Regulated fragmentation organises care of the vulnerable older people into elements provided by the caring family, professionals, care workers from public/private providers and volunteers. In this exploratory article, I consider the role of the stranger in modern care management, a role that has up to now been neglected or been understood largely in terms of a migrant worker. Using literature, applying discourse analysis and drawing upon Simmel and Kristeva, I outline dimensions of the stranger and the unfamiliar that can further research and policy considerations.
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.
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.
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).
In this insightful collection, academic experts consider the impact of neoliberal policies and ideology on the status of care work in Nordic countries. With new research perspectives and empirical analyses, it assesses challenges for care work including technologies, management and policy-making.
Arguing that there is a care crisis even in the supposedly feminist Nordic ‘nirvana’, this book explores understandings of the care crisis, the serious consequences for gender equality and the hitherto neglected effects on the long-term sustainability of the Nordic welfare states.
This astute take on the Nordic welfare model provides insights into what the Nordic experience can tell us about wider international issues in care.