Gender equality: Calls to reform homecare long overdue
State must get more involved in care options for elderly and caregivers’ rights
The Citizens’ Assembly’s recommendations on caregiving and about the status and remuneration received by family carers, most of whom are women, are long overdue. File photograph: iStock
The Citizens’ Assembly on gender equality has made recommendations on 45 key priority areas, likely to affect the everyday lives of Irish people. They cover changes to the Constitution, politics and leadership, childcare and caregiving, gender quotas, pay and the workplace and sexual and gender-based violence. In making these recommendations, Irish citizens have provided the Government with a useful policy framework, reflecting news ways of looking at gendered roles within and outside the home.
A long overdue recommendation is for a change to article 40.1 of the Constitution, to ensure gender equality. Another is for the deletion and replacement in article 41.2 of the clause that implicitly implies that a woman’s place is in the home. This change will mean that the State will be obliged “to take reasonable measures to support care within the home and wider community”. This is a profound statement, probably never before so explicitly expressed in Irish society. Another compelling finding is that 95 per cent of Irish citizens would, if deemed necessary, pay higher taxes in order to have quality public services delivered to them.
Perhaps it was fortuitous that the assembly occurred during the earlier period of Covid-19 as this probably allowed the spotlight focus on caregiving issues in more depth. The assembly’s recommendations on caregiving and about the status and remuneration received by family carers, most of whom are women, are long overdue. There are about half a million family caregivers in Ireland today, whose hard physical and emotional work behind closed doors save the exchequer enormous sums of money. These family caregivers provide free personal and social care supports, services the Government would otherwise have to deliver at significant costs. For some time, advocacy groups have been calling for changes to the eligibility for the carer’s allowance – a means-tested payment available to those with limited income and have been arguing for a more universal basic income.
The Citizens’ Assembly has recommended reform to the carer’s allowance by increasing the level of income a family caregiver can earn in paid employment and still remain eligible. Other recommended changes includes ex-carers being allowed more immediate access to State employment and training programmes. Currently most State reactivation programmes such as the Community Employment Scheme and JobsPlus are only available to those unemployed for periods of six, 12 months or longer. This means that if family carers previously in receipt of the carer’s allowance want to avail of these programmes to return to paid work, they must sign on for prolonged periods of time, even though they have ostensibly been out of the workforce because of caring.
Another recommendation is that some of the hidden costs of caring as for example indirect costs associated with water usage or waste disposal should be reimbursed. A further recommendation is for an individualised pension system for family caregivers and for improving the terms and conditions for those employed in paid care work. All of these recommendations are laudable and communicate a very strong signal from the assembly that policymakers need to place much greater value on caregiving work.
Recommendations about older people having a statutory right to more personalized homecare packages are hugely welcome but of no real surprise. For years there has been a major incongruence in government policy that purports to favour homecare over long-term residential care yet apportions significantly more of its health budget to nursing-home care. Accordingly, the assembly has recommended that older people and those with disabilities should have access to person-centred financial supports that address their needs. They should also be afforded choice and enabled to participate as best as possible in decision-making on care needs in line with human rights principles. In particular it recommends that for older people who wish to be cared for at home, the homecare budget should be increased to meet growing demand. Older people should have a statutory right to payment for homecare packages as well as for nursing homes.
State vs family
This more direct involvement of the State in the supposed private sphere of family life is noteworthy and reflects a significant departure. Traditionally, the Irish policy response to long-term care provision for older people has been based on the Anglo Saxon system of means testing, strict eligibility criteria and on a residual model of welfare, reflecting Catholic principles of subsidiarity and by and large non-interference by the State in family matters. In fact subsidiarity underpinned most social care provision both within the informal care system and within the voluntary sector, and the State’s role in service provision was minimal. This is in direct contrast to the Nordic model of welfare where people pay high taxes, and where in times of need the State rather than the family step in.
A key question centres around the future availability of caregivers, both paid and unpaid, to provide support to older people in Ireland. Given that a significant number of paid caregivers in Ireland are migrant workers, can the country continue to rely on this “reserve army of labour”? And even if State support for long-term care increases significantly, the country will always need family members to co-ordinate care.
With a weakening of gendered obligations and more Irish women absorbed into the paid labour market, who will be around to provide this care and what lessons can be learned from other countries? Should Ireland be following the example of some European countries by attempting to further formalise the informal care role? Other very valuable examples emerging from Europe include public provision of alternate models to long-term care rather than merely care “at home” or “in a home”. Such would include State provision of assisted living facilities, supportive housing, housing with care, sheltered housing and the adaptation of normal domestic dwellings with relevant assistive technology. The latter could potentially take huge pressure off family caregivers. Given how we are already in the process of long-term care policy reform, these are all critical questions that need urgent attention.
Prof Suzanne Cahill is adjunct professor of the school of social work and social policy at Trinity College Dublin