The Cost of Caregiving

For Sung, it was an overload of work when she started supporting her parents by living together, while also having to care for her two adolescent children and working for her job at the same time. Sung said she had suffered from depression a few years ago due to the high stress of managing all her responsibilities. She had to seek psychiatric and medical treatments to overcome her depression.

Sung is considering sending her mother to the 24-hour nursing home as her health status is gradually deteriorating. She has applied for the institution for her mother’s stay, but she faces a long waiting list with more than 200 people. Sung said the reason for such a long waiting list is because this is a public nursing home, which is believed to provide better quality care and facilities.

Two years, she said, is what she thinks as the maximum number of years that she would be able to live with her mother if the current situation holds. But if it worsens, that is, if her mother’s dementia symptoms get worse, Sung will also consider sending her mother to some other facility with a shorter waiting list but also with lower quality of care.

She said that she would have to set a deadline to her caregiving for her own sake. She does not want to spend the rest of her 50s trapped with the care duty to her mother. Her children are now independent adults. Sung wants to start living her own life. She also feels she has done enough for her mother, her families and relatives all know it, and nobody will blame her for making this decision. Sung said because she is also a human, she needs to have her life and has the right to pursue it instead of sacrificing for her family.

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See the surveys utilized for conducting this research below:

2018 South Korea Eldercare and Childcare Household Survey – Childcare

2018 South Korea Eldercare and Childcare Household Survey – Eldercare

The 2018 fieldwork for the CWE-GAM project aimed to understand and measure care work in the South Korean context in order to inform gender-aware care macroeconomic models. The fieldwork consisted of both quantitative and qualitative surveys. The quantitative surveys include two sets of questionnaires for paid care workers in eldercare and childcare (Paid Care Worker Survey) and two sets of questionnaires for the unpaid care providers in the households for eldercare and childcare (Care Work Family Survey). The qualitative component consists of two sets of in-depth interview questionnaires for care providers and care recipients.

PAID CARE WORK SURVEY

The Care Work and the Economy Paid Care Work Survey includes two sets of questionnaires for eldercare and childcare workers and a 24-hour time use diary. A purposive sampling method was used to sample 600 paid care workers, 300 eldercare workers and 300 childcare workers, because the exact size and distribution of paid care workers in Korea are unknown. Paid care workers are defined as those working in institutional settings, at the care recipients’ home, and informal workers working without formal contracts. The sample targeted those providing care of the elderly and children’s daily lives, excluding kindergarten teachers and  health care workers at hospitals and medical eldercare facilities. The sample of paid care workers associated with institutions were allocated to reflect the national distributions of eldercare facilities and daycare centers, and the sample of informal care workers were equally allocated across regions.

The Paid Care Worker Survey collected detailed and comprehensive information on the care work provided by paid care workers. The stylized questions and time use diaries of paid care workers collect information on the type, intensity, duration, and evaluation of care work from the perspective of paid care providers. The survey aimed to investigate the characteristics and working conditions of paid care workers, including their background, condition of contract, working environment, task arrangement, and subjective evaluation of the working conditions, and their well-being. The 24-hour time use diaries were collected to provide insights on how the day of a care worker is constructed and how care work is associated with other domains of daily life and time use, which can be analyzed in tandem with the stylized questions on the well-being of care workers.

FAMILY CARE WORK SURVEY

The Care Work Family Survey also consists of two sets of questionnaires for main care providers in the household engaged in childcare and eldercare respectively. 1,000 cases of main care providers in the household were interviewed (500 cases for childcare, 500 cases for eldercare) using a stratified cluster sampling method. Because it is not possible to know the distribution of the population of people who provide unpaid care in a society, children aged below 10 and the elderly aged over 65 were treated as the target population from which to draw the sample. Based on the distribution of the 2018 National Resident Registration Data in Korea, we allocated the number of target households to each area, identified eligible households with elderly or children in need of care, and then selected eligible respondents within the selected households.

The Care Work Family Survey was developed to provide a detailed and comprehensive picture of the care arrangements in South Korea. The survey aimed to investigate how care provision is arranged for the children and the elderly and why it is arranged in such ways. Therefore, the survey collects information from the main care provider, not the care recipients themselves, as it is often the case that the main care provider is the one who knows most about the care arrangements.

After screening for eligibility, respondents were asked questions on their demographic characteristics and information on the respondent, care recipients and other household members. Respondents were asked about the specific activities involved with their care work including frequency, subjective intensity, preferences and willingness to engage in the activities. Information on care arrangements were collected as well including how the care work is shared within the household, whether there are any gaps of care provision, the history of caregivers, use of care services, and decision-making of using care services. Other information such as financial responsibility and burden, experience and evaluation of care work, dual care burdens and well-being of caregivers were collected.

IN-DEPTH INTERVIEWS

The purpose of the in-depth interviews of paid and unpaid caregivers was to provide useful care narratives based on the Korean context to inform macro-modelling. The qualitative research team intervened 25 family caregivers of the elderly, 20 family caregivers of children, 20 paid care workers for elderly, and 31 paid care workers for children. The interviews of family caregivers focused on the decision-making process and evaluation of care arrangements for the elderly and children. Interviewees were also asked about their experiences with caregiving. The interviews of paid caregivers focused on dual care burdens in terms of paid care work in addition to unpaid care work in the home.

SIGNIFICANCE AND LIMITATIONS

The fieldwork for paid and unpaid care work in Korea was designed and conducted to investigate the nature and context of care work in Korea. The Paid Care Worker Survey and Care Work Family Survey have distinct characteristics that contribute to enhancing our understanding about the experience of caregiving in Korea. First, the set of questions that have been developed can be commonly applied to caregivers regardless of the type of care work or the subject of care to enable comparative analysis on the experience of caregiving. Second, not only the caregiving situation, but also the broader aspect of the caregiver’s life including the preferences and attitudes of the caregiver have been studied. Third, the surveys collect detailed information on how care is arranged. Lastly, a caregiver focused 24-hour time use diary has been developed to understand which activities could be considered as care.

This fieldwork only included certain types of caregivers due to the limited budget, time, and scope of the fieldwork. For instance, the sample did not include caregivers for the disabled, caregivers who work at hospital settings, and migrant care workers, despite their importance. Also, as the family survey for childcare limited the respondents to ‘mothers’, and consequently fathers and grandparents were excluded. We hope that the future rounds of surveys can be extended to have a larger sample size and to include a broader range of caregivers. Questions explored in this fieldwork provide important information about the experience of caregiving in Korea, and we hope the fieldwork in Korea can inform fieldwork in other countries.

Learn more about care arrangements and activities in South Korea based on our analysis on the 2018 Care Work and Family Survey here.

This blog was authored by Bong (Regina) Sun Seo, contributing researcher for the Understanding and Measuring Care group