Abstract
Caring for a Living explores the organization of long-term care in Italy and analyzes the growing need for eldercare associated with the dramatic population aging experienced over the last decades in many postindustrial societies. The book describes the global trends that have contributed to the feminization of the migration processes and explores how this growing supply of migrant caregivers meets the growing demand for home eldercare, creating a broad market for these services. The author also explores the difficulties that Italian state on the one hand and families on the other encounter in providing eldercare arrangements.
Care is a set of social relations that involve power and dependency, specific skills and work commitment, emotional aspects, and ethical practices. In order to fully understand the organization of care, it is critical to understand the distribution of labor, responsibility, and costs across the family, the state, the market, and the volunteer sector too. Today people are living longer, particularly in the wealthy countries, as a result of the decrease in fertility rates and the improvements in medicine and technology. This extended life expectancy represents one of the greatest achievements of the past century, but also entails one of the main concerns related to aging, that is, the increased need for long-term care. Among the oldest the need for support in accomplishing daily activities arising from functional and cognitive limitations increases steeply, and often sums up to pathologies such as senile dementia, Alzheimer’s disease, Parkinson’s disease, and so on.
The government response to this growing demand for eldercare is hampered by the public sector budget constraints. As most public transfers go to the growing elderly population, whereas most of the fiscal burden is borne by the shrinking active-age population, such public transfers like those granted in the past become unrealistic in the near future. In the past, demographic and economic growth was sustained by the baby boomer generations that are now replaced by much smaller cohorts.
As the fiscal balance worsens rapidly, the goal of achieving long-run fiscal sustainability leads the Italian state to push care work out of hospitals and institutions, handing it back to families. As this growing demand for care comes at a time when the increase of women’s participation in the labor market and the decrease in family size reduce available caregivers at home, families in turn are pushed toward looking for care in the market, organizing new arrangements among different care providers, and transforming families into employers of home eldercare assistants.
This supply of eldercare assistants in people’s own homes is provided, for the most part, by immigrant women coming from different areas of the world, commonly known as badanti. These migrant workers actually share their lives with the care recipients and spend many daily hours with them because families no longer live geographically near one another, and women—the most important providers of care work—are increasingly becoming co-breadwinners and are pressured by children and career.
The author draws on interviews with home eldercare assistants, family caregivers who care for disabled elders, cultural mediators, academics, researchers, trade unionists, and nongovernmental organization representatives. These interviews are conducted in 2003–2004 with follow-up interviews in 2011. They describe the routines of both live-in and live-out workers throughout a typical day on the job. The narrative analysis shows that while this job is often depicted as unskilled, in reality it requires that the workers take on different roles, each requiring a different set of skills, work commitment, and emotional involvement. The findings suggest that the ability to care is not an extension of gendered beings; rather it is the result of skills such as sensibility, attention, imagination, creativity, and empathy that affect the quality of the relationships between home care workers and care recipients.
This book not only provides insights that enrich eldercare analysis but it also provides an appropriate basis for policy interventions. It is time to acknowledge that economic, political, and social realities no longer match gender roles and gendered expectations. Men can become good care providers in the same way women can become excellent Prime Ministers. Overall, Caring for a Living is an insightful, incisive book, a persuasive evidence of what each of us will face in old age and how, as a society, we are shaping our future.