What's in a title: Understanding meanings in community care
What's in a title: Understanding meanings in community care

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What's in a title: Understanding meanings in community care

4 Care

‘Care’ is a word which summons up positive and highly moral meanings for many people. It has associations with giving, sacrifice and feelings of empathy. However, Activity 1 suggests that things are not perhaps quite so straightforward. One way of understanding how and why there may be contrasting ideas of what care means is suggested by Joan Tronto, a social scientist. She has pointed out how care is both ‘universal’ and ‘particular’. She argues that caring is an activity which everyone is likely to have been involved in. At some point, all of us need to be cared for. As babies and in late old age we are likely to have needs which can only be met with help and support. In adult life there may be times when we are dependent on the help of others. In all these ways, care is a universal experience. However, Tronto also points out that the meanings people associate with care vary from society to society and through historical time (Tronto, 1994, pp. 109–10). Care, therefore, can also have different and specific meanings which relate to particular situations and places. For example, while some frail older people are happy to accept meals-on-wheels and a weekly bath, others may prefer to be in a position to be given a payment so that they can choose what services to buy for themselves. And while it might have been expected until the mid-twentieth century that the appropriate care for someone with a severe learning disability was in a hospital, this is now no longer seen as appropriate or indeed as care at all. Individual preferences shape the meaning of what is meant by care and, over time, attitudes towards certain groups in society determine what is seen as appropriate care.

Figure 5
Top left and right: Ulrike Preuss/Format; bottom left: John Birdsall Photography ©
Top left and right: Ulrike Preuss/Format; bottom left: John Birdsall Photography
Figure 5 Care is universal and it is particular

Stereotypical views of how Asian families care have led to the under-provision of help and support by service providers. The assumption that they ‘look after their own’ is ‘simplistic’, as Ahmad and Atkin point out. Although the extended family is common, it is by no means universal, and ‘a significant proportion’ of Asian people live on their own and have few relatives in the UK. In addition, job mobility and the lack of appropriate housing make it difficult for extended family networks to carry out what they feel strongly are their obligations. Ahmad and Atkin point out that these changes in role expectations mean that for some older Asian people, care may be seen in terms of disappointment, shame or loss (1996, pp. 76–7). If only one set of ideas about what care means is used we risk ignoring differences within, as well as between, groups of individuals.

You might like to pause and think about this for a moment for your next activity.

Activity 5: Meanings of care

0 hours 10 minutes

Here are two examples of caring. Read them through and then, putting yourself in the place of each person, note down any words which come into your head which might suggest how that person feels about the caring that's involved.

  1. Clare lives alone and is a wheelchair user. She needs help to get dressed in the morning to be ready for work. She has also organised help at night to get her to bed. Andrea comes in at seven o'clock every weekday morning and when Clare calls her in the evening. Andrea is paid by the hour and visits two other disabled people during the day. Someone else takes over from Andrea at the weekends.

  2. Michael is worried about how his 85-year-old mother is managing since she recently became a widow. Clarice came to England from Jamaica to work as a nurse in the 1950s and, although she and Michael have no relatives in England, she has many friends. He's arranged to take her to visit a couple of sheltered housing developments on the other side of the city where he lives. Clarice is pleased to be spending a weekend out and about with Michael but she's worried about how her dog is getting on with her friend's cat while she's away.

Discussion

There are some differences between these two examples. Andrea might be said to care for Clare. She also cares for other people during her working day. She is a professional – caring is a job of work for her. What Andrea does for Clare might be described as care, but it might also be described as a service, a set of actions which needs to be done in order for Clare to be able to do her work and manage her life independently. Seen from the other side, Clare might prefer to call what Andrea does assistance, or a service. She may not like to think of herself as someone who needs care, in fact sometimes she feels quite angry about having to rely on other people. For Andrea, Clare is just one person on her list of people to visit. Of course, if Andrea were not to do her job carefully, with sensitivity and awareness of how Clare likes things to be done, then she would be unlikely to keep her job. She doesn't just have to be able to care for Clare, she may need to care about her as well. This is a distinction which a social policy analyst, Roy Parker, drew over 20 years ago (Parker, 1981, p. 3). Feminists later took this distinction further, pointing out that the expectation is that caring is always linked to love, so that even when love falters caring must continue. This of course has particular implications for women who tend to be assumed to be natural carers (Graham, 1983, p. 16).

Michael clearly cares about his mother and it seems he's also keen to make sure that she is cared for, though not by him directly. The problem is that he and Clarice may not see her situation the same way. His expectation is that she needs to be cared for, but is that necessarily hers? It sounds as if she's also involved in caring relationships in her own neighbourhood and she might be worried about a move into a sheltered unit where possibly she'll be the only black resident. This might bring back mixed memories of their early years in England, and on top of all that she might have to find another home for her dog as well.

Care as an activity is now established in law as policy, defined in the statute books under such legislation as the 1990 NHS and Community Care Act and the 1995 Carers (Recognition and Services) Act, and well established in public debates following the activities of Carers UK which campaigns for the rights of carers. In this way, care has recently come to be identified, organised, regulated and costed (Johnson, 1998). This move opens up the possibility that caring for family members or friends need no longer be viewed as exclusively the unpaid responsibility of mothers, daughters and daughters-in-law. It could be something people get paid to do.

Figure 6
© LIFFE ©
© LIFFE
Figure 6 How can ‘the values of care’ be integrated into our ‘social institutions’?

In keeping with this, some feminists have shifted the argument about care away from the idea of care as women's burden towards recognition that care should be acknowledged as a universal activity. Selma Sevenhuijsen, a Dutch feminist and professor of the ethics and politics of care, argues that the state's role should be to support and maintain care as basic to social relations in a democratic society. She highlights the extent to which everyone is dependent on care at some point in their lives, and points to the ‘privileged irresponsibility’ of those powerful people in society, at all levels, from family to top management, who do not acknowledge that they are dependent on the caring work of others. She suggests that care should be included as a starting point in debates about society, not as an add-on or separate from other activities. She argues:

Democratic societies should take it as their responsibility to guarantee their citizens an equal share in processes of care giving and care receiving. This not only pertains to ‘family life’; on the contrary, the politics of care have for too long been marked by patterns of domestication and privatisation of care. When we take care as a lens to evaluate different social practices, it can have extensive consequences for better integrating the values of care in a variety of social institutions, like health care, education, city planning or business management, and also family practices.

(Sevenhuijsen, 2000, p. 29)

She makes a powerful argument but the problem remains that care has not always had a good history and it may continue to be experienced as something which is controlling, even abusive. Many disabled people resist the word entirely, arguing that it conjures up oppressive and disabling practices. From time to time, press exposures give some support to this view, showing how care is also a word which has been much corrupted.

Figure 7
Figure 7

Key points

  • The words ‘care’, ‘welfare’ and ‘community’ are part of everyday speech and yet evoke different meanings.

  • Identifying these meanings involves acknowledging individual and social difference in experience.

  • Exploring the meanings of ‘care’, ‘welfare’ and ‘community’ helps to identify how people support each other at interpersonal and societal levels.

  • Awareness of why and how these different meanings are evoked makes a positive contribution to meeting need and supporting people in ways which they find acceptable.

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