The Nordic welfare regimes are often referred to as ‘caring states’ (Vabø and Szebehely, 2012), care-work-friendly (Wrede et al, 2008), social-democratic welfare regimes characterised by universalism (Esping-Andersen, 1990) and as potentially women-friendly welfare states (Hernes, 1987). However, major changes have taken place within these welfare regimes prompted by policies promoting neoliberalism and austerity. Neoliberalising¹ has involved a wave of change with marketisation (contracting out) of elder care, self-responsibilising the elderly with concepts of ‘self-care’ and ‘re-ablement’ as well as the increasing amount of documentation, performance measurement and quality control in institutions providing care (Clarke and Newman, 1997; Meagher and Szebehely, 2013; Dahl et al, 2015; Dahl, 2017). Simultaneously, there are recurring recruitment problems with training and retaining sufficient numbers of professional carers for the elderly and for pre-school children (Wrede et al, 2008; Danmarks Radio, 2018). Given these profound changes, the question arises as to how to describe these changes and their effects upon care.

A convenient term that has emerged to describe these trends is ‘care crisis’. The ‘care crisis’ concept was first introduced two decades ago by US sociologists (Phillips and Benner, 1994; Hochschild, 1995). The use of the term ‘crisis’ signals a derangement of matters, which can be thought of as relating to arrangements, decisions and beliefs (Wolin, 1969: 1080). While ‘care crisis’ can be seen as a useful shorthand for a wide gamut of trends, there are also risks in simply using a general, aggregate term and transferring an Anglo-American framing of care crisis into a different context.

This book began by asking whether it is justified to talk about the existence of a care crisis in the Nordic welfare states that have implemented neoliberal reforms and, if so, what are the characteristics of this crisis and the major areas of concern in terms of gender equality and welfare state sustainability? The book concludes that it is possible to talk about a care crisis in the Nordic welfare states, and that there are issues of concern regarding both gender equality and welfare state sustainability. It is an uneven crisis, which takes different forms in the various fields of care and in the different Nordic states. Although the care crisis might not be fully visible yet, it produces insufficient and inadequate care, sometimes poor working conditions and too little time for the care workers to care for themselves, their families and communities. However, the Nordic welfare states have also made a difference to the depth of the crisis: regulations and institutions have prevented the development of a full crisis. Moreover, care workers, care-givers and care-receivers and their organisations are taking part in social struggles against the consequences of neoliberalism and financialisation. Yet, the outcome has – so far – been less caring and less gender-equal Nordic states.

In the introduction, we argued in favour of rethinking the notion of a care crisis. We defined a care crisis as characterised by inadequate resources for care and the absence of ‘good-enough care’, applying the theorisations of Hochschild (1995) and Fraser (2016) and combining them with the insights of Phillips (1994) considering the industries of care. In this book, the contributors have directed their attention to what happens inside the Nordic welfare state(s).

The question of care, and how to organise it, is globally pertinent and touches not only gendered care and dependencies, but also ethics of care, reflected in the ways in which care is governed and what becomes emphasised in the analyses. Societal discourses on the governance of care revolve around the issues of quality (ethics), costs (economy) and remedies (technology). The three discourses hold separate realms in research but enmesh in everyday life, visible for example in the reactions, actions and repercussions in the current COVID-19 pandemic. Globally, the COVID-19 crisis societal discourses seem to constitute three differing logics: the costs to economies due to lockdowns and restrictions; the costs to citizens’ health and lives due to loosening restrictions; and the restoration of ‘normality’ by vaccination as remedy. Ethics cut through these discourses by questioning, for example, the values in the political decisions and the politically set national priorities and reactions.

Seeing care as an ‘informal’ or ‘formal’, or ‘market’ or ‘non-market’ activity aligns with other societal contracts and arrangements that are part of societally accepted patterns, cultures, policies and gendered social contracts (Kovalainen, 2004), but also vehicles for transferring embedded discriminatory and/or unequal practices and processes. With the emergence of market governance mechanisms, the categories of ‘public’ and ‘private’, and formal and informal, are blurred and fluid. The bending of boundaries in the organisational and institutional arrangements is reality (for example Kovalainen and Sundin, 2012; Sandberg and Elliott, 2019). The creation of quasi-markets (for example Le Grand and Bartlett, 1993) intensified ‘marketisation’, that is, the adoption of market as a governance form in the public sphere.

The Nordic welfare states are often described as ‘potentially women-friendly’ due to the availability of publicly provided services that support women to combine paid work and caring responsibilities. While such services reduce the extent of informal care tasks and increase the possibilities of labour market participation for large groups of women, paid elder care workers have often been neglected in this narrative of women-friendliness (Theobald, 2003; Dahl, 2004). Therefore, care workers face the risk of being invisible in the feminist dialogue concerning a ‘care crisis’. Recurring reports on the problematic work situation in Swedish elder care (for example Work Environment Authority, 2015, 2020), calls for analyses of care workers’ position in society and what is needed in terms of redistribution of material needs and institutional recognition to achieve gender justice (Fraser, 2007).

Long-term care for older adults is generally characterised by austerity, cost-cutting and new market-inspired models of governance in the public sector (Rostgaard et al, 2012; Deusdad et al, 2016). These wide-ranging trends and changes in the public sector influence women generally because they are the primary users of many of the state benefits, and women tend to fill the gaps of state withdrawal by providing additional informal care (Anttonen, 1990). Women are also affected as paid workers, since the public sector is highly staffed by women. Within the Nordic labour market and the rest of the Anglo-Saxon world, frontline care staff are part of a low-status, low-paid and low-skilled group (Waerness, 1984; England, 2005; Weir, 2005; Razavi and Staab, 2010; Newman, 2017). In paid care work, women are the ‘default caregivers’ (Penz and Sauer, 2017).

The aim of this chapter is to place Nancy Fraser’s care crisis concept in the Nordic welfare society context. Fraser has developed her discussion of the care crisis with a focus mainly on the Anglo-American model, that is, in societies very different from the Nordic welfare model regarding the organisation of reproductive work, gender equality policies and labour market regulation. In her broad framework, ‘crisis of care’ is ‘best interpreted as a more or less acute expression of the social-reproductive contradictions of financialised capitalism’ (Fraser, 2016: 99, emphasis added). In this chapter, we argue that her understanding of the role of reproductive work in capitalist societies today, as well as the idea of a deepening care crisis also makes sense in a discussion of Nordic societies. There is, however, a need to take into account the historically specific institutional configurations, policies and social practices that render the dynamics of care crisis in the Nordic welfare states different and variegated, but nonetheless fundamentally engender crisis tendencies that are becoming more and more visible.

Fraser’s main argument is that reproductive work is rendered invisible, even though it constitutes a necessary ‘background condition of possibility’ for production (Fraser, 2016). This argument is not new. Feminist care theorists argue that care is at the core of any society (for example Tronto, 1993, 2013, 2017; Kittay, 1999). Feminist economists (Dalla Costa and James, 1975; Waring, 1988; Ferber and Nelson, 1993; Henderson, 1996; Folbre, 2001, among others) have argued that all production of economic value is based on unpaid work and resources whose value – and costs – are not reflected in the formal economy, and that the appropriation of unpaid work and unvalued resources is central to the accumulation of capital on a global scale (Mies, 1986).

Care, and being in need of care at various points of your life, is a condition of our existence. We can’t live without giving and receiving care. You wouldn’t be here reading this text without having been cared for as a baby. Being fed, bathed, nappies changed and having clean clothes put on. Care is embedded within practices in various institutional contexts, including the home, the hospital, the crèche and the nursing home. In these contexts most people are ‘doing good’ (Mol, 2007) in relation to those that are currently sick, disabled/challenged, children or fragile. Those that are doing less well need to receive help, support and coaching in a dialogic, ongoing, although possibly fragmented, process and adjust to the care provided. Throughout life we experience being dependent upon others to maintain our existence – or improve it. Care can be a burden, and care can create pleasant feelings of belonging, doing something together, doing good, and being seen as someone in need of care, or someone providing care. Care can be paid and unpaid, but regardless of this, it constitutes ‘care work’ as one of the founding mothers of Nordic care research, Kari Wærness, has argued (Wærness, 1982).

In this book we discuss the status of care work, and especially paid care work, in the Nordic welfare states in light of the neoliberal turn in welfare politics, and what this means for gender equality and the sustainability of the Nordic welfare state. When care work is commodified i.e. paid either in a market or by the state, it simultaneously becomes a public form of care work.

For several decades now, elder care services have been characterised by recurring crises in Finland. In 2006, a political scandal erupted when allegations became public of insufficient staff ratios in Koukkuniemi, the largest unit of institutional care for older adults in the Nordic countries at the time (Yle, 2006). In 2019, a scandal broke when the National Supervisory Authority for Welfare and Health (Valvira) ordered the closure of several care homes owned by private care companies due to severe neglect in the quality of care, and announced that they were investigating several complaints regarding deficiencies in elder care (Valvira, 2019). Valvira’s lawyer described the situation in the first care home as an ‘acute crisis’, which is why it was closed down immediately (Tiessalo, 2019). The situation was described as a ‘care crisis’ by the media, expert commentators and opposition politicians as well as the Regional State Administrative Agencies (AVI, 2020).

Care crisis is understood here as referring to a situation in elder care that has reached a critical phase in relation to the quality of care, also involving public concerns over the quality and conditions of care work. While a crisis is commonly understood as a temporary disruption, for many people in the world, such as older adults in poor health, a crisis can become a lasting, endemic condition. Nevertheless, when a crisis has been identified by central actors in the field, action needs to be taken.

In Finland, a common line of action is routinely suggested as a solution to the crisis of elder care: improvements in the management of care.

Care research does not take place in a vacuum, especially in the context of a global pandemic that has magnified the care crisis dynamics discussed in this book. Perhaps the COVID-19 crisis will actually give impetus to a more enduring, transformative restructuring of care and justice. And yet there is only limited room to reflect on these developments in the format of academic book chapters written mainly in the pre-COVID-19 period. How then can we make sure to position this book in its time, so that you, the reader engaging with our discussions, get a sense of the unsettling, disruptive context in which it has been finalised?

This postscript brings together a range of vignettes by some of the book’s contributors on dimensions of COVID-19-related developments in their respective context. Taking the care crisis concept as reference point, each vignette describes a concrete moment, development or process that offers reflections on the discussions in the book within the COVID-19 context. Carsten Juul Jensen provides a glimpse from the perspective of a practitioner of care. Birgitte Ljunggren highlights the ambiguities of the impact of policy reactions to COVID-19, where unintended consequences have indeed shown what early childhood care could look like if there was sufficient political will. Carsten Juul Jensen’s poetic rendering of an interview with a nurse volunteering for the COVID-19 unit conveys a feeling of how mundane and at the same time existential hospital care is, on so many levels. Finally, in a reflection on what it means to write and edit a book on the care crisis, Laura Horn highlights the disruptive context of academic work in the time of COVID-19.

The field of early childhood education and care (ECEC) is characterised by great diversity in status and organisation in different countries. Care for children is commonly heavily dependent on unpaid and non-formal care work by mothers and relatives, or poorly paid nursing and child-minding, for instance by migrant workers (Acker, 1990; Bäck-Wiklund, 2004). Consequently, a common strategy for the valorisation of care work pursued by feminist policy-makers and researchers, in the Nordic countries in particular, is that of professionalisation or ‘professional projects’ (Witz, 1990; Williams, 1996; Dahl, 2010). In Denmark, this political strategy has been advocated not only by the labour unions of the (social, educational and health) care workers and by their educational institutions. The possibilities and advantages of professionalisation have also been taken up and promoted as part of policy discourses and regulatory reforms around the ‘modernisation’ of public services as a means to enhance the quality of care, and the legitimacy of public service and reproduction on a broader scale (Wrede et al, 2008; Dahl, 2010). Seen from this point of view, professionalisation is not a controversial strategy.

Taking a closer look at the underlying interests and explicit reasons for professionalisation, there is however less consensus among the advocating agents. In fact, discussions of professionalisation expose controversies not only about the aims, but also the means of professionalisation. Following Witz (1990), this chapter argues that the potential of professionalisation as a strategy rests on the validation of the substance of the professional practice at its core: on the one side, the basic understandings and recognition of the services rendered; on the other side, the status of professional knowledge, qualifications and necessary judgements, values and ethics needed to act with professionalism to secure the quality of the tasks and services provided.