In Roskilde and Rome, and in Beijing, Berlin and Brussels, struggles about elderly care are taking place. The issues around which these struggles are many: Who should we care for? What is āproper careā and how should it be regulated? Who should provide the care? And what kind of working conditions should caregivers endure? By struggles I refer to clashes at the individual and collective levelsānot involving violence or weaponsāthat may stem from disagreements, tensions between social processes, discourses and between different policy goals and different logics in care practices and resistance to existing discourses by individuals, groups and/or social movements.
Some of the issues mentioned above have turned into collective struggles. In 2007 in Denmark, for example, home helps and municipal staff charged with caring for the elderly protested in front of the Danish parliament, carrying banners saying: āUnion of Disregarded Workersā, āPoor and Overworkedā and āTime to Careā (Dahl 2009). In Finland, there have been struggles over a new elderly care act (Hoppania 2015) following media scandals about deficiencies in elderly care. Between 2010 and 2014 Finnish politicians and other stakeholders debated the framing of a new elderly care law. Originally, the new legislation was justified as a response to insufficient resources and poor quality care. However, during these struggles, the problem of elderly care was reframed as one of insufficient legislation. The original problem was forgotten, and elderly care was de-politicized (Hoppania 2015). The Finnish and Danish examples are not unique. In Sweden and Norway as well, there have been struggles about elderly care spurred by neo-liberalism and the effect of New Public Management (NPM) 1 reforms and the need to ensure the rights of elderly people (VabĆø and Szebehely 2012). These examples illustrate the kinds of struggles about elderly care taking place in Nordic countries, but the Nordic cases are not exceptions.
Outside the Nordic welfare states, in countries with varying political constellations, struggles have taken place concerning care of the elderly and the working conditions for caregivers. In Great Britain, struggles over elderly care have centered on the formal recognition of informal care, that is, caregiving by family/close others. Carers UK, an organization of those caring for the sick and elderly, has instigated a campaign about the use of the positively valorized word of ācarerā to be exclusively used by family carers (Lloyd 2006), arguing that the government should grant the kind of labor rights to informal carers to ensure their working conditions, including pension rights. At the EU level, the organization āEurocarersā was formed as an interest organization for unpaid family carers (Williams 2010). Struggles over elderly care can also be observed in continental European and Mediterranean countries. In Rome, live-in workers from Eastern Europe struggle for proper working conditions while working in the midst of families and caring for the Italian elderly at the same time. These migrant workers struggle to receive vacation benefits and with their host families about providing adequate care (Isaksen 2011).
Struggles over elderly care are not limited to Europe. In China struggles about elderly care concern the role of children (typically the single child) and his/her responsibilities to either provide or finance the care of elderly parents. The Chinese state frames the issue of elderly care not as a question of state responsibility, but of the childās (childrenās) responsibility. The state provides normative guidance and governance through its publication and dissemination of an instruction manual of how to care for oneās parents. In the manual, the state urges the child (children) to uphold family obligations of care for oneās parents and to purchase health insurance (Jacobs and Century 2012): Here the political solution is to promote familialism, 2 marketization (buying health and care insurance) and ensure that these obligations are enforced through law. Chinese law now codifies moral obligations and sanctions any adult child who does not care for his/her parents.
These examples illustrate the kinds of struggles over elderly care that we find in many parts of the world. Nearly everywhere the āelder burdenā and the ādemographic challengesā are at the top of the national, political agenda. This is not a coincidence inasmuch as sociopolitical problems can become transnational discourses, traveling around the globe. Nation states are increasingly part of a more global form of governance, interacting in international organizations such as the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) or in intergovernmental organizations such as the EU. Through these forums, there occurs a spill-over effect by which problem framings, solutions and best practices are promoted, and then imported or translated into the specific institutional context of the nation state in question. These international organizations themselves are not devoid of internal conflicts about the issues they seek to solve, nor do the international organizations always understand the problem of elderly care in precisely the same way. Hence, we observe struggles within states, within and between international organizations, and between the elderly in need of care, their family members and the care worker/professional carer.
The Proliferation and Intensification of Struggles
The intensification and proliferation of struggles about elderly care reflect a profound global transformation of elderly care. This transformation tends to create uncertainty and tensions that can fuel resistance and struggles among the various stakeholders in the elder care regime. Hence, we witness dramatically changing conditions of care, heightened expectations about what proper care should be, and increasing discussions about the quality of care. The changing conditions, I will argue, involve seven social and political processes: commodifying, globalizing, professionalizing, de-gendering, bureaucratizing, neo-liberalizing and late modernizing. These processes are not inevitable, but they are mediated and translated by agency. Instead of nouns I use verbs to indicate that they are political processes and not deterministic. The intersection of these seven processes creates more fragmentation, insecurity of care and clashes between different logics. 3 Processes that will be elaborated in Chap. 2 of this book. Logics are not understood as something inherent and stable in social life, as in the immanent, ideal-typical rationalities behind social action in Weberās social theory (Weber 1921) or in the ārationality of careā as understood in the work of WƦrness (1987). Instead, logics are dynamic ways of seeing and arguing that can only be identified empirically. Here I am inspired by the Dutch philosopher Annemarie Mol, who defines a logic as a rationale of the practices that are appropriate to do at a particular site or in a particular situation (Mol 2008: 8). Following Mol, a given field of care and a logic of care do not exist in themselves. Rather, there is a field of care 4 with vulnerable bodies traversed by different logics in time and space.
The conditions of possibility for care are dynamic. However, care is also increasingly being discussed in various contexts. This discussion derives from the fact that care has now moved out of, and away from, the domestic or intimate sphere and is now a global policy issue. Care policies, standards and practices are now being discussed in policy forums as diverse as those in Beijing, Brussels, Gothenburg, Geneva, Madrid, Manila, Rome, Roskilde and Washingtonāto name but a few. As Williams (2010) has noted, care has emerged as a āpolitical concernā; care is increasingly being discussed in political assemblies (parliaments, governments, municipalities). However, care is also part of what is termed āthe politicalā; the conflictual element constituted by the boundary between the social and the political. Here I draw on Chantal Mouffeās understanding of the political (2005). Whereas the social consists of the sedimented (frozen) social practices, the political arises at the very moment that one of these social practices is questioned. In this sense, the political is based on an unstable and changing boundary between the social and the political. Questioning existing practices or values makes the political visibleāand creates a moment of openness (Hoppania and Vaittinen 2015). It is at this juncture that existing care practices become political or contested.
Care has left the exclusively private sphere and entered the social sphere. Care is now paid, managed, regulated and professionalized (Arendt 1958; Tronto 1993; Stone 2000; Johansson 1994; Dahl 2000a, 2010; Williams 2010). In contrast to an earlier era, care is now spoken about in politics and in the political. Care is no longer silenced; it is increasingly visibleāit is brought into existence in the articulation of ideas and political deliberation by the increasing proliferation of discourses about care. Discourses form and limit the understandings available and in so doing, they constitute a horizon of understanding. Such a horizon limits what can be said and done, including the positions that persons can occupy legitimately (Norval 1996: 4). In this way the discourse limits the objects being dealt with, the subject positions that agents can occupy and the legitimate ways of arguing. 5
By āstrugglesā I refer to clashes at the individual and collective levels and they do not necessarily imply an intention by the individual agentsāas struggles can arise suddenly, as a reaction to a particular practice. This reaction can take the form of āresistanceā a broad concept that could include inaction, persistence, dissent, counterforce, and interruption or in the most radical case, rebellion (Brƶckling et al. 2010: 18ā19). For example, some hospital doctors resist filling out forms that are part of a new regime of quality control and standardization. For them, the work of treating patients, some in acute danger, is more important than doing what they view as meaningless paperwork (Rasmussen 2012). The resistance of doctors consists of inaction toward required processes of documentation. In Austria and Italy, care workers are working within families and care for elderly family members through state financed cash-for-care schemes given to the families. Domestic workersāsuch as those in Austria or Italyāaround the globe have struggled to become included in unions and to have their work, much of it intimate personal care, regulated more globally, such as through the International Labor Organization (ILO). These struggles were successful in 2011, with the decision of a āDomestic Workers Conventionā. Social movements, such as the womenās movement and the disability movement, have also fought to bring care to the political agenda and to form care according to specific values. The focus of this book will be on paid care. As such, paid care is part of a care market, where professional carers, designated care workers and some family members are paid a wage or a sum of money. Being paid can become politicized and thereby public. By becoming public, care can be related to regulation in the broad sense, that is, to the state and state institutions. Struggles about boundaries of the state (to care or not to care?) take place in the debates about division of responsibilities between the state and civil society (read: families and close others) or between the state and the market. Boundaries between the state and the āoutsideā are not as solid as they used to be. With market-based services paid by the state (in the form of vouchers)...