I have just returned from the World Congress of Gerontology and Geriatrics in San Francisco. Held every four years, like the Olympics of ageing, it’s an opportunity to learn about new research on ageing in all its glorious complexity.
With over 6000 participants, it is impossible to participate in everything. Typically there were more than 20 different lectures and presentations going on at any one time – often competing with vast numbers of prestigious researchers presenting posters of their original research.
My interest in care and support led me to attend a number of sessions on care and caregiving, a topic that these days includes unpaid care provided by family members and volunteers, paid care and formal care services provided by care professionals and an increasingly large and diverse range of casualised care workers, and a relatively new field often referred to simply as technology.
These three distinct fields represent a historic progression of ways that assistance can be organised. Until recently, care has been exclusively provided by people – it is a form of physical labour as well as a social relationship and an altruistic way of thinking about the wellbeing of others.
Unpaid care can be considered the default or traditional system. It’s been the basic system of support as long as humans have roamed the earth. Care given within the family or in other close personal relationships continues to be by far the most important form of assistance to those who need help in old age.
The work of volunteers is more recent, but also goes back at least a millennium, as communities found ways of providing support to those without family or money.
Paid care and other formal services are more recent but have been with us for the past couple of centuries. Because markets fail many of those who most need assistance, in most advanced countries the state has assumed a major role in granting people access to services they need but might not be able to afford.
Just how the informal and formal systems of care interact has long been the subject of conjecture. Does formal service displace informal? When we turn to paid services, is it because we no longer care? Or is it the other way round – that we pay for additional help, more expert, available for longer hours, because it provides something extra?
This was a topic that received considerable attention at the conference – with papers from a number of different countries now clearly demonstrating that the two systems are complementary.
By using paid care services, unpaid carers are able to keep going longer. They are also able to sustain other work and make contributions beyond the family. But they don’t go away or give up. We know that in Australia because the services have not displaced family care – but have supported it.
Finding new and better ways for informal and formal care to work together remains vital. If we think of consumers too narrowly, as simply those who need the care themselves, we can exclude unpaid family carers and cause real damage to family relations and personal support.
One of the most fascinating and frustrating parts of the World Congress was when it devoted an entire day to new technology advocates. Often this seemed to combine apparently half-mad scientists and half-crazed wanna-be entrepreneurs whose main motivation seemed to be to get rich quickly with what they tried to tell us was the solution to the crisis in care.
Sometimes their ideas concerned robot nurses of various forms, other times robot pets that would distract and quieten someone with dementia.
Another category of products concerned new apps and software solutions you could download onto your phone to coordinate the work of real people.
A third category of device was a sort of electronic sentry, not unlike the computer Hal in the movie 2001: A Space Odyssey, that would guard the care recipient, answer some of their questions and sound the alarm if things went wrong.
How appropriate that this should take place in San Francisco, where the memories of the Summer of Love live on alongside the mirage of high-tech and crazy ideas of Silicon Valley.
Will paid care replace unpaid care provided for love?
Will the market replace the welfare state as a system of secure provision?
It seems to me that there is room for more resources and better models of provision, but these systems are not substitutes or alternatives. Each builds on the other, and in the end, all depend on love.
Michael Fine is an honorary professor at Macquarie University.
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