industry & policy
Mechanical carers
or a caring world?
How do we strike a balance
between formal and informal
methods of care?
By Michael Fine
I
have just returned from the World
Congress of Gerontology and Geriatrics
in San Francisco. Held every four
years, like the Olympics of ageing, it’s an
opportunity to learn about new research on
ageing in all its glorious complexity.
With over 6000 participants, it is
impossible to participate in everything.
Typically there were more than 20
different lectures and presentations going
on at any one time – often competing
with vast numbers of prestigious
researchers presenting posters of their
original research.
My interest in care and support led me to
attend a number of sessions on care and
caregiving, a topic that these days includes
unpaid care provided by family members
and volunteers, paid care and formal care
services provided by care professionals
and an increasingly large and diverse
range of casualised care workers, and a
relatively new field often referred to simply
as technology.
These three distinct fields represent a
historic progression of ways that assistance
can be organised. Until recently, care has
been exclusively provided by people – it
is a form of physical labour as well as a
social relationship and an altruistic way of
thinking about the wellbeing of others.
Unpaid care can be considered the
default or traditional system. It’s been the
basic system of support as long as humans
have roamed the earth. Care given within
the family or in other close personal
relationships continues to be by far the
most important form of assistance to those
who need help in old age.
The work of volunteers is more recent,
but also goes back at least a millennium,
as communities found ways of providing
support to those without family or money.
Paid care and other formal services
are more recent but have been with us
for the past couple of centuries. Because
markets fail many of those who most need
assistance, in most advanced countries the
state has assumed a major role in granting
people access to services they need but
might not be able to afford.
Just how the informal and formal
systems of care interact has long been the
subject of conjecture. Does formal service
displace informal? When we turn to paid
services, is it because we no longer care?
Or is it the other way round – that we pay
for additional help, more expert, available
for longer hours, because it provides
something extra?
This was a topic that received
considerable attention at the conference
– with papers from a number of different
countries now clearly demonstrating that
the two systems are complementary.
By using paid care services, unpaid
carers are able to keep going longer. They
are also able to sustain other work and
make contributions beyond the family.
But they don’t go away or give up. We
know that in Australia because the services
have not displaced family care – but have
supported it.
Finding new and better ways for
informal and formal care to work together
remains vital. If we think of consumers too
narrowly, as simply those who need the
care themselves, we can exclude unpaid
family carers and cause real damage to
family relations and personal support.
One of the most fascinating and
frustrating parts of the World Congress
was when it devoted an entire day to new
technology advocates. Often this seemed
to combine apparently half-mad scientists
and half-crazed wanna-be entrepreneurs
whose main motivation seemed to be to
get rich quickly with what they tried to tell
us was the solution to the crisis in care.
Sometimes their ideas concerned robot
nurses of various forms, other times robot
pets that would distract and quieten
someone with dementia.
Another category of products concerned
new apps and software solutions you could
download onto your phone to coordinate
the work of real people.
A third category of device was a sort of
electronic sentry, not unlike the computer
Hal in the movie 2001: A Space Odyssey,
that would guard the care recipient, answer
some of their questions and sound the
alarm if things went wrong.
How appropriate that this should
take place in San Francisco, where the
memories of the Summer of Love live on
alongside the mirage of high-tech and
crazy ideas of Silicon Valley.
So, will technology replace the personal
provision of care?
Will paid care replace unpaid care
provided for love?
Will the market replace the welfare state
as a system of secure provision?
It seems to me that there is room for
more resources and better models of
provision, but these systems are not
substitutes or alternatives. Each builds
on the other, and in the end, all depend
on love. ■
Michael Fine is an honorary professor at
Macquarie University
agedcareinsite.com.au 11