How long can you go without going to the washroom, bathing, eating, buying groceries, cleaning the house, and other essential activities of life? For those who need help in day-to-day life, it doesn’t take long for home care service gaps to become a personal crisis. If you don’t need care yet, you, like most people, likely want to remain in your home if the time comes. Yet unmet home care needs, even in the short term, can unnecessarily lead people to residential care. Women, adults with disabilities, people who live alone, and people who live in rural areas are more likely to experience such unmet home care needs.
Ito Peng highlights how vital the care economy is to a functioning society. During waves of COVID-19, unpaid friends and family, especially women, stepped up when care services were disrupted. By stepping up, unpaid caregivers often struggled to maintain balance with work and other life responsibilities and many even withdrew from the labour force. An over-reliance on informal care masks system deficits, negatively impacts the economy, widens gender inequality, and strains individual caregivers. Unfortunately, this approach can also lead to simply not enough care for those who need support at home.
People with disabilities, older people, and unpaid caregivers have long known how essential and precarious home care services can be, and service disruptions throughout waves of COVID-19 thrust this reality into the public arena. Inadequate home care services affect the health and well-being of caregivers and recipients alike and may indicate a broader “care poverty.”
European researchers Kröger, Puthenparambil, and Van Aerschot introduced the concept of “care poverty” to describe the situation of ongoing unmet home care needs. Care poverty describes specifically what kinds of needs are unmet in relation to the availability of informal and formal care. The European team found care poverty is more common for help around the house rather than personal care needs such as getting dressed or bathing. If we are to truly prioritize home care and support older people who want to stay in their homes, services must include help with household maintenance and running errands. This doesn’t begin to address other important social supports that allow people to maintain ties and combat loneliness and isolation, such as support for attending social, religious, or cultural events.
In global economics, poverty is defined as the minimum income needed to meet basic needs in specific geographic and economic contexts. Poverty is a useful lens to examine care as it compels us to measure material differences while also reflecting on the social and health implications of living at or below the poverty line. As the World Bank puts it, “Although it is often thought of as a lack of material resources, poverty is correlated closely with all aspects of a person’s life…. Understanding poverty is thus fundamental to understanding how societies can progress.” Similarly, care poverty is a key indicator of societal wellbeing and population health.
The fragility of home care services should not drive our policy responses towards residential care. In a recent book, Patrik Marier from Concordia University documents how home care has been a priority of Canadian governments for over 20 years, and yet funding patterns continue to emphasize residential care. Despite the emphasis on funding residential care over home care, COVID-19 showed us that residential care is frankly dangerous to the health and safety of the people who live and work there. This too has long been recognized by people advocating for deinstitutionalization and creative home care programs that centre on rights and full social participation for those who need support.
The time to confront care poverty is not now, but yesterday. Care poverty can help us see how access to high quality home care is a vital social determinant of health. On the contrary, lack of access to home care is a form of systematic exclusion with troubling equity implications, both for caregivers and for those who need care.