Creating a Caring Society

Author(s): Evelyn Nakano Glenn

Source: Contemporary Sociology, Vol. 29, No. 1, Utopian Visions: Engaged Sociologies for the
21st Century (Jan., 2000), pp. 84-94
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2654934 .
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84 Symposium
Creating A Cartng Society
Why is it importantto achievea societythat
values caringand caringrelationships? The
answermightappearobvious:It seemsinherent
in the definitionof a goodsocietythat those
who cannotcarefor themselvesarecaredfor;
thatthosewhocancareforthemselves cantrust
that,shouldtheybecomedependent,theywill
becaredfor;andthatpeoplewillbesupported in
theireffortsto carefor thosethey careabout.
But even moreis at stake.Currentlywe are
caughtin a nastycircle.To the extentthatcar-
ingis devalued,invisible,underpaid, andpenal-
ized,it is relegated to thosewholackeconomic,
political,and socialpowerand status.And to
the extentthatthosewhoengagein caringare
drawndisproportionately fromamongdisadvan-
taged groups(women,people of color, and
immigrants), theiractivity that of caring is
furtherdegraded. In short,the devaluingof car-
ingcontributes to the marginalization,exploita-
tion,anddependency of caregivers.Conversely,
valuingandrecognizing caringwouldraisethe
statusandrewards of thosewhoengagein it and
alsoincreasethe incentivesforothergroupsto
engagein caring.Thus,a societythatvaluescare
andcaringrelationships wouldbenot onlynicer
andkinder,butalsomoreegalitarian andjust.
In addressing the questionof howto createa
societyin whichcaringis valued,I firstgive a
briefaccountof the contemporary "crisis"in
carewhichstemsfromitsbeingdefinedasa pri-
vatized, feminized,and thereforedevalued
domain.InthenextsectionI reviewrecentfem-
inistattemptsto rethinkthe conceptof carein
waysthatopenit up to criticalanalysis.I then
definesomedesirable goalsfora societythatval-
uescare.In thefinalsectionI outlinefourmajor
directions forchangein socialcitizenship rights,
familyresponsibility, organizationof paidcare,
andemployment policiesandpractices.
The Contemporary Problem of Care
A spateof popularbooksandarticlesin the
lastdecadehas soundedan alarmabouta new
"crisisin care,"a crisisoccasioned
bythe exodus
of womenfromthe homeinto the workforce.
The needforcareof children,the elderly,and
the chronicallyill anddisabledhas not dimin-
ished,andmayhavegrownbecauseof increased
longevityandmedicaladvancesthatkeeppeo-
ple with seriousinjuriesor illnessesalive.Yet
NAKANO
EVELYN GLENN
University of California, Berkeley
traditional caretakersstay-at-home wivesand
mothers arenowlessavailableto providecare
on a full-timebasis.
Dual-worker families andmoreconcretely,
employedwomen are said to be increasingly
overburdened andstrainedby the needto meet
both earningand careresponsibilities. At the
sametime,mostfamiliesdon'thavetheeconomS
ic meansto purchase care,andstateservicesare
grosslyinadequate. As MonaFIarrington (1999:
17)saysin a recentpopular treatment, "wehave
patchwork systems,butwe havecomenowhere
nearreplacingthe hoursor qualityof carethat
the at homewomenof previous generationspro-
videdforthecountry." Thequestionof howcare
is to get done withoutsubstantial numbersof
nonemployed womento do it has becomethe
subjectof researchand policyinitiatives.For
example,the AlfredP. Sloan Foundation has
fundedseveraluniversityresearchcenterson
workandfamilylife,including oneatmycampus
devotedto "Cultures of Care."
The "crisisin care"is justone impetusfor
recentcriticalexaminations of the conceptand
organization of carein modernpoliticaldemoc-
racies.Feministtheoristsand researchers for
sometimehavebeenexamining carein itsgen-
dereddimensions.Their workmakesit clear
thatthecurrentcrisisis a productof a privatized
andgenderedcaringregimein whichfamilies,
ratherthanthelargersociety,areresponsible for
caringandin whichwomen(andothersubordi-
nategroups)areassignedprimary responsibility
r . .
torcareglvlng.
The relegationof careto the privatesphere
andto womenhas had two furthercorollaries:
the devaluation of caringworkandcaringrela-
tionships,and the exclusionof both fromthe
arenaof equalityandrights.As feministcritics
of liberalpoliticalphilosophyhave explained,
the veryconceptof citizenship(i.e., fullmem-
bershipin the community, includingreciprocal
rightsandresponsibilities)hasbeenpremised on
two conceptualdichotomies.Firsthas been a
splitbetweenthe publicandprivate,with the
privaterealm of concrete relationsof care
definednot only as separatefrom,but also in
Opposltlonto cltlzensrlp. ne prlvateream
encompasses emotion,particularity, subjectivity,
andthe meetingof bodilyneeds,whilethepub-
 Symposium 85

lic arenaof citizenship is ruledby thought,uni- ily allowances, childcareservices,housingsub-

versality,objectivity,andthe abilityto act on sidies,andhealthcarecoveragehavebeencom-
abstractprinciples.Thoserelegatedto the pri- mon (Fraserand Gordon1993). Duringthe
vate sphereand associatedwith its values- WorldWarI era,Progressive reformers pushed
women, servants,and children were long though maternalistprograms,such as the
excludedfromfullcitizenship. Secondhasbeen Mothers'Pensionprogram,to allowwidowed
a dichotomy betweenindependence anddepen- womento keeptheirchildrenratherthansend-
dence, with the ideal citizen definedas an ing themto orphanages. Butpensionswereso
autonomous individualwho can makechoices low thatsinglemotherswereforcedto workas
freelyin the marketandin the politicalrealm. well as carefor theirchildren.The Mothers'
Withinthe liberalpolity,citizenship supposedly Pensionwasquicklyphasedout. New Deal-era
createda realmof equalityin whichindepen- socialwelfarepoliciesinstitutionalized a two-tier
dentindividuals hadidenticalrightsandrespon- systembasedon a male breadwinner-female
sibilities,regardless
of differences in economic caregivermodel.The uppertier consistedof
standingand other attributes.Those deemed safetynet entitlementsfor malebreadwinners,
dependent, whethercategorically (asin thecase whichprovided relativelygenerous,non-means-
of women,slaves,andchildren)or by reasonof testedbenefitssuchasunemployment insurance,
condition(as in the caseof mentalor physical social securityretirement,and disabilitypay-
disability)lackedstandingand thereforewere ments. Dependentsof male breadwinners,
definedas outsidethe realmof equality(Okin includingfemalecaregivers,receivedindirect
1979;Pateman1988).lThe fiction of liberal benefitsthroughtheir relationshipto a male
philosophythat independentand autonomous earner,viaprovisions suchassocialsecuritysur-
actorsexistalsoobscures the actualinterdepen- vivorbenefits.The lowertierforwomenwith-
denceamongpeopleandthe needforcarethat outconnectionsto malebreadwinners provided
even"independent" peoplehave. relativelyungenerous, means-tested "welfare"as
Historically,then, in the UnitedStatescar- in the originalAid to DependentChildren
ingworkwithinthe familyhasnot beenrecog- (ADC) and in the laterAid to Familieswith
nized as a public societal contribution DependentChildren(AFDC).These benefits
comparableto paid employment.As Judith wereconsidered a responseto the needinessof
Shklar(1991) has pointedout, eaming has children,not asanentitlementformothers' car-
alwaysbeenseen as a responsibility of citizen- ing labor (Nelson 1990; Gordon 1994;
shipbecauseit is the basisforindependence. In Abramovitz1996). These programs were not
thisview,eamersfulfillcitizenship responsibili- onlygendered, theywerealsoraced.Blacksingle
ties andthereforedeservecertainentitlements, mothersin theSouthandMexicansinglemoth-
suchas old agepensions,unemployment insur- ersin theSouthwest wereroutinely deniedrelief
ance,andhealthandsafetyprotection.In con- on the groundsthat they were"employable."
trast,unpaidfamilycaregivers performstrictly Thus,these womenwerenot seen as "depen-
privateresponsibilitiesanddonot fulfillbroader dent"caregiversin the sameway that white
citizenship responsibilities.Hence,theyarenot womenwere(Mink1994).
accordedentitlementscomparable to those of Yet despitethe prevailingideologyof the
wageeamers. familyasthe realmof care,thegrowingneedfor
Moreover,the dominant family model carehasgenerated a demandforpaidcaregiving
assumesthat supportfor dependentsand care asanalternative orsupplement to unpaidfamily
givers comes from the male breadwinner. care.Someof thedemandhasbeenmetbyinsti-
Historically,the UnitedStateshasprovidedlit- tutionsand servicesadministered by the state
tle supportfor caregiving,comparedto other and nonprofit organizations.The greatest
Westernnationswherepaidparental leave,fam- growth,however,has been in institutionsand
servicesorganizedbyfor-profitcorporate entities
formedto takeadvantage of payments available
Kittay(1995)has extendedthe critiqueto argue
thatdependence andrelationsof dependence are through(industry-backed) govemmentmedical
simplynotaccommodated in liberaltheoriesofjus- insurance. Overall,then,there hasbeena shift
tice,whicharepremised on a modelofautonomous of someportionof caringto publiclyorganized
individualswho can makechoicesin theirown settings,whetheradministered by state, non-
bestinterests. profit,orfor-profit
entities.
86 Symposium

In thesesettings,the actualworkof caringis costs and protectcare receivers,nonetheless

done by "strangers" paidworkers,sometimes oftenrestrictthe caringactivitiesof caregivers.
supplementedby unpaidvolunteerworkers. Forexample,becauseof Medicareregulations,
Whencaringis doneas paidwork,it not only healthcareinstitutions tryto limitstaSto per-
remainsgendered, it alsobecomesconspicuously formingstrictlymedicaland medical-related
racialized. In institutional settingssuchashospi- taskssuchaschangingdressings, andnotgetting
tals,nursinghomes,andgrouphomes,nursing involved in social and emotional caregiving.2
aidesandotherworkers whoactuallydotheday- All of these pressures directlyaffectthe care
to-day work of caring are overwhelmingly relationship. Caregivers complainaboutthelack
womenof color,manyof them recentimmi- of timeandautonomyto respondto individual
grants.Homecareworkersalsoaredrawndis- needs.Carereceivers maybe subjectto controls
proportionately fromthe ranksof womenof that maintain"order"under conditions of
color(Glenn1992). understaffing (e.g., throughuse of sedationor
Whencareworkis doneby peoplewho are physicalrestraints).Care receiversmay not
accordedlittle statusandrespectin the society receivethekindof individualized andtime-con-
by reasonof race,class,or immigrant status, it suming care that would allow them maximum
furtherreinforcesthe view of caringas low- dignityandautonomy.
skilled"dirty" work.Thisdualdevaluationof
care workand care workers rationalizes the Rethinking Care
lowwagesandlackof benefitsthatcharacterize To developaltemativesto the presentsitua-
carework.Fromher analysisof nationalwage tion, we need to rethinkthe conceptof care.
data,PaulaEngland(1992:182)concludedthat Becausecareis so closelyassociated withwom-
"beingin a jobrequiring nurturing carriesa net anhood, feminist philosophers and social theo-
wage penalty of between $.24/hour and rists have subjected care to close analysis. My
$1.70/hour." Taking into account such factors as reading of several theorists of care, including
workers' education,servicejobsinvolvingcare JoanTronto(1993), DiemutBubeck(1995),
giving paid less than comparablejobs not EmilyAbel and Margaret Nelson (1990), and
involvingcaregiving.Thuschildcareworkers Sara Ruddick (1998), suggests the usefulness of
earnedlessthanmanicurists; nursingaidesand defining care as a practice that encompasses an
orderliesearnedless thanjanitors;andpsychi- ethic(caringabout)andanactivity(caringfor).
atricaideseamedless thanelevatoroperators. "Caring about"engagesboththoughtandfeel-
Oneironicresultis thatthosewhocareforoth- ing, including awareness andattentiveness, con-
ersusuallyhaveto giveupcaringfortheirown cem about and feelings of responsibility for
dependents, yet cannotaffordto payanyoneto meeting another's needs. "Caring for" refersto
carefor them.Caringworkis consideredlow- the varied activities of providing forthe needs or
skilledandlargelyphysicalin nature,despitethe well-beingof anotherperson.3 Theseactivities
importanceof emotionaland psychological
aspectsof caring.
Carein institutional settingsis compromised Thus,visitingnursesor healthcarecoordinators
2

by a combinationof factors:pressures to cut maybeallowedto makea singlehomevisitto give

costs, governmentregulations, medicalization, discharged patientsinstructions on medicalself-
care,butnot to takelongerto providesocialand
and bureaucratization (Foner1994). Deborah emotional support to helpthemadjustto theirnew
Stone(1999)notesthatcost-containment pres- limitations.
suresaffectbothprivatefor-profit careandpub- 3 Forthe purposes of this essay,I am deliberately
lic nonprofitand taxpayer-supported facilities. limitingthe meaningof careto thatof caringfor
Efforts to reduceorcontrolcostshaveresultedin people,eventhoughforotherpurposes, onemight
inadequate trainingand chronicunderstaffing. conceptualizecare as encompassing caringfor
Govemmentregulations,reflectedin institu- objects,animals,andthe environment. Forexam-
tional procedures,also requirecaregiversto ple, political theorist Joan Tronto (1993: 103)
definescaringas "aspeciesactivitythat includes
spendtimeon extensivepaperwork.As workers everything thatwe do to maintain,continue,and
are stretchedthin, they experiencestressand repairour'world' so thatwecanliveaswellaspos
frustration,leading to burnout and high sible.Thatworldincludesourbodies,ourselves,
tumover.Bureaucratic structuresand regula- and our environment, all of whichwe seek to
tions,whichare designedto both keep down interweave in a complex,lifesustaining web."At
 Symposium 87

includephysicalcare (e.g., bathing,feeding), that "independent adults"may preservetheir

emotionalcare(e.g.,reassuring, sympathetic lis- senseof independence if they have sufficient
tening),anddirectservices(e.g.,drivinga per- resources,economicor social,to "command"
son to the doctor, runningerrands).The carefromothers,ratherthanbeingbeholdento
definitionis not freeof ambiguity, but it does relativesorcharity.
establishsomeboundaries. Forexample,defin- A secondaspectof definingcareaspracticeis
ing caringin termsof directmeetingof needs that careis seen as creatinga relationship; as
differentiates caringfromotheractivitiesthat Ruddick(1998: 14) puts it, "[caring] workis
mayfostersurvival.Thus,economicprovision constitutedin and throughthe relationship of
wouldnot be included,eventhoughit mayhelp thosewhogiveandreceivecare."The relation-
supportcaregiving.Men are often saidto be ship is one of interdependence. Generallywe
"taking careof theirfamily" whentheyearnand thinkof thecaregiver ashavingthepowerin the
bringmoneyintothehousehold. Despitetheuse relationship; butthecarereceiver,evenif subor-
of the termcare in this phrase,breadwinning dinateor dependent,alsohas agency/power in
wouldnot be considered "caring." In fact,eco- the relationship.Focusingon relationships
nomic supporthas historicallybeen seen as bringsintoreliefthe influenceof the recipients
men'scontribution in lieuof actualcaregiving; of careon caringwork.Tronto(1993)notesthat
simultaneously, caregivinghasbeenviewedas forthe workof careto be successful, its recipi-
women'sresponsibility, an exchangefor being ents have to respondappropriately-e.g.,a
supported bythe primary breadwinner. screaming childbetokensfailure.In somesitua-
Withinthis definitionof careas a practice, tionswherethe carereceiveremploysthe care-
threefeaturesare important. First,this defini- giveror has socialauthority(e.g., due tO the
tiorlrecognizesthat everyoneneedscare,not normof respecttowardelders),thecarereceiver
just those we considerincapableof caringfor mayhavemorepowerthanthe caregiver.
themselves. Oftenonlychildren,theelderly,the Third,the definitionof careas practicerec-
disabled,orthechronically ill areseenasrequir- ognizesthatcaringcanbe organized in a myriad
ingcare,whiletheneedforcareandreceivingof of ways.The paradigmatic carerelationship is
care by so-calledindependentadultsis sup- themotherchilddyad,whichoftenservesasthe
pressedor denied.As SaraRuddick(1998:11) templateforthinkingaboutcaring.In thismod-
notes,"mostrecipients of careareonlypartially el, caring(mothering) is viewedas naturaland
'dependent' andoftenbecominglessso;mostof instinctive women's natural vocation.
their'needs,'eventhoseclearlyphysical,cannot However,this idealizedmodelis deceptivein
be separatedfrom more elusive emotional that it ignoresthe actualdiversityin the ways
requirements forrespect,affection,andcheer." mothering/caring is actuallycarriedout within
At the sametime, even thosewe see as fully andacrosscultures. Caringcantakeplacein the
independent-thatis, able to care for them- householdor in publiclyorganized institutions,
selvesin termsof "activitiesof dailyliving"- and can be carriedout individually or collec
mayforreasonsof timeor energyor temporary tivelyandaspaidor unpaidlabor.Muchcaring
conditionneedcareto maintaintheirphysical, takesplacein the family,usuallyas the unpaid
psychological, andemotionalwell-being.They workof women,butit is alsodoneaspaidwork
maytumto a familymember, friends,a servant, (e.g.,bybabysitters,homehealthaides,andthe
or a serviceproviderfor hot meals,physical like). It also takesplacein the communityas
touch,or a sympathetic ear.The differenceis unpaidvolunteerwork,as in the caseof church
or charitable
organizations thatrundaycareor
senioractivitycenters.It also takesplace in
the sametime,I amadoptinga somewhat broader institutions
organizedbythe state,corporations,
definitionthan one that restrictscaringonly to or individualsas commodified servicesusing
meetingthe needsof thosewho cannotcarefor .

themselves-e.g., DiemutBubeck's(1995: 129)
definitionof "caringfor"as "themeetingof the
needsof onepersonbyanotherpersonwhereface-
to-faceinteraction
betweencarerandcaredforis a
crucialelementof the overallactivityandwhere
theneedis of sucha naturethatit cannotpossibly
be metbythepersonin needherself."
palc . careglvers.
Care can also be "fragmented," divided
amongseveralcaregivers andbetween"private"
and"public" settings.Thus,a parentmaytake
ultimateresponsibility
forensuringthata child
has care afterschoolbut delegatethe actual
workof caregivingto a babysitter,
a relative,a
88 Symposium

paidhomecareworker,and/oran after-school all whoneedit i.e., carethatis indi-

program.BarrieThome (1999) foundin her vidualized, and
culturallyappropriate,
studyof childhoodsin an urbanmulticultural responsive of those
to the preferences
communitythat parentsoften have to patch whoarecaredfor.
togetherseveralof thesearrangements. * The responsibility and actualworkof
caringisshared sothatthebur-
equitably
What Should Our Goals Be? denof caredoesnot falldisproportion-
To achievea societyin whichcaringis val- ately,as it nowdoes,on disadvantaged
ued in all spheresof sociallife, all of the ele- groups-women,racializedminorities,
ments the workof caregivingandthe people anclmmlgrants.
involved(carereceivers andcaregivers)would
haveto berecognized andvalued.Hence,a soci- Some Directions for Change
ety in whichcaringis valuedwouldbe one in Rethinking socialciiizenship:One important
which: stepis to redefinesocialcitizenship to makecare
centralto therightsandentitlements of citizens.
* Caring isrecognized as"realwork" andas Thiswouldinvolvea radicalreversal of the pre-
a socialcontribution ona parwithother sentsituation,in whichcareis definedas a pri-
activitiesthatarevalued,suchaswork- vate responsibility and thereforeoutsidethe
ing,military service,or community ser- realmof citizenship. Makingcarecentralto cit-
vice,regardless of whethercaringtakes izenshipwouldentailthreeelements:establish-
placein the familyor elsewhere or as ing a rightto careas a core rightof citizens;
paidorunpaid labor. establishing caregivingasa publicsocialrespon-
* Thosewho needcare(includingchil- sibility;andaccording caregiversrecognition for
dren,the elderly,disabled, andchroni- carrying outa publicsocialresponsibility. These
callyill) arerecognized asfullmembers threeelementsareinterrelated. Ifcitizenshavea
of the societyandaccorded correspond- right to care, then there is a corresponding
ingrights,socialstanding, andthevoice responsibility on the partof the community to
of citizens.Thiswouldmeanthatcare ensurethatthosewhoneedcareget it. Further,
receivers areempowered to haveinflu- if caregivingis a publicsocialresponsibility,
enceoverthe typeof care,the setting, thenthosewhodo caregivingfulfillan obliga-
andthe caregivers, andthattheyhave tionof citizenship andthusareentitledto soci-
accessto sufficient resources
material to etal benefitscomparable to thoseaccordedfor
obtainadequate care. those fulfillingthe obligationto earn for
* Thosewhodo caringworkareaccorded example,socialsecurity,seniority,and retire-
socialrecogrlition andentitlements for mentbenefits.
theireffortssimilarto thosewhocon- Additionally, a constraintthat is specificto
tributethrough paidemployment ormil- caring(in contrastto earning)andthatneedsto
itaryservice.Theseentitlements include beaddressed iswhatKittay(1995)hascalledthe
workingconditionsand supportsthat "secondary dependence" of the caregiver.By
enablethemtodotheirworkwellandan takingon the careof a dependentandforegoing
appropriate level of economicreturn, eaming,unpaidcaregivers becomedependent
whetherinwagesorsocialentitlements. on a thirdparty a breadwinner or the state-
for resources to sustainboth those theycarefor
Foreachof theseidealsto be achieved,addi- and themselves (sec-
tionalspecificconditionswouldhaveto be ful- (primary dependents)
ondary dependents). Historically, U.S. welfare
filled;these conditionsare also desirablefor on theassumption that
reasonsof equityandsocial'justice. policyhasbeenpremised
supportfor caregivingbelongedto the male
* Caringis legitimatedas a collective breadwinner, andthat the stateshouldassume
(public)responsibility ratherpurelya responsibility for supportof caringonly in the
familyorprivate responsibility. absenceof a malebreadwinner. Sometimes, asin
* Accessto careis relativelyequallydis- the caseof blacksinglemothers,the lackof a
tributedandnotdependent on econom- male breadwinner was not seen as adequate
the ideal
ic or socialstatus.Ultimately, groundsfor the stateto stepin. Instead,black
wouldbe a societyin whichthereis an singlemothersweredeemedto be "employable
adequate amountandqualityof carefor mothers"who shouldsupportthemselvesand
 Symposium 89

theirdependents. In a stepbackward fromrec- twentiethcentury,the secondcivilrightsmove-

ognizingcaregivers' need for support,the U.S. mentandsecond-wave feminismimpelledlegal,
Congress passedthe Personal Responsibility Act political,and socialchangesthat dramatically
in 1996,whichabolished AFDC,devolvedwel- expandedemployment,education,and legal
farebackto individual states,andrestricted the rightsforracialminorities andwomen.
amountof lifetimebenefits;most stateshave An important recentexampleof expanding
mandatedstringent"workfare" to get single citizenshipis the successof the disabilityrights
mothersoffwelfare. movementin establishing federallawsandpoli-
In contrastto the U.S. welfaresystem, cies that requireschools and universities,
European welfarestateshaveall providedsome employers, andpublicprograms to providefacil-
formsof familyallowanceforcitizenswithchil- itiesandactivitiesthatenabledifferently-abled
dren.Mostcountrieshavesupported caregivers citizensto work,study,travel,and otherwise
withchildallowances, andsomeevengivesmall participate in the socialandculturallife of the
pensionsto those who engagein unpaidcare society.The lattermovementcomesclosestto
work.In conservative welfareregimes,suchas addressing the issuescentralto caringandsocial
FranceandGermany, the rationaleformaternal citizenship.It addressesthe rightsof citizens
allowances typicallyhasbeenframedin termsof who havephysicalandmentalconditionsthat
childwelfareandpromoting natalism,to ensure limittheirphysicalandeconomicindependence
the sizeandwell-beingof the futurepopulation, to receiveservicesand accommodations that
ratherthanin termsof the valueof caringand allowthemto achievesocialandpoliticalinde-
socialcitizenshiprightsand responsibilities in pendence.5 Thereis thusa precedentforclaim-
caring.Nonetheless,the allowances havebeen ingthe rightto careas essentialformeaningful
designedas universalentitlementsnot tied to citizenship.
incomeor meanstesting,unlikeU.S. welfare Rethinking thefamilyas theprimary siteofcare:
programs. In moreprogressive socialdemocratic The previousdiscussion aboutstatepolicieson
welfareregimessupport forcaregivingis exten- social citizenshipand care has assumedthat
sive,includingallowances, anddirect
subsidies,
mostcaretakesplacewithinthe familyandis
services,such as child care and home aides
1996). carried out as partof unpaidlaborof family
(Pederson1993;Sainsbury
Transformingcitizenshipin the United members. However,if we take seriouslythe
Statesto makecarecentralto rightsandentitle- notion that caringis a publicsocialresponsibili-
mentswouldrequireus to challengethe linked ty, we also need to examinecriticallythe con-
ideologiesof individual independence andfami- ception of the family as the institutionof first
ly responsibilitythat I have describedabove. resort for caring. Indeed, one can arguethat
The UnitedStatesfor the mostparthas not keeping the family as the "natural" unitforcar-
even recognized mothering/parenting as a con- ing relationships helps anchor the gender divi-
tributionto the nationalwelfare,nor has it sion of caring labor. Seeing family and women's
assumeda largersocietalresponsibility forsup- caringas "natural" disguisesthe materialrela-
portingcaregivers.As with previoushistoric tionshipsof dependencethat undergirdthe
changesin the boundaries andmeanings of citi- arrangement. But as thosewho careforothers
zenship,it wouldrequireconcertedstruggle. know, love is not enough:Carerequires materi-
in the formof suffrage,
Politicalcitizenship, was al resources. We need therefore to consider
graduallyextendedto includepreviously exclud- "defamilializing" carein orderto relievewomen
edgroups: nonpropertied whitemenin the early of disproportionate responsibility forcaregiving
nineteenthcentury,blackmen afterthe Civil and also to freeboth carereceiversandcare-
War,and,finally,womenin 1920.The democ- giversfromeconomicdependenceon a male
ratizationof the vote was achievedonly after breadwinner.
concertedstruggles byeachof the groupsin the
courseof over100years.Socialcitizenship rights
veterans'benefits,theG.I.Bill,hospital-
of the welfarestate, includingsocialsecurity, 4 Similarly,
ization,and other social welfarebenefitscame
unemployment relief,minimumwage,andjob aboutpartlybecauseof veterans' politicalorganiz-
creationwereresponsesto the politicalmobi- ingefforts.
lizationof millionsof Americansdisplacedby 5 Therehas beena recentmovementto franchise
the GreatDepression.4 In the secondhalfof the citizenswithmentalillness.
90 Symposium

Utopiansocietiesin the past,rangingfrom passdiversekinrelations,including"voluntary"

communesto the Kibbutzmovement,have or "fictive" relationships.
attemptedto transform care,especiallyinfant Regarding the knottyquestionof the prima-
and child care, into a public or communal cyoffamilyvs.thelargercommunity in caregiv-
responsibilityby collectivizingchild care. ing:In a surveyconductedin EnglandbyJanet
Theoretically,communal arrangementsin Finch(1996),respondents affirmedthe impor-
whichchildcareis treatedas a formof "public" tanceof kin ties;they indicatedthat "rallying
laborequalto otherformsof laborfree those aroundin timesof crisis"waswhatdefineda
who engagein caringfromdependenceon a functional family.Theactualdegreeof responsi-
breadwinner andalsofreechildrenfromdepen- bilitythat respondents felt in particular situa-
denceon (andthereforesubordination to) bio- tions and towardparticularrelativesvaried,
logicalparents.In practice,collectivizedcare however,dependingon priorrelationship and
hasnot eliminated the gendered divisionof car- current circumstances. (I would also add thatin
inglabor,sinceit wasstillwomenwhowerethe a diverse society,there is considerable cultural
difference in degreeof obligationandin whois
principalcaregivers in publiclyorganized child includedin the net of obligation.)In general,
care.Moreover, collectivizedcaregenerallyhas Finch'srespondents emphasized that relatives
arisenin homogeneous religiousand socialist shouldnot expector takeforgrantedassistance
communities wheremembers sharedfundamen- from other familymembers.AnotherBritish
talculturalandpoliticalvalues.Completely col- researcher, SennyMorris,foundthat, in turn,
lectivizedcarewouldbe unlikelyand perhaps peoplerequiring careoftenprefernot to relyon
undesirable in large-scale multicultural
societies family.Many of the disabledadult women
in whichpeoplemaintaindivergent culturaland Morrisinterviewedsaid they preferredpaid
politicalvalues.Familyremainsthe maininsti- helpersor helpersprovidedby socialserviceto
tutionalnexusforanchoring distinctivecultural help fromfamilymembers,becauseit allowed
andsocialidentities. themmoreindependence (citedin Cancianand
Thus,forbothpracticalandideologicalrea- Oliker2000:99).
sons it seems likely that families (broadly Finch(1996:207) arguesthatthe moralrea-
defined)willcontinueto valuecaring,andthat soningof peoplein hersurveysuggests the prin-
familymembers will feel responsibleforcaring ciple that peopleshouldhave the rightnot to
forchildrenand,to a lesserextent,elderlyand haveto relyon theirfamiliesforhelp:"Topoint
disabledmembers andwillchooseto do so.This in anotherway,thefamilyshouldnotbe seenas
doesnot meanthatthefamilyshouldbe defined the optionof firstresortforgivingassistance to
in the traditionalwayastheconjugalheterosex- its adultmembers, eitherfinancialorpractical."
ualhousehold orthatit shouldbe thefirstresort Finchis carefulto saythatherpointis not to
forcarein all cases.The states'andemployers' deprecategenerosity,care,and supportwithin
care policiescurrentlyrecognizedependency families,butonlyto see theseas "optional, vol-
and caringrelationships in rathertraditional untary,freely given" (1996: 207).
termsof parentsandchildren(whetherbiologi- Takentogether,the findingsfromFinch's
cal or adoptive)and spouses(definedthrough and Morris'sstudiessupportthe case that the
legalmarriage). However,therearemanyother community, asrepresented bythe state,haspri-
typesof familyrelationsthatgeneraterelation- mary responsibilityfor care of its citizens,and
shipsof care,includingcohabitingcouples,gay thatcitizens in turnhave the rightto nonfamily
andlesbiancouples,extendedkinsuchasgrand- care.Public policywould thus bethatallpersons
are entitledto publiclyorganizedcare or to
parentsandsiblings,andsometimes "fictivekin" allowances orvouchersto payforcare,regardless
who participatein mutualsupport.As Carol of whetheror not familymembers areavailable
Stackand LindaBurton(1994) point out in to provlce lt. .

relationto theirstudyofAfrican-American fam-

ilies, men,women,andchildrenmaybe "kin- Rethinking Paid Care
scripted"to care for the childrenof siblings, As noted in the introduction,the sheer
grandparents, grandchildren, aunts,and uncles demandforcare,the inabilityof familiesto pro-
whenthereis no one elseableto do so. To the videall care,andeconomicincentivesto com-
extentthatcaringin the "family" is valued,the modifycarehavebroughtaboutsignificant shift
notionof"family" mustbe extendedto encom- of caringto paidcaregivers. Thisis especially the
 Sytnposiutn 91

case for those needingphysicallydemanding, "helpthemholdon to memories of theirpast."

round-the-clock care,suchas childrenor adults Diamondobserved thatthesekindsof emotion-
withseverementalandphysicaldisabilities, and al supportwere not listed in the aides'job
elderlywithdementiaor Alzheimer's. Muchof descriptions, nor were the aidesrewarded for
the lattercaretakesplacein institutional set- theseactivities.Inthenursinghomeshestudied,
tings,nursinghomes,hospitals,andresidential FonerfoundthatAna,a nursingaidewhoregu-
facilities,wherethe intensiveface-to-facecaring larlytooktimeto talkto patients,andcomfort
is done by nursingaidesandothernonprofes- or reassure themwhilebathingthemor chang-
sionalworkers underthesupervision andauthor- ingthem,wasconstantlyreprimanded forbeing
ity of administrators and medicaland nursing inefficient,whileMs.James,an aidewhonever
professionals. spoketo patientsandhandledthemroughlyto
Thus, any schemeto createa society in get themthroughtheirroutines,waspraisedby
which caringis valued in all spheresmust supervisors as a modelaide.
addressthe growing commodificationand DeborahStone(2000)foundthathomecare
defamilization of care.We needto thinkabout workersalso faceda conflictbetweenbureau-
thechangesthatoccurwhencaringis madeinto craticrulesandprinciples andtheirownethicof
a publicratherthan privatefunction,when care.Thus,theyoftenstretchedor evadedrules
"strangers" ratherthanfamilymembers provide and supervisors to providepersonalcare, or
care, when care giving is paid ratherthan spentoff-worktimeor moneyto provideextra
unpaid,and most importantly when caringis services.
regulatedand controlledby bureaucratic rules The variousethnographic studiesrevealthat
andhierarchy. manycareworkers do providequalityemotional
Transferring caringfromprivatehousehold care,buttheydo so "around the fringes"so that
into publiclyorganizedsettingsinserts"third theirskillsandeSortareunrecognized ortheydo
parties"into the caringrelationship.Bothcare- so in directdefianceof the rules.Thesestudies
giversandcarereceivers arehemmedin byrules pointto the existenceof"oppositional cultures"
andregulations abouttime spentandkindsof in whichworkers cooperateto providethe kind
care that are covered(e.g., shopping).Foner of carethatthe bureaucratic structuredoesnot
(1994) and othershave arguedthat the "iron recognize or disallows. One casestudyof a psy-
cage"of bureaucracy that constrainspeoplein chiatrichospital(Lundgren et al. 1990)found
organizations createsfundamental dilemmas for the qualityof carewasexcellentbecausepsychi-
careworkers whoarecaughtbetweenconflicting atrictechnicianswhodid the dailycarecarved
ideals.Whereasbureaucracies operateaccording outareasof autonomy in whichtheycouldactin
to principlesof standardization, impersonal accordance with an ethosof care.Becausethe
rules,andefficiency,carerelationships encour- psychiatrictechnicianshad opportunitiesto
age individualtreatment,personalties, and interactfreelywhen residentswerein classes,
patience. theydevelopedcamaraderie. Workers supported
Bureaucratic rulesandcontrolwereinstitut- one anotherto go beyondthe policiestheycon-
ed becauseof publicityaboutwidespread abuse sideredunreasonable or againstthe interestsof
andneglectof patients.Havingdonean ethno- the residents.Theydevelopedcustoms,suchas
graphicstudyof a nursinghomein New York, "timeout"to leave the unit when they were
Foner(1994)agreesthatbureaucratic rulesand aboutto lose control.Thesekindsof practices
oversight are necessaryto protect elderly that workersthemselvesdevelop could be
patients,and that nursingaides,who do the incorporatedinto organizationalpractices.
actualphysicalcare,feeding,cleaning,bathing, Encouraging a teamapproach in whichworkers
and so on, cannot be allowed to act modelandsupporteachotherforsensitivecar-
autonomously. However,the rulesandthe way ing would be one such salutarypractice.
theyareadministered emphasize "efflciency" in Procedures couldalsobe reformedto buildin
gettingphysicalcaretasksdone,meetingtime moreopportunity andrecognition foraideswho
deadlines,andmaintaining Yet,asTim show kindnessand go out of their way for
records.
Diamond(1988:48) foundin his ethnography patients.Organizations couldoSermoreregular
of a nursinghome,emotionalcareis essentialto trainingin sensitivityandemotionalaspectsof
the nursingaide'sjob:"holdingsomeonetrying care, includeemotionalcaringwork in job
to gaspfor breath"or talkingto residentsto descriptions and workerevaluations,and pro-
92 Syrnposiurn

vide a rewardsystemfor caregiverswho go to herownappearance. Shehadherpaidhelper

beyondthe callof dutyto helppatients. assistherwithclothingandmakeup,whichshe
At the professional level, the bureaucraticfelt justifiedin doingbecause"Theyneedto be
andchart-keeping imperatives of caringinstitu- patientandI'mpayingforthatpatienceso I feel
tionscouldbeharnessed to buildin accountabil- OKaboutexpectingit"(quotedin Cancianand
ity for the socialand emotionalwell-beingof Oliker2000:99). One groupalreadyhasdirect
care receivers.Foner (1994) notes that one accessto government fundsforpaidcare.The
reformthat has beenadoptedin manyinstitu- Department of Veterans'Affairshas a program
tionsis the psychosocial modelof care,which for UniversalAid and AttendanceAllowance
paysattentionto the emotionaland socialas that givesdirectunrestricted cashpaymentsto
well as the physicalaspectsof caring.The psy- 220,000veteransto pay for homeworkers or
chosocialmodelinvolvesa case management attendants(Cancianand Oliker2000: 155).
approachthat includesboth healthand social The rightof veteransto state supported paid
serviceneeds of care receivers.Cancianand care is acknowledged because of their "service to
Oliker (2000) describea "ClinicalPractice the country." What is needed is a more univer-
Model"of nursingthat BonnieWesorickhas salapproach thatextendsentitlements to nonfa-
developedand introduced in severalhospitals. milialpaidcareto allcitizens.
This modelchallengesthe medicalmodelby Inshort,bothpaidcaregivers andreceivers of
emphasizing "holisticcaring." It doesso bysuch paid care need to be empowered. Sometimes,
methodsas keepinga recordon each patient when the interestsof caregiversand care
thatincludespersonalhistories,religiousorien- receiversintersect,it makessensefor themto
tation, familysituation,and individualcon- organize together.Forexample,whensocialser-
cerns.Importantly, it callsforwritinga planof vice agency budgetsarecut andhomecareand
carethat documentsthe patient'sneeds,con- other servicesare reduced,caregivers maybe
cerns, and problemsand an individualized forced to serve more clientsless well and clients
approach to reachdesiredoutcomes. don't get the care they need.During the 1980s
Encouraging caregivers to focuson socialand and '90s, coalitions of home health care workers,
emotionalaspectsof care may be salutaryin care receivers,and communityleadershave
somerespects. Yetthereis an inherentpitfallto formedto improvewagesandbenefitsfor care
empowering caregivers:It mayexacerbatethe workers. SinceservicesarepaidfromMedicaid
alreadyunequalrelationship betweencaregivers or other public funds,carereceivers willsupport
andcarereceivers. Caregivers mayfeelthatthey wage increases for care workers, especially if it
understand the needsof carereceiversandthat means that their caregiverswill continue rather
than leavingfor higher-paying jobs in other
theyareactingin theirbestinterests.However, fields(Cobble1996;SEIU1999).
carereceiversmighthave differentvaluesand
priorities.To the extent that care receivers Rethinking Employment Practices
dependemotionallyand physicallyon their Changesin employmentpracticesare also
caregivers,they mayfeel they have no choice neededto makeit possiblefor peopleto inte-
butto deferto the caregiver's judgment. grateworkandcareandsothatcaregivingisnot
Thus, an additionalconcernshouldbe to penalized.A smallproportion of citizenscur-
ensurethat carereceiversaregivenvoice and rentlybenefitfromprivate-sector initiativesby
influenceovertheircare.In the caseof mental- corporations thatrecognize the caringresponsi-
ly competentadultsrequiring homecareassis- bilitiesof theiremployees. Someof thesecorpo-
tance,for example,it wouldbe preferable for rate employersprovidechild care and unpaid
themto begivengrantsorvouchersto hiretheir leavesto carefor childrenor elderlyrelatives.
own caregiversratherthan being assigneda Model programsincludethose by CitiBank,
helperby a socialserviceagency.Severalof the StrideRite, andCampbell's Soups,whichpro-
50 disabledwomeninterviewed byJennyMorris videchildcareon orneartheirpremises. Bristol
in Englandsaidthey especiallyvaluedhelpers Myers-Squibb has a familyleave policy for
theyhiredandpaidforthemselvesratherthan employeesthatcoverscareforelderlyrelatives
those sent by governmentsocial services, (CancianandOliker2000:75, 155).
becausetheyhad greatercontrol.One woman Thepassageof the 1993FamilyandMedical
saidthat only whenshe startedemployingher LeaveAct markeda firststep in developinga
ownhelperdidshefeel shecouldpayattention nationalpolicythat supportscombiningwork
 Sytnposiutn93

andcare.Theactrecognizes careresponsibilities can be justifiedon economicas well as social

forthoseengagedin paidworkandacceptspub- welfaregrounds. The40-hourweekwasthe goal
lic responsibility so thatdependents canreceive of labormovements startingaftertheCivilWar,
adequate care.As in manyEuropean countries, but it wasonly whenorganized laboracquired
the statedgoalof the legislationwasthe devel- sufficientpoliticalpowerin the 1930sthat it
opmentof childrenandpromotion of thefamily becamethe standard. It involvedthe recogni-
unitratherthanrecognitionof caregivingas a tion of workers' rightsfora life apartfromthe
socialresponsibility. The preambleto the Act job. It is now time to recognizethe realityof
recognizes job securityandparentingas impor- workers' multipleresponsibilities forearningand
tant for citizens'well-beingand acknowledges caringbyreducing workhoursthrougha combi-
the role of the state in supportingboth. nationof reducingthe standardfor "full-time
However,coverageis extremelylimited. By work"andincreasing vacationandleavetime.
mandating only unpaidleave,the government
accommodates careratherthanfullysupporting Closing Thoughts
it, sincefewparentscanaffordto usethe unpaid I have focusedon specificideologicaland
leave.Moreover, by exemptingemployers with structuralconstructionsof caring.But ideas
fewerthan50 employees, the lawleavesanesti- aboutandstructures of caringaretied to other
matedhalfof theworkforce uncovered 56 per- ideologies and structures that theysupportand
centofwomenand48 percentofmen,according are supported by. Achieving the kinds of
to Spalter-Roth and Hartmann (1990). changesneededto createa societythat values
Ultimately,when employerinterestsare at caringwill requiretransforming the wayswe
stake,employer needsareallowedto trumpcare think about ourselves, our relationships with
needs.Finally,the Act recognizes dependency others, the family, civil society, the state, and
onlywithintraditional conjugalfamilyrelation- the politicaleconomy. Ultimately, the transfor-
ships-spouse, children,and parents(Kittay mation of caring must be linked to major
1995).It thereby"refamilizes" carebyexcluding changesin political-economic structuresand
othertypesof voluntary relationsof dependency relationships. Perhaps most fundamentally, the
andcare. liberal concept of "society" as made up of dis-
Besidesparentaland care-givingleave and crete,independent, andfreelychoosingindivid-
childcare,employment policymustconsiderthe uals will have to be discarded in favorof notions
sheer numberof hours needed for care. A of interdependence among not wholly
nationalsurveyof a representative sampleof autonomous members of a society.
1509 English-speaking householdsfound an References
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