Guest editors' introduction.
King, Debra ; Martin, Bill
Over recent decades, Australian arrangements for caring for those unable to look after themselves have been changing rapidly, as they have in other similar societies. Most obviously, much caring has shifted from the realm of informal, usually familial, relationships to the public realm of formal arrangements involving paid carers. Caring for the old and the young involves the paid labour of an increasing number of Australians, and there is every reason to believe that the ranks of paid carers will grow in coming years. Child care usage has been steadily increasing and is unlikely to fall from its current levels. Indeed, the number of Australian children aged under 5 in formal child care rose by 44% between 1996 and 2005 (ABS 2005). Population aging, combined with increasing life expectancy and declining expectations of informal care for the aged, virtually guarantee growing demand for paid care for the aged (see Hugo, this issue). Increasing demand for paid care is not confined to the old and the young either, with a range of other forms of care increasingly involving market relations (AIHW 2006).
Prompted by these developments, we convened a workshop sponsored by the Academy of Social Sciences in Australia and Flinders University, in April 2006 on the topic of "Paid Care: Now and in the Future". Our aim was to bring together researchers working on various aspects of paid care in Australia to discuss their work, and the wider issues arising from it. The rise of paid care stimulates a variety of responses. Some are concerned with the quality of care given by paid caters: can paid care provide the depth of social connection and sustenance that unpaid care expresses? And how can the provision of paid care be organised to maximise quality? What issues does the combination of paid and unpaid care raise? What about those who provide care for pay? Much research suggests that their jobs are inferior and coloured by the ambiguities of being paid to do what was done in the past out of love, or obligation. What about the supply of paid carers, should we be concerned about ensuring sufficient workers will be willing to provide care for pay in the future? And behind all of these, what is care, and what are the essential social feelings and relations that define it?
The papers in this special edition are representative of the current flourishing of Australian research and thinking about paid care and its future. The first three papers provide approaches to broad issues in paid care: how care and paid care might be conceptualised, what the Australian paid care workforce looks like, and the demographic outlook for aged care demand and its satisfaction. The collection begins with Michael Fine's useful survey of the most influential recent approaches to thinking about care. Fine shows that the concept of care remains contested, but that it may be possible to extract sufficient common ground from the existing literature to develop a useful approach to understanding the recent expansion of paid care. He focuses on general agreement that care is 'a necessary social response to human frailty and vulnerability', that it involves personal sacrifice on the part of carers, and, at the same time, that it can be enriching for both providers and receivers of care. His argument is that by conceptualising arrangements for care in terms of a 'social division of care' (analogous to the social division of labour), it is possible to thematise and bring together analysis of key issues in paid care. For example, the concept provides a useful framework for examining three key relationships in contemporary arrangements for paid care" those between paid and unpaid care, those between different kinds of paid carers, and those between providers and recipients of care.
Gabrielle Meagher uses 1996 and 2001 census data to draw a comprehensive overall picture of a large part of the paid care workforce, that working in community services industries. Her analysis highlights several matters of concern in this workforce, which add up to the impression that it is not a workforce particularly well balanced with needs. First, unlike some other parts of the economy, the community services sector shows no evidence of increased use of professional workers, with possible indicators of some 'deprofessionalization'. At the same time, workers' qualification levels have been rising, suggesting that carers' skills are not always being used to maximum effect. Second, Meagher provides data to show that, as many have long argued, care workers are not well paid. Gender plays a significant part in care earnings: men earn more than women with the same qualification. Moreover, it appears that qualified carers are able to increase their earnings by moving into non-caring community service occupations. Meagher draws out the policy implications of these results, noting particularly the evidence of a 'care penalty' in paid carers' wages.
The aging of Australia's population is now a widely known feature of our future. But how is it likely to affect the need for aged care over coming years? Graeme Hugo shows that the number of older people requiting care will at least double in the next 25 years. The result will be that the number of nursing home and hostel residents, which has been steady in recent years as more care has been provided in older people's homes, will soon start to increase, probably sharply. Moreover, demand for community based care for older Australians will continue to grow. Using the limited data available, Hugo's projections suggest that there may be real difficulties in ensuring an adequate supply of paid carers for Australia's aging population, especially given the current age profile of the aged care workforce. Like Meagher, Hugo notes that existing ABS data is severely limited in its ability to provide a detailed or comprehensive picture of paid care in Australia.
The remaining papers in this issue take up the need to understand the large variety of guises in which paid care currently occurs. Each focuses on paid care in a particular setting or type of setting, and explores an important set of issues. Bill Martin begins by examining aspects of the jobs and experiences of direct care workers in nursing homes and hostels. Using data from a 2003 survey of these workers, he concludes that jobs in aged care facilities compare reasonably well with other jobs that are likely to be available to the workers in them. However, the vast majority of this workforce is female, and women in aged care suffer the same disadvantages as women in other sectors, particularly with regard to pay. Martin goes on to show that pay appears to be a relatively minor factor in whether workers expect to continue working in aged care. Other working conditions and the experience of work, particularly job satisfaction, are the main determinants of their future expectations. These results suggest that the day to day management of aged care facilities will have a crucial impact on whether facilities are able to recruit staff as demand grows in the future.
Debra King focuses on a different aspect of managing the organisation of care work by thinking about the effect of organisational arrangements on the relationships between those requiring care and paid carers. Echoing the concerns of many advocates of rounded social care, she identifies several tensions between the provision of care under a managerialist-market logic and the provision of care that satisfies the relational needs of those being cared for. Focusing on supporting the complex relations between care recipients, unpaid family carers and paid care workers, she suggests managing emotional relationships is crucial. 'Bounded emotionality' provides a route for thinking about how to manage and develop legitimate, but appropriately limited, space for emotional connections between carers and those they care for.
Whether for-profit care providers can give the same quality of service as not-for-profits is widely debated. Deborah Brennan focuses on the provision of childcare, and argues that the recent history of childcare provision in Australia represents a large scale and risky 'national experiment'. With a rapid shift towards the dominance of for-profit centres, especially those owned by large corporate providers rather than owner-operators, issues of adequate regulation are to the fore. Brennan argues that for-profits have been able to influence government regulation and policy regarding childcare costs and assistance, in ways that enhance their position without necessarily improving the quality and availability of childcare. Add the problem of the affordability of childcare, and the limited capacity of the existing regime of government benefits and tax rebates to ease this for those most in need, and it is not surprising that childcare continues to be a contentious issue.
As paid care expands, occupational boundaries are constructed and reconstructed, and new occupations are created. Mafia Zadoroznyi and Jessica Sutherland focus on the initial development of one such new occupation, that of 'mothercarers' who provide care to postnatal women in their homes. Describing the results of an evaluation of the mothercarer program initiated at an Adelaide hospital, they illustrate the complexity of any new initiative. In this instance, the initiative was concerned as much with providing skills and employment for young unemployed women as with providing assistance to new mothers. In many respects, it was a success. But it highlighted the importance of carefully integrating new kinds of care providers with the work of existing professionals, particularly midwives in this case. Moreover, new mothers' acceptance that mothercarers had something to offer them was not automatic, and mothers sometimes saw the mothercarers as too young, inexperienced or unskilled to be useful.
The final two papers examine aspects of the relation of the market to care that is not directly paid. Bettina Cass uses two case studies to argue for a focus on 'social care' as a route to understanding the complex relationships of paid an unpaid care, and the market situation of carers, across the lifecourse. The cases of young carers and grandparent carers illustrate the need to break down a dichotomy between formal and informal care that is often assumed in the literature. Seeing the caring of young carers and grandparents as social care involves recognising that it is labour, that it involves obligations, and that it incurs costs. Each aspect transgresses the formal/informal divide, emphasising the complex implications of private relationships and decisions for people's participation in the public realm, and vice versa. Michael Bittman, Trish Hill and Cathy Thomson examine the relation between caring and the market by focusing on the impact of unpaid caring on people's labour market participation and earnings. They make innovative use of the longitudinal HILDA data to show that unpaid carers appear to substitute caring for paid work. Moreover, unpaid caring appears to have long-term effects on carer's net income, particularly when it occurs over a number of years. Bittman, Hill and Thomson point out that these effects, which amount to the privatisation of the costs of caring, have significant implications for public policy.
Taken together, these papers offer a multi-faceted picture of paid care in Australia, both now and into the future. They highlight major issues and problems that face us in providing fully 'social care'. Population ageing and shifts in the ways we arrange care of the elderly and children constitute much of the background for the future development of paid caring. The paid care workforce is large and complex, and we currently have an incomplete picture of how it is developing. Nevertheless, it is clear that how caring work is organised by care providers has major effects both on the nature and quality of care, and on the workplace experiences and future supply of care workers. The complex issues here include: how providers conceptualise care, the day to day organisation and management of care work, relations between different caring occupations, and the role and impact of the growing group of for-profit providers. The collection also emphasises that paid care cannot be considered in isolation from unpaid care, whether our concern is with the character and quality of care, the experiences of paid and unpaid care workers, or the sharing of the costs between families and more formal institutions. We hope that, in throwing light on many of these issues, these papers represent a significant step forward in the Australian public discussion of care arrangements now and into the future.
References
ABS (2005) Child Care, Australia, Jun 2005, Cat. No. 4402.0, Canberra, ABS.
AIHW (2006) Disability and Disability Services in Australia, AIHW Cat. No. DIS43, Canberra, AIHW.
