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Creating a Caring SocietyAuthor(s): Evelyn Nakano GlennSource: Contemporary Sociology, Vol. 29, No. 1, Utopian Visions: Engaged Sociologies for the21st Century (Jan., 2000), pp. 84-94Published by: American Sociological AssociationStable URL: http://www.jstor.org/stable/2654934 .

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84 SymposiumCreating A Cartng Society

EVELYNAKANO LENNUniversity of California, BerkeleyWhy is it importanto achievea society hatvalues caring and caringrelationships? heanswermightappear bvious:t seems nherentin the definition f a good society hat thosewho cannotcarefor themselves re cared or;that hosewhocancare or hemselvesantrustthat,should heybecomedependent,heywillbe caredor; nd hatpeoplewillbe supportedntheirefforts o care orthosethey careabout.But even more is at stake.Currently e arecaught n a nasty ircle.To the extent hatcar-ing is devalued,nvisible, nderpaid,ndpenal-ized, t is relegatedo thosewho ackeconomic,political, nd socialpowerand status.And tothe extent hatthosewhoengage n caring redrawn isproportionatelyrom mong isadvan-taged groups women,people of color, andimmigrants),heiractivity that of caring isfurther egraded.n short, he devaluingf car-ingcontributeso themarginalization,xploita-tion,anddependencyf caregivers.Conversely,valuing ndrecognizingaringwould aise hestatus ndrewardsf thosewhoengagen it andalso ncreasehe incentivesorothergroupsoengagen caring. hus, society hatvalues areandcaring elationshipsould e not onlynicerandkinder, utalsomore galitariannd ust.In addressinghe questionf how o createsociety n whichcarings valued, firstgive abriefaccountof the contemporarycrisis"ncarewhich tems romts beingdefined s a pri-vatized, feminized,and thereforedevalueddomain.n the nextsection review ecent em-inistattemptso rethink he concept f care nways hat open t up to critical nalysis. thendefine omedesirableoals ora society hatval-uescare. n thefinal ection outline ourmajordirectionsorchange nsocial itizenshipights,family esponsibility,rganizationf paidcare,andemploymentolicies ndpractices.The Contemporary Problem of CareA spateof popularooksandarticlesn thelast decadehas sounded n alarm bouta new"crisisn care," crisis ccasionedythe exodusof women rom he home nto the work orce.The needfor careof children,he elderly, ndthe chronicallyll anddisabled as not dimin-ished, ndmayhavegrown ecause f increasedlongevity ndmedical dvanceshatkeeppeo-ple with serious njuries r illnesses live.Yet

traditionalaretakers tay-at-homeivesandmothers arenow essavailableo provide areon a full-time asis.Dual-workeramilies and moreconcretely,employedwomen are said to be increasinglyoverburdenedndstrainedy the needto meetboth earning nd care responsibilities.t thesame ime,most amilies on'thave heeconomSic means o purchaseare,and tate ervices regrosslynadequate.s MonaFIarrington1999:17) says n a recent opularreatment,wehavepatchworkystems, utwehavecomenowherenearreplacinghe hours rquality f care hatthe at homewomen f previousenerationsro-vided or hecountry."hequestion f howcareis to get done without ubstantialumbers fnonemployed omen o do it has become hesubjectof research nd policyinitiatives. orexample, he AlfredP. Sloan Foundation asfunded everaluniversityesearch entersonwork nd amilyife, ncludingneat mycampusdevoted o "Culturesf Care."The "crisisn care" s just one impetusorrecent ritical xaminationsf the concept ndorganizationf care n modern olitical emoc-racies.Feminist heoristsand researchersorsome imehavebeenexaminingare n its gen-dereddimensions. heirworkmakes t clearthat he currentrisis s aproduct f a privatizedand gendered aring egime n which amilies,ratherhan he largerociety, reresponsibleorcaring nd n whichwomenandother ubordi-nategroups) reassigned rimaryesponsibilityr . .torcareglvlng.The relegation f care o the private phereand to womenhas had twofurther orollaries:the devaluationf caringwork ndcaring ela-tionships, nd the exclusion f both from hearena f equality ndrights.As feminist riticsof liberalpoliticalphilosophyave explained,the veryconceptof citizenshipi.e., full mem-bershipn the community,ncluding eciprocalrights ndresponsibilities)asbeenpremisedntwo conceptual ichotomies. irsthas been asplitbetween he publicand private,with theprivate realm of concreterelationsof caredefinednot only as separaterom,but also inOpposltlono cltlzens lp. ne prlvatereamencompassesmotion, articularity,ubjectivity,and he meeting f bodily eeds,while he pub-


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Symposium 85lic arena f citizenships ruledby thought, ni-versality, bjectivity, nd the ability o act onabstract rinciples. hoserelegatedo the pri-vate sphereand associatedwith its values-women, servants,and children were longexcludedrom ullcitizenship.econdhasbeena dichotomy etweenndependencenddepen-dence, with the ideal citizen definedas anautonomousndividual ho can makechoicesfreely n the market nd n the political ealm.Within he liberal olity, itizenshipupposedlycreated realmof equality n which ndepen-dent ndividualsad dentical ights ndrespon-sibilities, egardlessf differencesn economicstanding nd other attributes. hose deemeddependent, hether ategoricallyas n the caseof women, laves, ndchildren) r by reason fcondition as in the caseof mentalor physicaldisability)acked tanding nd thereforeweredefined s outside he realmof equality Okin1979;Pateman1988).l The fiction of liberalphilosophyhat independent nd autonomousactors xistalsoobscureshe actual nterdepen-denceamong eopleandthe need orcare hateven"independent"eoplehave.Historically,hen, in the UnitedStates ar-ing workwithin he family asnot beenrecog-nized as a public societal contributioncomparableo paid employment.As JudithShklar(1991) has pointedout, eaming hasalways een seen as a responsibilityf citizen-shipbecauset is the basis or ndependence.nthisview,eamers ulfill itizenshipesponsibili-ties and therefore eserve ertain ntitlements,suchas old agepensions, nemploymentnsur-ance,andhealthandsafety rotection.n con-trast,unpaid amily aregivers erformtrictlyprivate esponsibilitiesnddo not fulfillbroadercitizenshipesponsibilities.ence, heyarenotaccorded ntitlements omparableo those ofwage amers.Moreover,the dominant family modelassumeshat supportor dependents nd caregivers comes from the male breadwinner.Historically,he UnitedStateshasprovidedit-tle supportor caregiving,comparedo otherWestern ationswhere aidparentaleave, am-

Kittay 1995)has extended he critiqueo arguethat dependencendrelations f dependenceresimply otaccommodatedn liberalheories f jus-tice,which repremisedn a model f autonomousindividuals ho can makechoices n theirownbest nterests.

ily allowances,hildcare ervices, ousing ub-sidies, ndhealth are overage avebeencom-mon (Fraser nd Gordon1993). During heWorldWarI era,Progressiveeformersushedthough maternalistprograms, uch as theMothers' ensionprogram,o allow widowedwomen o keep heirchildren atherhansend-ing them to orphanages.utpensionsweresolow that singlemotherswere orced o workaswell as care for their children.The Mothers'Pensionwasquickly hased ut. New Deal-erasocialwelfare oliciesnstitutionalizedtwo-tiersystembased on a male breadwinner-femalecaregivermodel.The upper ier consistedofsafetynet entitlementsor malebreadwinners,whichprovidedelativelyenerous,on-means-testedbenefitsuchasunemploymentnsurance,social security etirement, nd disability ay-ments. Dependentsof male breadwinners,including emalecaregivers,eceived ndirectbenefits hrough heir relationshipo a maleearner, iaprovisionsuchas social ecurityur-vivorbenefits.The lower ierforwomenwith-out connectionso malebreadwinnersrovidedrelatively ngenerous, eans-testedwelfare"sin the originalAid to DependentChildren(ADC) and in the laterAid to FamilieswithDependentChildren AFDC).These benefitswereconsidered responseo the neediness fchildren, ot asan entitlementormothers'ar-ing labor (Nelson 1990; Gordon 1994;Abramovitz 996). These programs ere notonlygendered,heywere lsoraced.Black inglemothersn the SouthandMexican inglemoth-ers n the Southwest ere outinely enied eliefon the grounds hat they were "employable."Thus,these womenwerenot seen as "depen-dent"caregiversn the same way that whitewomenwere Mink1994).Yet despite he prevailingdeologyof thefamily sthe realm f care, he growing eed orcarehasgenerateddemandorpaid aregivingasan alternativer supplemento unpaidamilycare.Someof the demand asbeenmetby nsti-tutionsand services dministeredy the stateand nonprofit organizations.The greatestgrowth, owever, as been in institutions ndservices rganizedy or-profitorporatentitiesformedo takeadvantagef paymentsvailablethroughindustry-backed)ovemmentmedicalinsurance. verall, hen,therehasbeena shiftof someportion f caring o publicly rganizedsettings,whetheradministeredy state, non-profit, r for-profitntities.


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86 SymposiumIn these ettings,he actualwork f caringsdoneby "strangers"aidworkers,ometimessupplementedy unpaidvolunteerworkers.Whencarings doneas paidwork, t not only

remainsendered,talsobecomesonspicuouslyracialized.ninstitutionalettingsuchashospi-tals,nursing omes,and group omes,nursingaides ndotherworkershoactuallyo theday-to-day work of caringare overwhelminglywomenof color,manyof them recent mmi-grants.Homecareworkerslso aredrawn is-proportionatelyromthe ranksof womenofcolor Glenn1992).Whencarework s doneby peoplewhoareaccordedittlestatus ndrespectn the societybyreason f race,class,or immigranttatus,tfurther einforceshe view of caringas low-skilled"dirty"ork.This dualdevaluationofcareworkand care workersrationalizeshelowwages nd ackof benefitshatcharacterizecarework.Fromheranalysis f nationalwagedata,PaulaEngland1992:182)concludedhat"beingn a jobrequiringurturingarries netwage penalty of between $.24/hour and$1.70/hour."akingntoaccountuch actorssworkers'ducation,erviceobs nvolving aregiving paid less than comparableobs notinvolving aregiving.Thuschildcareworkersearnedessthanmanicurists;ursing idesandorderliesarnedessthanjanitors;nd psychi-atricaideseamed essthan elevator perators.Oneironic esult s that hosewhocare oroth-ersusually aveto give upcaring ortheirowndependents,et cannotaffordo payanyoneocare or them.Caringwork s consideredow-skilled nd argely hysicalnnature, espiteheimportance f emotionaland psychologicalaspects f caring.Care n institutionalettingss compromisedby a combinationf factors: ressureso cutcosts,governmentegulations,medicalization,and bureaucratizationFoner1994).DeborahStone 1999)notes hatcost-containmentres-sures ffect othprivateor-profitareandpub-lic nonprofit nd taxpayer-supportedacilities.Effortso reducercontrol ostshaveresultedninadequateraining nd chronicunderstaffing.Govemment egulations,eflected n institu-tional procedures,lso requirecaregiversospendimeon extensive aperwork.As workersarestretchedhin, they experiencetressandfrustration, eading to burnoutand hightumover.Bureaucratictructuresnd regula-tions,whichare designedo bothkeep down

costs and protectcare receivers, onethelessoftenrestricthecaring ctivities f caregivers.Forexample, ecause f Medicareegulations,healthcare nstitutionsryto limitstaS o per-forming trictlymedicaland medical-relatedtasks uchaschangingressings,ndnot gettinginvolved n socialandemotional aregiving.2All of thesepressures irectlyaffectthe carerelationship.aregiversomplainbout he lackof timeandautonomyo respondo individualneeds.Care eceiversmaybe subjecto controlsthat maintain"order" nderconditionsofunderstaffinge.g.,through seof sedation rphysicalrestraints).Care receiversmay notreceivehekindof individualizednd ime-con-suming arethatwouldallowthemmaximumdignity ndautonomy.RethinkingCareTo develop ltemativeso thepresent itua-tion,we need to rethink he conceptof care.Becauseare s socloselyassociated ithwom-anhood, eminist hilosophersndsocial heo-ristshavesubjectedareto closeanalysis.Myreading f several heorists f care, includingJoan Tronto(1993), DiemutBubeck 1995),EmilyAbeland Margaretelson(1990),andSaraRuddick1998),suggestsheusefulnessfdefining areasa practicehatencompassesnethic(caringbout) ndan activitycaringor)."Caringbout"ngages oth thought ndfeel-ing, ncludingwarenessndattentiveness,on-cem aboutand feelingsof responsibilityormeeting nother'seeds."Caringor" efersothevaried ctivitiesf providingor heneeds rwell-being f anotherperson.3hese activities

2 Thus,visitingnurses rhealthcarecoordinatorsmaybeallowedo make single omevisit o givedischargedatientsnstructionsn medical elf-care,butnot to take ongero provideocialandemotionalupporto help hemadjusto theirnewlimitations.3 Forthe purposesf thisessay, am deliberatelylimitinghe meaningf care o thatof caringorpeople,ven houghorotherpurposes,nemight

conceptualizeare as encompassingaring orobjects,nimals,nd heenvironment.or xam-ple, political heorist oanTronto(1993:103)defines aring s "aspecies ctivityhatincludeseverythinghatwe do to maintain,ontinue,ndrepairur world'o thatwecan iveaswellaspossible.Thatworldncludes urbodies, urselves,and ourenvironment,ll of whichwe seek tointerweaven a complex,ife sustainingeb."At


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Symposium 87includephysical are(e.g.,bathing, eeding),emotionalare e.g.,reassuring,ympatheticis-tening),anddirect ervicese.g.,driving per-son to the doctor, runningerrands).Thedefinitions not freeof ambiguity,ut it doesestablishomeboundaries.orexample, efin-ingcaring n termsof directmeetingof needsdifferentiatesaring romotheractivities hatmay oster urvival. hus,economicprovisionwould ot beincluded,venthough tmayhelpsupportaregiving.Men areoftensaidto be"takingareoftheir amily" hen heyearnandbringmoneynto hehousehold. espiteheuseof the term are in thisphrase, readwinningwouldnot beconsideredcaring."nfact,eco-nomicsupporthas historically een seen asmen's ontributionn lieuofactual aregiving;simultaneously,aregivinghasbeenviewedaswomen'sesponsibility,n exchangeorbeingsupportedy theprimaryreadwinner.Within hisdefinition f careas a practice,three eatures reimportant.irst, his defini-tiorlrecognizeshateveryone eedscare,notjustthose we considerncapable f caring orthemselves. ftenonlychildren,heelderly,hedisabled,rthechronicallyllare eenasrequir-ingcare,while heneed orcareandreceivingfcare by so-called ndependent dults s sup-pressedrdenied.As SaraRuddick1998:11)notes,"mostecipientsf careareonlypartially'dependent'ndoftenbecomingessso;mostoftheirneeds,'ven hose learly hysical,annotbe separated rom more elusive emotionalrequirementsorrespect, ffection, ndcheer."At the same ime,even thosewe see as fullyindependent-that s, able to carefor them-selves n termsof "activities f daily iving"-may orreasonsf timeorenergy rtemporarycondition eedcare o maintainheirphysical,psychological,ndemotionalwell-being. heymay umto afamilymember,riends, servant,or a serviceprovideror hot meals,physicaltouch,or a sympatheticar.The differences

thesame ime, amadoptingsomewhatroaderdefinitionhan one that restrictsaringonlytomeeting he needsof thosewhocannotcare orthemselves- .g., DiemutBubeck's1995:129)definition f "caringor"as "themeeting f theneeds f oneperson yanotherersonwhereace-to-facenteractionetweenarer ndcaredor sacrucial lement f theoverall ctivity ndwheretheneed s ofsuchanaturehat tcannotpossiblybemetbythepersonnneedherself."

that "independentdults"maypreserveheirsense of independencef theyhave sufficientresources,conomicor social, to "command"care rom thers, atherhanbeingbeholdenorelatives rcharity.A second spect fdefining areaspracticesthat care s seenas creating relationship;sRuddick1998:14) putsit, "[caring] ork sconstitutedn andthrough he relationshipfthosewhogiveandreceive are." herelation-shipis one of interdependence.enerallywethinkof thecaregivershaving hepowern therelationship;ut hecare eceiver,ven fsubor-dinateordependent, lsohasagency/powernthe relationship.Focusingon relationshipsbringsntorelief he influence f therecipientsofcare ncaringwork.Tronto1993)notes hatfortheworkof care o besuccessful,tsrecipi-ents have to respondappropriately-e.g.,screaminghildbetokensailure.n some itua-tionswhere hecarereceivermployshecare-giveror has socialauthoritye.g., due tO thenorm frespectowardlders),hecare eceivermayhavemorepower han hecaregiver.Third, hedefinition fcareaspracticeec-ognizeshatcaringanbeorganizedn amyriadof ways.The paradigmaticarerelationshipsthemother hilddyad,whichoften erves sthetemplateor hinking bout aring.n thismod-el, caring mothering)s viewedasnatural ndinstinctive women's natural vocation.However,his idealizedmodel s deceptive nthatit ignores he actualdiversityn the waysmothering/carings actuallyarried utwithinandacrossultures. aringantakeplacen thehouseholdr in publiclyrganizednstitutions,andcan be carried ut individuallyr collectivelyandas paidorunpaidabor.Much aringtakesplace n thefamily, sually s theunpaidwork fwomen, ut t isalsodoneas paidwork(e.g.,bybabysitters,omehealthaides, nd helike). It also takesplacein the community sunpaid olunteer ork, sin thecaseofchurchorcharitablerganizationshatrundaycareorsenioractivitycenters. t also takesplace ininstitutionsrganizedythe state, orporations,or individuals s commodifiedervicesusing

.palc . careglvers.Care can also be "fragmented,"ividedamongeveralaregiversndbetween private"and"public"ettings.Thus,a parentmay akeultimateesponsibilityorensuringhat a childhas careafterschool but delegate he actualwork f caregiving o a babysitter,relative,


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88 Symposiumpaidhomecareworker, nd/or n after-schoolprogram. arrieThome (1999) foundin herstudyof childhoodsn an urbanmulticulturalcommunityhat parents ftenhave to patchtogethereveral f thesearrangements.WhatShouldOurGoalsBe?To achievea societyn whichcaringsval-uedin all spheres f social ife,all of the ele-ments thework fcaregivingandthepeopleinvolvedcare eceiversndcaregivers)wouldhave obe recognizedndvalued.Hence,a soci-ety in whichcarings valuedwouldbe one inwhich:

* Caringsrecognizeds"real ork"nd sasocial ontributionn a parwithotheractivitieshatarevalued,uchas work-ing,militaryervice,r communityer-vice,regardlessfwhetheraringakesplace n the family relsewherer aspaid runpaidabor.* Thosewhoneedcare(includinghil-dren, heelderly, isabled,ndchroni-cally ll)arerecognizedsfullmembersofthesociety ndaccordedorrespond-ingrights,ocialtanding,nd hevoiceof citizens. hiswouldmean hatcarereceiversreempoweredo have nflu-enceover hetypeof care, hesetting,and hecaregivers,nd hattheyhaveaccessosufficient aterialesourcesoobtain dequateare.* Thosewhodocaring ork reaccordedsocialrecogrlitionndentitlementsortheireffortsimilaro thosewhocon-tributehroughaid mploymentrmil-itaryervice. hese ntitlementsncludeworkingonditionsndsupportshatenablehemo do heirworkwellandanappropriateevel of economic eturn,whethernwagesrsocial ntitlements.

For achof these dealsobeachieved,ddi-tional pecific onditionswouldhaveto beful-filled;these conditionsare also desirableorreasonsf equity ndsocial'ustice.* Caring s legitimateds a collective(public) esponsibilityatherpurelyfamilyrprivateesponsibility.* Access o care s relativelyqually is-tributedndnotdependentneconom-ic orsocial tatus.Ultimately,heidealwould ea societynwhichheres anadequatemountndqualityf care or

all whoneed t i.e.,care hat s indi-vidualized,ulturallyppropriate,ndresponsiveo the preferencesf thosewhoare aredor.* The responsibilityndactualworkofcaringssharedquitablyothat hebur-denofcaredoesnot falldisproportion-ately,as it nowdoes,on disadvantagedgroups-women,acializedminorities,anc mmlgrants.

Some Directions for ChangeRethinkingocialciiizenship:ne importantstep sto redefineocial itizenshipomake arecentralotherights ndentitlementsf citizens.Thiswouldnvolve radicaleversalf thepre-sentsituation,nwhichcare s defined sa pri-vate responsibilitynd therefore utsidetherealm fcitizenship.Makingarecentralo cit-izenshipwould ntail hreeelements:stablish-ing a right o careas a core rightof citizens;establishingare iving sa publicocial espon-sibility;ndaccordingaregiversecognitionorcarryinguta public ocial esponsibility.hesethree lementsre nterrelated.fcitizens avearightto care,then there is a correspondingresponsibilityn thepartof thecommunityoensurehatthosewhoneedcaregetit. Further,if caregiving s a publicsocialresponsibility,thenthosewhodo caregiving ulfillan obliga-tionof citizenshipnd husareentitledo soci-etal benefits omparableo those accordedorthose fulfillingthe obligationto earn forexample, ocialsecurity,eniority, nd retire-mentbenefits.Additionally,constrainthatis specificocaringincontrastoearning)nd hatneeds obe addresseds whatKittay1995)hascalledhe"secondaryependence"f the caregiver. ytaking nthecareof a dependentnd oregoingeaming,unpaid aregiversecomedependenton a thirdparty a breadwinnerrthestate-forresourceso sustain oththose heycare or(primary ependents)and themselves sec-ondary ependents).Historically, .S. welfarepolicyhasbeenpremisedn theassumptionhatsupportor caregivingbelongedo the malebreadwinner,ndthat the stateshouldassumeresponsibilityorsupport f caring nlyin theabsencef a malebreadwinner.ometimes,s nthe caseof black inglemothers,he lackof amalebreadwinneras not seen as adequategroundsorthe stateto stepin. Instead, lacksinglemothersweredeemedo be "employablemothers" ho should upporthemselves nd


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Symposium 89theirdependents.n a stepbackwardrom ec-ognizingaregivers'eedfor support,he U.S.CongressassedhePersonal esponsibilityctin 1996,whichabolished FDC,devolvedwel-fareback o individualtates, ndrestrictedheamountof lifetimebenefits;moststateshavemandatedtringent"workfare"o get singlemothersffwelfare.In contrastto the U.S. welfaresystem,Europeanelfaretateshaveall providedomeforms f family llowanceorcitizenswithchil-dren.Mostcountries avesupportedaregiverswithchildallowances,nd ome vengivesmallpensionso thosewho engage n unpaid arework. n conservative elfare egimes,uchasFrancendGermany,herationaleormaternalallowancesypicallyasbeen ramedn terms fchildwelfarendpromotingatalism,o ensurethesizeandwell-beingf thefuture opulation,ratherhan n terms f thevalueof caring ndsocialcitizenshipightsandresponsibilitiesncaring.Nonetheless,he allowancesavebeendesigned s universalntitlements ot tied toincomeor means esting,unlikeU.S. welfareprograms.nmoreprogressiveocialdemocraticwelfareegimesupportorcaregivingsexten-sive, ncludingllowances,ubsidies,nddirectservices, uch as child careand home aides(Pederson993;Sainsbury996).Transformingitizenship n the UnitedStateso make are entralo rights ndentitle-mentswould equires to challengehelinkedideologiesf individualndependencend ami-ly responsibilityhat I havedescribedbove.The UnitedStates or the mostparthasnotevenrecognized othering/parentingsa con-tributiono the nationalwelfare,nor has itassumed larger ocietal esponsibilityorsup-portingcaregivers. s with previoushistoricchangesnthe boundariesndmeaningsf citi-zenship, t wouldrequire oncerted truggle.Politicalitizenship,n theform fsuffrage,asgraduallyxtendedo include reviouslyxclud-edgroups:onpropertiedhitemen n theearlynineteenth entury, lackmen after he CivilWar,and, inally,womenn 1920.The democ-ratizationf the vote wasachieved nlyafterconcertedtrugglesy eachof thegroupsn thecourse f over100years. ocial itizenshipightsof the welfare tate,includingocialsecurity,unemploymentelief,minimumwage,andjobcreationwereresponseso the politicalmobi-lization f millionsof Americansisplaced ytheGreatDepression.4nthe secondhalfof the

twentiethentury,hesecond ivilrightsmove-mentandsecond-waveeminismmpelledegal,political,andsocialchanges hat dramaticallyexpanded mployment,ducation,and legalrightsorracialminoritiesndwomen.An importantecentexample f expandingcitizenships the success f thedisabilityightsmovementnestablishingederalawsandpoli-cies that requireschools and universities,employers,ndpublic rogramso provideacil-itiesandactivitieshatenabledifferently-abledcitizens o work,study, ravel,andotherwiseparticipaten the socialandculturalife of thesociety.The lattermovementomesclosest oaddressingheissues entralocaring nd ocialcitizenship.t addresseshe rightsof citizenswho havephysical ndmental onditionshatlimit heirphysicalndeconomicndependenceto receiveservicesand accommodationshatallow hem o achieve ocialandpoliticalnde-pendence.5here s thusa precedentorclaim-ing theright o careas essentialormeaningfulcitizenship.Rethinkingheamilys theprimaryiteof care:The previous iscussionbout tatepolicies nsocialcitizenship nd carehas assumedhatmostcare akesplacewithin he family ndiscarried ut as partof unpaid aborof familymembers.However, f we take seriouslyhenotion hatcaringsa publicocial esponsibili-ty, we alsoneedto examine riticallyhe con-ceptionof the family s the institutionf firstresort or caring. ndeed,one can argue hatkeepinghe family sthe "natural"nitforcar-ing relationshipselpsanchorhe gender ivi-sionofcaringabor. eeing amily ndwomen'scaringas "natural"isguiseshe materialela-tionshipsof dependencehat undergirdhearrangement.ut as thosewhocare or othersknow,ove isnot enough:Care equires ateri-al resources.We need thereforeo consider"defamilializing"are n ordero relievewomenof disproportionateesponsibilityorcaregivingand alsoto freebothcarereceivers nd care-givers romeconomicdependencen a malebreadwinner.4 Similarly,eterans'enefits,heG.I.Bill,hospital-ization,and other socialwelfarebenefits ameaboutpartly ecausef veterans'oliticalrganiz-ingefforts.5 Therehas beena recentmovemento franchisecitizenswithmentalllness.


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90 SymposiumUtopian ocieties n the past,rangingromcommunes o the Kibbutzmovement,haveattemptedo transformare,especiallynfantand child care, into a public or communalresponsibilityby collectivizingchild care.Theoretically,communal arrangementsnwhichchildcare s treated s a form f "public"laborequal o otherformsof labor ree thosewho engage n caring romdependence n abreadwinnerndalso reechildrenromdepen-denceon (and hereforeubordinationo) bio-logicalparents. n practice, ollectivized arehasnot eliminatedhe genderedivision f car-ing abor, ince t was tillwomenwhowere he

principal aregiversn publicly rganizedhildcare.Moreover,ollectivizedaregenerally asarisen n homogeneouseligious nd socialistcommunities heremembersharedundamen-talcultural ndpolitical alues.Completelyol-lectivized are wouldbe unlikely nd perhapsundesirablen large-scale ulticulturalocietiesin whichpeoplemaintain ivergentultural ndpolitical alues.Family emainshe main nsti-tutional exus oranchoringistinctiveulturaland ocial dentities.Thus, orbothpractical nd deologicalea-sons it seems likely that families (broadlydefined)willcontinue o value aring, nd hatfamilymembers ill feel responsibleor caringforchildren nd, o a lesser xtent,elderly nddisabledmembersndwillchoose o do so. Thisdoesnot mean hat he family hould e definedin the traditional ayasthe conjugal eterosex-ualhouseholdrthat t should e thefirst esortforcare n all cases.The states' ndemployers'care policiescurrently ecognizedependencyand caringrelationshipsn rather raditionalterms f parents ndchildren whether iologi-cal or adoptive) nd spouses defined hroughlegalmarriage). owever,herearemany thertypesof family elationshat generate elation-shipsof care, ncluding ohabitingouples, ayand esbian ouples, xtended insuchasgrand-parents nd iblings, nd ometimesfictive in"who participaten mutual upport.As CarolStack and LindaBurton 1994) point out inrelationo their tudy f African-Americanam-ilies, men, women,and childrenmaybe "kin-scripted"o care for the childrenof siblings,grandparents,randchildren,unts,and uncleswhen here s no one else able o do so. To theextent hatcaring n the "family"s valued, henotionof"family" ustbe extendedo encom-

passdiverse in relations,ncluding voluntary"or "fictive"elationships.Regardinghe knottyquestion f the prima-cy of family s.the argerommunityn care iv-ing:In a survey onductedn England yJanetFinch 1996),respondentsffirmedhe impor-tanceof kin ties;they indicatedhat "rallyingaround n timesof crisis"was what definedafunctionalamily. he actual egree f responsi-bilitythat respondentselt in particularitua-tions and towardparticular elativesvaried,however, epending n priorrelationshipndcurrent ircumstances.I would lsoadd hat na diverse ociety, here s considerableulturaldifferencen degree f obligation nd n who sincludedn the net of obligation.) n general,Finch's espondentsmphasizedhat relativesshould ot expector take orgranted ssistancefrom other familymembers.AnotherBritishresearcher,ennyMorris,ound hat, in turn,people equiringareoftenprefer ot to relyonfamily. Many of the disabledadult womenMorris nterviewed aid they preferred aidhelpers r helpers rovided y social ervice ohelp from amilymembers, ecause t allowedthemmore ndependencecited n Cancian ndOliker 000:99).Finch 1996:207) argueshat he moral ea-soning f people n hersurveyuggestshe prin-ciple that people houldhave the right ot tohave o relyon their amiliesorhelp:"Topointin anotherway, he family hould ot be seenasthe optionof first esort orgivingassistanceoits adultmembers,ither inancial r practical."Finch s carefulo say hatherpoint s not todeprecate enerosity,are,and supportwithinfamilies, utonlyto see theseas "optional,ol-untary,reely iven" 1996:207).Taken together, he findings romFinch'sand Morris'studies upporthe case that thecommunity,s representedy the state,haspri-mary esponsibilityor careof its citizens, ndthatcitizensn turnhave he right o nonfamilycare.Public olicywould husbe thatallpersonsare entitledto publiclyorganized are or toallowancesrvoucherso pay orcare, egardlessof whether r not familymembersreavailable

.to provlc lt.Rethinking Paid CareAs noted in the introduction,he sheerdemandorcare, he inability f familieso pro-vide all care,andeconomic ncentiveso com-modify arehavebrought bout ignificanthiftof caringo paid aregivers.his s especiallyhe


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Sytnposiutn 91casefor thoseneedingphysically emanding,round-the-clockare, uchaschildrenr adultswithseveremental ndphysical isabilities,ndelderlywithdementia r Alzheimer's. uchofthe lattercaretakesplace n institutionalet-tings,nursing omes,hospitals,ndresidentialfacilities, herehe intensiveace-to-facearingis donebynursing idesandothernonprofes-sionalworkersnderhesupervisionndauthor-ity of administratorsnd medicalandnursingprofessionals.Thus, any schemeto createa society inwhich caringis valuedin all spheresmustaddress he growingcommodification nddefamilizationf care.We needto thinkaboutthechangeshatoccurwhen aringsmade ntoa publicrather han private unction,when"strangers"atherhan amilymembersrovidecare, when care giving is paid ratherthanunpaid, ndmost importantly hencaring sregulatedndcontrolled y bureaucraticulesandhierarchy.Transferringaring romprivatehouseholdinto publiclyorganizedettings nserts"thirdparties"ntothe caring elationship.othcare-givers ndcare eceiversrehemmednbyrulesandregulationsbout ime spentandkindsofcarethat arecovered e.g., shopping). oner(1994)andothershavearguedhatthe "ironcage" f bureaucracyhat constrainseople norganizationsreatesundamentalilemmasorcareworkershoare aught etweenonflictingideals.Whereasureaucraciesperateccordingto principlesof standardization,mpersonalrules,andefficiency,arerelationshipsncour-age individualreatment,personal ies, andpatience.Bureaucraticulesandcontrolwere nstitut-ed because f publicityboutwidespreadbuseandneglectof patients.Having onean ethno-graphictudy f a nursing ome n New York,Foner1994)agreeshatbureaucraticulesandoversightare necessary o protect elderlypatients,andthat nursing ides,who do theactualphysicalare, eeding, leaning, athing,and so on, cannot be allowed to actautonomously.owever,herulesandthe waytheyareadministeredmphasizeefflciency"ngettingphysical aretasksdone,meeting imedeadlines,ndmaintainingecords. et,as TimDiamond1988:48) found n his ethnographyof anursingome, motionalare s essentialothenursingide's ob:"holdingomeoneryingto gasp orbreath" r talking o residentso

"helphemholdon to memoriesf theirpast."Diamondbservedhatthesekinds femotion-al supportwere not listed in the aides' obdescriptions,or werethe aidesrewardedortheseactivities.n thenursingome hestudied,FoneroundhatAna,a nursingidewhoregu-larly ooktimeto talkto patients, ndcomfortor reassurehemwhilebathinghemor chang-ingthem,wasconstantlyeprimandedorbeinginefficient, hileMs.James, n aidewhoneverspoke o patients ndhandledhemroughlyogetthem hroughheirroutines, aspraisedysupervisorssa model ide.Deborahtone 2000) oundhathomecareworkerslsofaceda conflictbetweenbureau-cratic ules ndprinciplesnd heirownethicofcare.Thus, heyoftenstretchedr evaded ulesand supervisorso providepersonal are,orspentoff-workimeor money o provide xtraservices.The variousthnographictudies evealhatmany areworkersoprovide ualitymotionalcare,buttheydo so"aroundhe fringes"o thattheir kills ndeSort reunrecognizedrtheydoso in directdefiance f the rules.Thesestudiespoint o theexistence f"oppositionalultures"inwhichworkersooperateoprovidehe kindof care hatthe bureaucratictructureoesnotrecognizerdisallows. ne casestudy f a psy-chiatrichospital Lundgrent al. 1990)foundthequalityf carewasexcellent ecausesychi-atric echnicians hodid thedailycarecarvedoutareas fautonomyn which heycould ct naccordance ith an ethosof care.Becausehepsychiatricechnicianshad opportunitiesointeractreelywhenresidentswere n classes,theydevelopedamaraderie.orkersupportedoneanothero go beyondhepoliciesheycon-sidered nreasonabler againsthe interestsftheresidents. heydevelopedustoms,uchas"timeout" o leavethe unitwhenthey wereabout o losecontrol.Thesekindsof practicesthat workers hemselvesdevelop could beincorporatednto organizational ractices.Encouragingteamapproachn whichworkersmodelandsupportachother orsensitive ar-ing would be one such salutarypractice.Proceduresouldalsobe reformedo build nmore pportunityndrecognitionoraideswhoshowkindnessand go out of their way forpatients.OrganizationsouldoSermore egulartrainingn sensitivityndemotional spects fcare, includeemotionalcaringworkin jobdescriptionsnd worker valuations,nd pro-


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92 Syrnposiurnvide a reward ystem or caregiverswho gobeyond he callof duty o helppatients.At the professionalevel, the bureaucraticandchart-keepingmperativesf caring nstitu-tions ouldbe harnessedo build n accountabil-ity for the socialand emotionalwell-being fcare receivers.Foner ( 1994) notes that onereformhat has been adoptedn many nstitu-tions is the psychosocial odelof care,whichpaysattention o the emotional nd socialaswell as the physical spects f caring.The psy-chosocialmodel nvolvesa case managementapproachhat includes oth healthand socialserviceneeds of care receivers.CancianandOliker (2000) describea "ClinicalPracticeModel" f nursing hat BonnieWesorick asdeveloped nd introducedn several ospitals.This modelchallenges he medicalmodelbyemphasizingholisticaring."t does o by suchmethods s keepinga record n each patientthat ncludes ersonal istories, eligious rien-tation, familysituation,and individual on-cerns. mportantly,t calls orwriting planofcarethat documentshe patient's eeds,con-cerns, and problemsand an individualizedapproacho reachdesired utcomes.Encouragingaregiverso focus n social ndemotional spectsof care may be salutarynsome espects. etthere s an inherent itfall oempoweringaregivers:t mayexacerbatehealready nequal elationshipetween aregiversandcare eceivers. aregivers ay eelthat heyunderstandhe needsof carereceivers ndthattheyareacting n theirbest nterests. owever,carereceiversmighthave different aluesandpriorities.To the extent that care receiversdependemotionally nd physically n theircaregivers,hey may eel they have no choicebutto defer o the caregiver'sudgment.Thus, an additional oncern houldbe toensure hat carereceivers re givenvoice andinfluence ver heircare. n the caseof mental-ly competent dults equiring omecareassis-tance,for example, t wouldbe preferableorthem o be givengrants rvoucherso hire heirown caregivers ather han being assignedhelperby a social ervice gency. everal f the50 disabled omen nterviewedyJennyMorrisin England aidthey especially aluedhelperstheyhiredandpaid or themselvesather hanthose sent by government ocial services,because hey had greater ontrol.One womansaid hat only whenshe started mploying erownhelperdidshe feel she couldpayattention

to herownappearance.he hadherpaidhelperassistherwithclothing ndmakeup, hich hefelt justifiedn doingbecause They eedto bepatient nd 'mpayingor hatpatience o I feelOKabout xpectingt" quotedn Cancian ndOliker2000:99). One group lready asdirectaccess o governmentunds or paidcare.TheDepartmentf Veterans' ffairs as a programfor UniversalAid and AttendanceAllowancethat givesdirectunrestrictedashpaymentso220,000 veterans o pay for homeworkersrattendants Cancianand Oliker2000: 155).The rightof veterans o state supported aidcare s acknowledgedecause f their"serviceothe country."What s needed s a moreuniver-salapproachhatextends ntitlementso nonfa-milialpaid are o all citizens.In short, othpaid aregiversndreceiversfpaid care need to be empowered.ometimes,when the interestsof caregiversand carereceiversntersect,t makes ense or them toorganizeogether. or xample, hen ocial er-vice agency udgets recut andhomecareandother services re reduced, aregiversmay beforced o servemore lients esswellandclientsdon'tget the care heyneed.During he 1980sand 90s, oalitions f homehealth areworkers,care receivers, nd communityeadershaveformed o improvewagesandbenefits or careworkers. inceservices repaid romMedicaidor otherpublic unds, are eceivers illsupportwage ncreasesor careworkers,speciallyf itmeans hattheircaregivers illcontinue atherthan leaving or higher-payingobs in otherfields Cobble 996;SEIU1999).Rethinking Employment PracticesChanges n employment ractices re alsoneeded o make t possible or people o inte-gratework nd areand o thatcare iving s notpenalized.A smallproportionf citizens ur-rentlybenefit romprivate-sectornitiatives ycorporationshatrecognizehe caring esponsi-bilities f their mployees.omeof these orpo-rate employers rovide hild care and unpaidleaves o care or children r elderly elatives.Model programsnclude those by CitiBank,StrideRite, andCampbell'soups,whichpro-videchildcareon ornear heirpremises. ristolMyers-Squibbas a family eave policy foremployeeshat covers are or elderly elatives(Cancian ndOliker 000:75, 155).The passage f the 1993Family ndMedicalLeaveAct marked firststep in developingnationalpolicythat supportsombiningwork


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Sytnposiutn93andcare.The actrecognizesare esponsibilitiesfor hoseengagedn paidwork ndaccepts ub-lic responsibilityo thatdependentsanreceiveadequateare.As in manyEuropeanountries,the stated oalof the legislation as he devel-opment f children ndpromotionf the familyunitrather hanrecognitionf caregivingas asocialresponsibility.he preambleo the Actrecognizesob security ndparenting s impor-tant for citizens'well-being nd acknowledgesthe role of the state in supportingboth.However, overage s extremely imited. Bymandatingnly unpaid eave,the governmentaccommodatesarerather han ully upportingit, since ewparentsanaffordo use he unpaidleave.Moreover, y exempting mployers ithfewer han50 employees,he law eaves n esti-mated alfof the workforcencovered 56 per-centof women nd48 percent f men,accordingto Spalter-Roth and Hartmann (1990).Ultimately,when employer nterestsare atstake, mployer eedsareallowedo trump areneeds.Finally, he Act recognizes ependencyonlywithin raditionalonjugalamily elation-ships-spouse, children,and parents Kittay1995). t thereby refamilizes"arebyexcludingother ypes f voluntaryelations f dependencyandcare.Besidesparental nd care-givingeave andchildcare, mploymentolicymust onsiderhesheer numberof hours needed for care. Anational urveyof a representativeampleof1509 English-speakingouseholds ound anaveragef 17.9hours f caregivingperweekperhousehold,while several therspecializedur-veys founda muchhighernumber f unpaidcaregiverours n households ithpersons av-ing specificmedical onditions r disabilities(Arno et al. 1999). At the same time, workhours f employed mericansavebecome helongestof those in all industrializedations,accordingo a 1997UnitedNations urvey. hesurveyound hatU.S. workersveraged0 per-cent morehours hanNorwegiansnd 25 per-cent more than the French calculatedromfiguresn theSanFrancisco hronicle,eptember6, 1999).

In combination ith ackof state upportornonemployedcaregivers, ong work hoursincrease he strainon U.S. workers ho havecare esponsibilities.omparisonsf worker ro-ductivity uggest hat the longerhoursof U.S.workersavenot producedomparablencreas-es in productivity.hus eductionf work ours

can be justified n economic s well as socialwelfare rounds. he40-hourweekwas he goalof labormovementstarting fter he CivilWar,but it wasonly whenorganizedaboracquiredsufficient oliticalpower n the 1930sthat itbecame he standard.t involved he recogni-tion of workers'ights or a life apart rom hejob. It is now time to recognizehe realityofworkers' ultipleesponsibilitiesorearning ndcaring yreducing ork ours hrough combi-nationof reducinghe standardor "full-timework" nd ncreasingacation nd eave ime.Closing ThoughtsI have focusedon specific deological ndstructural onstructions f caring.But ideasaboutandstructuresf caring re ied to otherideologies ndstructureshat they support ndare supportedby. Achieving the kinds ofchanges eeded o createa society hat valuescaringwill require ransforminghe wayswethink aboutourselves, ur relationships ithothers, he family, ivil society, he state,andthe political conomy.Ultimately,he transfor-mation of caring must be linked to majorchanges n political-economictructures ndrelationships.erhapsmost undamentally,heliberal onceptof "society"s madeup of dis-crete, ndependent,nd reely hoosingndivid-ualswillhave o be discardedn favor f notionsof interdependence among not whollyautonomous embersf a society.ReferencesAbel, Emilyand Margaret elson, eds. 1990. Circles fCare.Albany:State Universityof New YorkPress.Abramovitz,Mimi. 1996. Urlder ttack:Fightirlgack.

New York:MonthlyReview Press.Arno, Peter S., Carol Levine, and MargaretM.Memmott. 1999. "The Economic Value ofInformal Caregiving." Health Affairs 18 2 ):182-87.Bubeck, Diemut Elisabet. 1995. Care, Gerlder,arldJustice.Oxford:ClarendonPress.Cancian, FrancescaM. and Stacey J. Oliker. 2000.Carirlgarld Gerlder.Thousand Oaks, CA: PineForgePress.Cobble, Dorothy Sue. 1996. "The Prospects forUnionization n a Service Economy."Pp. 333-58in Workirlg rl a Service Ecorlomy,edited byCameron MacDonald and Carmen Siriani.Philadelphia: empleUniversityPress.Diamond, Timothy. 1988. "Social Policy andEverydayLife in Nursing Homes: A CriticalEthnography."p. 39-55 in TheWorth f Womerl'sWork: A QualitativeSyrlthesis, dited by AnneStatham, Eleanor M. Miller, and Hans O.


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94 SyrnposiurnMauksch.Albany:State Universityof New YorkPress.England,Paula.1992. Comparable orth:Theories rldEviderlce. awthorne,NY: Aldine de Gruyter.Finch, Janet. 1996. "Family Rights andResponsibilities." Pp. 193-208 in CitizerlshipToday: The Corltemporary elevarlce f T. H.Marshall, dited by MartinBulmerand AnthonyM. Rees. London:UCL Press.Foner,Nancy. 1994. TheCaregivirlgilemma:Work rlthe Americarl ursirlgHome. Berkeley:Universityof CaliforniaPress.Fraser,Nancy and Linda Gordon. 1993. "Contractversus Charity: Why Is There No SocialCitizenship n the United States?" ocialist eview212(3): 45-68.

Glenn, Evelyn Nakano. 1992. "FromServitude toService Work: Historical Continuities in theRacialDivisionof PaidReproductive abor." igrls18: 1-43.Gordon, Linda. 1994. Pitiedbut Not Erltitled: irlgleMothers rld heHistory f Welfare 890-1935. NewYork:FreePress.Harrington,Mona. 1999. CarearldEquality:rlverltirlga New FamilyPolitics.New York:Knopf.Kittay, Eva Feder. 1995. "Taking DependenceSeriously:The Family and Medical Leave ActConsidered n Lightof the Social Organization fDependencyWorkand GenderEquality." ypatia10: 8-29.Lundgren,Rebecka Inga and Carole H. Browner.1990. "Caring or the InstitutionalizedMentallyRetarded:Work Cultureand Work-Based ocialSupports." p. 150-172 in Circlesof Care, editedby Emily Abel and MargaretNelson. Albany:State Universityof New YorkPress.Mink, Gwendolyn. 1994. The Wagesof Motherhood.Ithaca,NY: CornellUniversityPress.Nelson, Barbara.1990. "The Origins of the Two-Channel Welfare State: Workmen'sCompensation nd Mothers'Aid." Pp. 123-51 inWomerl,The State arldWelfare, dited by LindaGordon.Madison:Universityof WisconsinPress.Okin, Susan. 1979. Womerl irl WesterrlPoliticalThought. Princeton, NJ: Princeton UniversityPress.

Pateman,Carole.1988. TheSexualCorltract.tanford,CA: StanfordUniversityPress.Pedersen,Susan. 1993. Family,Deperlderlce,rldtheOrigirls f The WelfareState: Britairl rldFrarlce,1914-1945. Cambridge:Cambridge UniversityPress.Ruddick, Sara. 1998. "Care as Labor andRelationship."Pp. 3-25 irl Norms and Values:Essays rl heWork f Virgirlia eld,editedbyJoramG. Haber and Mark S. Halfon. Lanham, MD:Lanham,Rowman& Littlefield.Sainsbury,Diane. 1996. Gender,Equality rldWelfareStates.Cambridge: ambridgeUniversityPress.SarlFrarlcisco hrorlicle. 999. "UN Says AmericansAre the HardestWorkers." eptember , p. 3.Service Employees' International Union (SEIU).1999. "Drive o ImproveL.A. HomecareTakesBigStep Forward." ressRelease.Shklar,Judith.1991. Americarl itizerlship:he Questfor Irlclusiorl.ambridge,MA: HarvardUniversityPress.Spalter-Roth,Roberta M. and Heidi I. Hartmann.1990. Urlrlecessaryosses:Cost to Americarlsf theLack of Familyarld MedicalLeave. Washington,DC: Institute or Women'sPolicyResearch.Stack, Carol and Linda Burton. 1994. "Kinscripts:Reflectionson Family,Generation,and Culture."Pp. 33-44 in Motherirlg:deology,ExperierlcerldAgerlcy, dited by Evelyn Nakano Glenn, GraceChang,and LindaForcey.New York:Routledge.Stone, Deborah. 1999. "Care and Trembling."TheAmericarl rospect 3 (March-April): 1-67.. 2000. "Careas We Give It, Work as WeKnow It." In Care Work:Gerlder,LaborarldtheWelfareState, edited by Madonna Harrington-Meyer.New York:Routledge.Thorne, Barrie. 1999. "Pick-Up Time at OakdaleElementarySchool: Work and Family from theVantagePoints of Children."WorkingPaperNo.2. Center for Working Families, University ofCalifornia,Berkeley.Tronto, Joan. 1993. Moral Bourldaries: PoliticalArgumerlt or arl Ethic of Care. New York:Routledge.

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