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Who Cares?

By Stephen Rainey & Yasemin J. Erden

How much of a role should the state play in taking care of us, as opposed to, say, our family members? According to some, care should “start at home” and should, moreover, be selfless. Statements like “Parents and other caregivers look after their children with little thought of return” from a recent New Statesman article sound nice, and elicit nods of approval – of course no returns are sought!

But are they true?

It’s true that many parents and caregivers operate in selfless ways, often under absurd pressures. But equally, many others treat children as an investment and give a lot of thought to their potential return. This can be seen in the thought that children will care for ageing parents once they need it, and this expectation is even offered as a rebuke to those who do not have or want children. Who will care for you when you’re old?, goes the remonstration. A cyclical care dynamic is a very real part of how many families operate, and consequently a very real part of the social fabric.

Pressure to perform these expected functions is meted out through emotional ties, such as through making children feel guilt or obligation, but also in terms of practical issues like access to shared family resources and to later inheritance. Sometimes raised in jest, and sometimes as a threat, the prospect of a payout for children in terms of the family house or a fat bequeathment is often part of the structure that constitutes and perpetuates this cycle. Neglecting this detail means neglecting at least part of why traditional systems of care now falter: not all children accept those terms once they grow up, despite even external pressures to comply. The UK Health Secretary’s recent remark that health and social care ‘begins at home’ illustrates the presumption of these dynamics.

The person who cares doesn’t have just one motivation, and they are not just one type of person. It’s important to challenge simplistic ‘social contract’ descriptions, but similarly simplistic accounts of ‘special’ family relationships won’t stand up to scrutiny. People can be motivated by care, of course, but also by pride, honour or ego, by respect, obligation, or tradition, because of fear, of guilt, and even because they don’t know they have a choice. Or maybe they really don’t have one, not in practical terms.

Binaries are unhelpful. Motivations are complex and can occur simultaneously (e.g. from both obligation and compassion). Describing motivation in binary terms – they’re caring from family obligation or in anticipation of inheritance – means the emotional toll that giving care involves is missed. For instance, it can be draining to manage competing feelings and motivations. Moreover, the guilt and shame placed on those who simply don’t conform to the assumptions about care beginning at home heaps misery on misfortune. Policies for social care ought to be focussed on what caring entails, not on the assumption that someone will do it regardless, and especially not that they should.

Partnered with this assumption that care happens because of dynamics at home is another about self-annihilation. From the New Statesman article this is seen clearly:

“We would give up our lives for the people we love. In fact, we do give up our lives for them, in large and small ways, every day, and that very fact makes those lives worth living.”

For many, this would prompt a clear no thank you. It is really quite a harmful notion that, because you care for someone, you ought to give up your own life in some way for them. Rather than making life worth living, this actually unravels lives in order to preserve minimum standards for loved ones. A person who finds themself in a position of having relatives or loved ones with complex needs ought not to be expected to have to uproot or subjugate their own life, wants and needs in order to preserve the basics for those relatives or loved ones. Any policy that so instrumentalises individuals can’t be justified. If this is what care beginning at home amounts to – the necessity for self-sacrifice, predicated on chance – then it’s a flawed and harmful notion.

We ought to recognise the protean nature of society and expect policy to build floors for social care through which those in need can’t fall. With such a floor, all motivations for care can be accounted for. Placing the onus on traditional assumptions is destructive and immoral. Besides that, it doesn’t work.

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