Who’s taking care of your mother? And who’s going to take care of you when you fall ill, break your hip or are diagnosed with dementia?
Amid the noisy policy debates about health care and long-term-care insurance we sometimes forget what an important role family and friends play in our larger elder-care economy.
Just imagine what would happen if they changed their minds, and decided not to take care of us, after all.
The National Alliance for Caregiving has sponsored a series of surveys that reveal the breadth and depth of informal elder-care provision. The numbers show what a crucial role that women play — and why it is hard for women to change this role.
The most recent report on care-giving in the United States provides rich details on the type of care that most of us both expect to give and hope to get: About 19 percent of United States residents provide some care to those 50 or older, averaging about 19 hours a week.
If we paid for these services, the total price tag would exceed total Medicaid expenditures — or, if you prefer a private-sector comparison, total sales of Wal-Mart.
Most of the money would go to women, who represent 67 percent of all caregivers. If care recipients themselves paid the bill, most of the money would come from women, who represent 68 percent of elder-care recipients. Indeed, the average unpaid elder-care provider, at age 50, balances on the cusp of the dependent age category.
Women live longer than men on average and therefore become more vulnerable to the care-intensive problems of extreme old age.
Economists tend to assume that women simply choose to provide care because it gives them satisfaction. But more than 43 percent of all caregivers in the survey reported that they felt that they had no choice. They stepped forward for a variety of reasons: because no other family member or friend was willing or able to provide adequate care or because paid services were economically out of reach.
Those who felt they had no choice were more likely to report emotional stress, poor physical health and financial hardship.
About 45 percent of women, compared with 38 percent of male caregivers, put themselves into the “no choice” category.
Many women would prefer to share care responsibilities more equally with others, but if they can’t, will take on them regardless, as a moral duty central to cultural ideals of womanhood.
Our gender norms tend to assign women greater moral responsibility than men for family care. Consider the following bit of dark humor from episode three of the first season of “Mad Men,” a series that highlights the overt sexism of the early 1960s:
So, the doctor says to him, I hope you’re happy. While you were out playing a round of golf, your wife was in a horrible accident. She’s going to need round-the-clock care — bathing, toilet … I’m just kidding. She’s dead. Hey, what did you shoot?
It’s hard to imagine a similar joke with the gender roles reversed.
And there’s some empirical evidence that the joke is not entirely out of date. A study of men and women with serious illnesses found that women are far more likely to be divorced by their partner than the other way around.
Women face an economic double-bind. Taking more responsibility than men for the care of family members lowers their lifetime earnings and leaves them vulnerable, especially in the event of illness, divorce or widowhood.
Partly as a result, older women remain dependent on younger women for unpaid care. They have an economic stake in younger women’s sense of obligation.
The bittersweet result is that the social organization of care reproduces some aspects of gender inequality. And vice versa.