Deficiencies in old age care are some of the most pressing human rights concerns in mature welfare states.
This book radically challenges the ethics of viewing care as a tradeable commodity and introduces a novel framework for understanding and analysing social care through the concept of ailment. Providing examples from the British and Finnish welfare states, it demonstrates how ailment shapes societies from the micro to the macro level. Addressing the marketisation and financialisation of care, the authors bring to light increasing inequalities in care.
This book argues that ailment is part of human life and society, and therefore the politics of care should begin with a politics of ailment.
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.
This chapter introduces the concept of ailment, which is about generalised care needs, including the need for self-care. Ailment does not indicate an immediate dependency on others. Rather, it is a human condition and force that mobilises emotions, actions and relations. Responses to ailment extend from concrete encounters between human beings in the immediate environment to political and institutional responses in societies across the world. The political relatedness that ailment enacts in the world and the different kinds of social orders that emerge through different personal and collective responses to the needs of ailing subjects are discussed.
This chapter’s sections – ‘Sanctioning the ailing’, ‘Protecting the ailing workforce’, ‘Acknowledging ailment’ and ‘Failing the ailing’ – trace how ailment as a social force has historically manifested itself in social and care policies in western societies. In pre-modern Europe, workhouses and other disciplinary institutions were used to control and sanction ailing individuals. Later, social policies began to recognise the need to protect the ailing workforce to secure the demands of an industrialising world. After the Second World War, social and care policies began addressing ailment throughout the life course, and collective and public responses to the needs of ailing individuals expanded to several areas of life as part of the modern welfare state. The transformation of the welfare state and the austerity politics of recent decades have undermined the acknowledgement of ailment in social and care policies. Through this exploration, it is demonstrated how ailment creates various relations and responses and how these responses combine elements of care, control and profit making to different degrees, depending on the historical, political and social context.
This chapter examines how the marketisation and financialisation of care are transforming and challenging the social and care policies developed during the heyday of the welfare state. Marketisation and financialisation significantly affect these politics of ailment by introducing the mechanisms of profit making, competition and choice as solutions to human ailment and by replacing the ailing subject with a market actor as the target of social policies. Nevertheless, ailment continues to be a mobilising force that simultaneously generates both social and care relations and market and financial activities. The problem with these trends and the neoliberal vision on which they rely is that the logic of the market is different from – and largely incompatible with – responses to ailment that are based on a logic of care. While businesses perceive ailment as producing unlimited market opportunities, they fail as to the more profound recognition of ailment as an existential human condition warranting ethically sound responses such as affordable care.
This chapter demonstrates how ailment mobilises concrete, embodied and emotional responses in immediate social encounters and care work, along with discussing the gendered, racialised and classed divisions of care labour that extend to a global scale. The relatedness and variance inherent in ailment – and care as a key response to it – mean that there is a large degree of unpredictability in the chain reactions that ailment creates. Moreover, as responses to ailment may include neglect, violence and humiliation, a variety of ethical and political identities and structures can ensue. Societal structures and the organisation of care work specifically affect and ail those who have less power, influence and money: typically, working-class women, racialised minorities and international migrants. The varying responses to ailment in the world may be imagined as an emergent and constantly changing network of relatedness and affects that organise societies. Within these local and global networks, those caring for others are also affected by their care relationships and may suffer various kinds of distress, which are discussed in terms of caregiver ailment. Political and institutional actors who ignore the relationality of care and often disregard the needs of the caregiver play a major role in engendering and perpetuating caregiver ailment.
This chapter concludes the book by focusing on today’s circumstances, with ailing bodies having become sources of profit making and the ailments of their caregivers largely unacknowledged or misrecognised. It is time to change how humans are perceived. The notion of homo aegrotus – the ailing human – recognises ailment as a permanent and all-encompassing feature of societies. It generates a variety of responses and creates webs of connections between individuals, families, communities, regions and countries. When approaching the field of care with the concept of ailment, a new political regime becomes imaginable. The new political regime derives from ailment in its two senses: the existential state of human ailing, and the affective or responsive state of being bothered by it. The ailing earth is also implicated here, emphasising human interdependency with biodiversity and ecosystems and thus opening possibilities for research into and the development of sustainable, caring policies. From this perspective, large portions of modern societies appear to be built around ailment.