The care crisis

MAJA MÓCZÁR: What are the signs that a care system is in a state of crisis?

KINGA MILÁNKOVICS Well that is a complicated question and there are many ways to answer it. There are many areas that we can focus on. There is a societal, as well as a more individual, context in which we can examine this. In a wider perspective, I would say that since the human population has doubled in the last few decades, society nowadays has higher expectations when it comes to taking care of children, the elderly, the disabled and everyone else who needs care. Furthermore, as medicine advances people are living longer. Therefore, the demand for care has grown drastically. Historically it was assumed that women would simply do this type of work. Despite this, the question of who should be doing care work, which demands resources, time and patience, still isn’t something that is really thought about at a societal level. Now the time has arrived where the demand for care is much larger than it was historically, when women could have been pressured into doing it. Consequently, this has created a big deficit in the number of people doing this kind of work.

From your career perspective, do you actually feel that there currently is a care crisis? For example, is healthcare and care work still being underpaid? Or are global tendencies, in which women move countries to find care work, changing this for the better?

This is an interesting question because I work in England in elderly care. From my point of view, on a personal level, globalisation is a positive development as this means better wages for us and a better negotiating position, because there simply aren’t enough care workers. But of course, we cannot forget the societal level issues that have appeared as a result of the fact that there simply are not enough carers. Often one carer has to take care of 15 patients in a care home, because they do not have a good negotiating position or cannot get out of their contract. Many times people have asked me what has changed with the pandemic and the care crisis. From a feminist point of view, I think the core issues today aren’t that different from those in the past. But now it affects socially more powerful people, so it is becoming a more talked about issue. More and more middle-class people are struggling to provide care for their family members, so it is now an issue in mainstream social dialogue. Care has always been delivered by mostly poor, lower class women who are subject to exploitation. Now at least women can get paid jobs and become more financially independent.

Since women have been participating in the labour market they have had this “double shift” of work from the beginning. The problem seems to be that we cannot get out of this dynamic.

It can be interpreted as a “double shift”. But then the opinion that runs against feminism arises. This argues that when women only did the housework and did not take part in the labour market, they did not have to work this double shift. But the same reasoning can be reversed, why is it that men do not have to take care of these kinds of tasks? Doing paid work and also care work is not a problem on its own, because it is possible to build a society in which everyone does paid and unpaid work. The problem is how is it possible for some people not to have these kinds of tasks? How is it possible for them to get away with not participating in these tasks? When there aren’t enough carers, nurses and social resources to satisfy the need for care, then this question becomes very important. How is it possible that some people don’t have to do their part?

Yes, that’s a really important point. I would like to ask you about global developments. As far as I know, carers from Eastern Europe often go and work in Western European countries. Women from semi-peripheral countries go to find work in the countries at the centre of the global economy. As someone who is doing exactly that, would you say that this is a widespread phenomenon?

 Absolutely, yes. But this is often presented as a negative phenomenon. Of course, on a societal level this may be seen as an unpleasant development by many people. Though this is not true for the ones who actually go. Among Hungarian carers, it is worse for those who cannot go, and many times they even say so. When we talk about what it takes to go and work in a foreign country, many women often say that they cannot go because they have a child or elderly parents to look after at home. So yes, care migration is very real and it is happening on a macro level. This phenomenon can be viewed as a negative development depending on someone’s point of view. The mainstream narrative reflects almost only the perspective of those for whom care migration is a problem. And not those for whom it really is the solution.

But isn’t it a problem for all, in the sense that it would lead to a care deficit in the places where carers are emigrating from? Shouldn’t the goal be to create better work conditions for nurses in countries like Hungary?

Yes, it should. When discussing this point it is very important to shift the focus to Hungarian care work conditions. We shouldn’t view care migration as a problem. Instead, we should scrutinise the impossible conditions faced by carers that work in countries like Hungary. That is the real problem for nurses and care workers, not care migration. Care migration is a problem for English nurses. As migrant nurses fulfil the need for care, they won’t have the chance to improve their own situation. Under these conditions, the system is not forced to improve itself. Despite this, I believe that there is little desire to improve the system even if there aren’t any Eastern European carers in the country. This is a very visible problem right now in England. At the moment, 120,000-plus people are needed for social care roles. However, fewer carers are coming from the EU and the government is clearly not making any moves to improve social care conditions. We should examine if care migration can actually help fill these gaps in employment. Carers who take part in care migration can only really be seen as a symptom of wider issues and processes in the global economy. Currently, governments aren’t trying to solve the care crisis, regardless of whether care migration exists or not.

And are there actual differences between Hungary and England, or is it the same systemic problem everywhere?

It is the same issue in the sense that there is generally a big need for nurses and carers. The need for care remains unmet in both countries and the two governments are not capable of solving this problem. Though I do see a difference in their approaches. The British government, at least in their communications, make it seem as though they care about the issue. Of course, compared to Hungary it is clear that the UK has different work conditions and that carers have different ways of putting pressure on their government. Overall, to me the level of arrogance shown by the Hungarian government regarding such issues appears unmatched. However, I do not know if the situation is any better in other Eastern European countries. I can only claim to have impressions of the Netherlands, United Kingdom, Malta, Hungary, Austria and Germany. So it is an interesting question: where do we place the blame for the care crisis? We can say that it is the governments that are responsible for solving it. In a sense, however, they similarly cannot solve it because it is a global problem.

I think we can say that the global pandemic made the care crisis more visible than it was before. Despite this, it seems like even with it being more visible, there aren’t any governmental plans to try to solve this problem. Would you say that we probably need systemic changes to improve the situation?

Absolutely, we need systemic changes, deep social changes. With regards to this, we can discuss various critiques of capitalism, as well as many related narratives. Simply put, I would say that we need to change society in a way that it wouldn’t be women who do care work mostly on their own and mostly unpaid. We can say that in many different ways and with different narratives but that would be the main goal.

And how would you define the critique of capitalism in relation to the care crisis?

The accumulation of capital and profit-oriented thinking and logic ignore reproductive work. As a result, this work becomes invisible and outsourced to women. They are subsequently left out of profit-making structures.

Besides systemic changes, what do we need, for example in Hungary, to improve the situation for nurses?

There are many ways we can talk about what changes we need, for example in Hungary, but not just there. I think that the country’s whole tax system has to be modified. That could be one solution. We should completely rethink where we direct taxes. We should rethink all types of care work and remove them from the tax regime altogether. Care and small scale food production should not be taxed in any way whatsoever. On the contrary, they should be subsidised through national funding. We should not punish farmers and carers, because care work is essential for society. We should also reform the VAT system, and not tax products that are necessary for a basic standard of living. The logic of the whole tax system needs to be changed, as it shouldn’t punish care workers and care organisations with any additional costs and expenses. It is also very important to place an emphasis on preventive health care and healthy ageing to lower the need for care in old age. Women’s movements should also discuss the problem more and encourage women not to take on additional care work. Women who are pushed out of the labour market often do underpaid care work because they have to look after a child. As a result, they become completely overburdened and burn themselves out over a short period of time. It seems that some people will have to take on extensive care work, or we will somehow have to decrease the need for care overall in our society. Somehow, we have to find a solution to this never-ending cycle of more and more people needing care, as well as the constantly growing need for carers.

Kinga Milánkovics works in elderly care. She is also an economist and co-founder of the Hekate Conscious Ageing Foundation.

Maja Móczár studies philosophy at ELTE in Budapest and has been involved in feminist activism for two years at NEM! – Women for Each Other Movement.

Care worker, labour market, migration, prejudice