How do reforms in long-term care for older people affect women’s unpaid care work?

By Thurid Eggers, Christopher Grages, Birgit Pfau-Effinger and Ralf Och, University of Hamburg, Germany.

How do reforms in long-term care for older people affect women’s unpaid care work? Since the 1990s, social rights and infrastructure with regard to long-term care for older people have been strengthened in many European welfare states. As a consequence of such reforms, women’s unpaid care work in the private sphere of the family, which is seen as a main basis of gender equality in feminist theorising, has partly been transformed into paid care work in the formal employment system outside the family.  The outsourcing of care to extra-familial service providers is seen as a main basis for women’s labour market integration and therefore also for gender equality. Many authors use the concept of de-familialisation/familialisation for comparative analyses of care policies.  Accordingly, welfare states either promote extra-familial care, thereby “freeing” women from their care-giving obligation, or they rely on informal and unpaid care and thereby promoting the persistence of gender inequality. However, this argumentation overlooks that many welfare states have introduced pay and social security for LTC by family members, which may enable women to act as financially autonomous caregivers.

In a new article just recently published in Aging & Society we explore to what extent the concept of de-familialisation/familialisation is still an adequate approach to the classification of welfare state policies towards long-term care for older people. It proposes a re-conceptualisation of the relation between de-familialisation and familialisation, arguing that they represent substantially different types of policy that, in theory, can vary relatively autonomously. It also explores the consequences for gender equality. In order to evaluate this theoretical assumption, the article investigates the relation between the generosity of both types of long-term care policies in five European welfare states (Denmark, Germany, Ireland, Czech Republic and Italy) based on a new multi-dimensional measurement approach.  

Our findings support the argument that de-familialising and familialising long-term care policies can vary relatively independently of each other and that it is problematic to conceptualize them as opposites or even substitutes. It seems that welfare states even tend to provide similar levels of generosity to both types of long-term care policies. Moreover, the article demonstrates that we get a better understanding of the relationship between long-term care policy and gender equality if we analyse the role of different combinations of extra-familial and familial long-term care policies for gender equality. Our results show, that a combination of a generous extra-familial long-term care policy with an equally generous policy on paid familial LTC is most effective in combating gender inequality.

The article brings new insights into the ways welfare states act in regard to their long-term care policies. It helps to clarify how the concept of de-familialisation/familialisation can be understood, and what this means for the relationship between long-term care policies and gender equality.

For more information:

Eggers, T.; Grages, C.; Pfau-Effinger, B.; Och, R. (2020): Re-Conceptualising the Relationship between De-Familialisation and Familialisation and the Implications for Gender Equality – The Case of Long-Term Care Policies for Older People,  Ageing & Society, 40, 4: 869-895.