RSS Feed for the unit What's in a title: Understanding meanings in community care

Introduction

The Open University — Mon, 25 Jul 2011 16:35:15 GMT

This unit is from our archive it is an adapted extracted from the module Care, welfare and community (K222) that is no longer in presentation, although other courses in this topic are available to study Social Work

The unit you are about to study is exciting and stimulating. Working with adults in the community is changing at a pace that can sometimes feel bewildering. Practitioners are being asked to review what they are doing in a critical way and to adopt new approaches. For example, the word ‘community’ is one that we all use quite readily and is at the heart of many social work policies. However, we tend to take it for granted that everyone means the same thing when they talk about a community or the community, and we seldom have time to analyse what we mean and compare this with other people's views. Understanding more about key concepts like ‘community’ and ‘care’ will help you to appreciate why policies such as the introduction of ‘community care’ have raised such complex and controversial issues, and why different individuals can experience them in such different ways.

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Learning outcomes

The Open University — Mon, 25 Jul 2011 16:35:15 GMT

After studying this unit you should be able to:

Demonstrate an awareness that the words ‘care’, ‘welfare’ and ‘community’ have a wide range of social, cultural and historical meanings.

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1 What's in a title? An introduction

The Open University — Mon, 25 Jul 2011 16:35:15 GMT

Because the words ‘care’, ‘welfare’ and ‘community’ are so much a part of everyday language and debate, there's perhaps an assumption that people agree about what they each mean. These are three words that mostly evoke warm and positive feelings. In Activity 1 you're asked to think about opposite points of view.

Activity 1: Contests of meaning

0 hours 10 minutes

For each of the three words ‘care’, ‘welfare’ and ‘community’ write down all the positive and negative associations that you can think of. Don't spend too much time on this, just jot down what comes into your head.

Discussion

‘Care’, ‘welfare’ and ‘community’ are words which tend to resonate so positively that you might have thought this was an unlikely task. It all depends on your starting point. These lists include some of the words that people who tested the unit came up with.

Positive:

Care – compassion, concern, looking after, support, warmth, protection, empathy, attachment, rewarding, interest, facilitating, helping, love, protect, watch over.

Welfare – concern, happiness, prosperity, wellbeing, success, profit, support, safety-net, sharing, goodwill, benefit, provision.

Community – sharing, identity, warmth, closeness, sameness, solidarity, shelter, strength, inclusion, belonging, empowering, equality, nearness, looking out for, togetherness.

Negative:

Care – burden, woe, worry, control, pressure, custody, managing, being in charge of, supervision, stress, pain, being inadequate, powerlessness, dependency, oppression, abuse, tiredness, thanklessness, hard work, demoralising.

Welfare – needy, failing, controlling, labelling, deserving, denying, official, not managing, stigma, shame, poverty, idleness, fecklessness, scrounging, hand-outs, charity, demeaning, benefits.

Community – control, pressure, authority, oppressive, exclusion, not belonging, rejection, rejecting, uniformity, duty, responsibility, fear, nuisance, disempowering, homogeneous, myth.

Your responses will depend on your own experience, of course. Maybe your experience of care is a monthly visit to your GP practice so that the nurse can give you the injection which helps you feel you can manage your life. Care then just becomes a matter of routine, something which isn't care at all, a controlling experience. On the other hand, care might mean that you've got your own front door for the first time in your life. Then your experience of care may be of something empowering which confers a welcome new identity. A word like ‘welfare’ means different things depending on where you live. Being ‘on welfare’ in some parts of the United Kingdom means being poor and dependent on help, a failure in some people's eyes. But welfare can also mean awareness of all that goes towards making life equitable and fair, compensating for disadvantage, ensuring that someone isn't denied the right to participate in society because of their income, health or particular circumstances.

Perhaps ‘community’ was the most difficult word to find negative meanings for. As Raymond Williams, the novelist and literary critic, points out:

Community can be the warmly persuasive word to describe an existing set of relationships, or the warmly persuasive word to describe an alternative set of relationships.
(1983, pp. 75–6)

He goes on to say that what distinguishes ‘community’ from other similar words, for example ‘state’, ‘society’ and ‘nation’, is that ‘it seems never to be used unfavourably and never to be given any positive opposing or distinguishing term’. The responses made to Activity 1 suggest that there are some contrasting meanings currently in use. In the next three sections each of these words is explored in more depth, beginning by carrying on with the discussion of ‘community’.

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2 Community

The Open University — Mon, 25 Jul 2011 16:35:15 GMT

As you've just seen, ‘community’, an ever present word, evokes some contrasting meanings. It has been described as a ‘keyword’, that is, a word which has its own particular history but which also plays a significant role in putting across different meanings. Identifying a keyword is to go further than just giving a dictionary definition because:

Keywords have been more than ways of seeing: they have been influential as ways of living, acting upon others.
(Yeo and Yeo, 1988, p. 229)

If a word can be described as powerful, it seems ‘community’ must be just that. It is a word which has long been associated with the provision of care and support, but which, since the NHS and Community Care Act of 1990, is now explicitly linked to central government policy.

Let's take a closer look at those meanings of ‘community’ which were generated in Activity 1. Among the positives and negatives there's obviously a wide range of contradictory associations, not all as ‘warm’ and ‘persuasive’ as Williams (1983) suggests. Perhaps how you feel about ‘community’, the meanings you give to this word, are influenced by:

who you are – for example whether you are a mother with young children or an older man living on your own
your own sense of identity – how you describe yourself and the people who are most important to you
a sense of belonging and not belonging – where you feel you belong, for example to a particular region in the UK or another country; and where you are made to feel you do not belong, for example by unfriendly or hostile neighbours.

These rather personally based meanings link to a long-standing interest in what ‘community’ actually is. University academics, practitioners, politicians and policy makers have struggled to pin down the word and debates continue. In a famous article, the sociologist George Hillery (1955) identified 94 different definitions of community and found that all they had in common with each other was that they dealt with people! This led another sociologist, Margaret Stacey, to conclude that ‘community’ was such a well-worn word that it was of scarcely any use at all at explaining how people relate to one another (Stacey, 1969). Despite this, ‘community’ has survived and come to be associated with even more meanings than either Hillery or Stacey might have imagined.

‘Community’ has many complexities in its meanings, as the journalist and writer, Yasmin Alibhai-Brown, suggests. She points out that ‘We, in the visible communities, have been denied equality and significance in the spaces where it is all happening’ (2000, p. 29). By this, she means people are ‘racialised’, that is they lose their individuality by being designated as having automatic membership in certain communities, the ‘Asian’, the ‘African-Caribbean’, simply because of their skin colour. At the same time, institutional racism can lead to their exclusion from powerful positions in other communities – those of work, education, health, and local and national politics, which determine opportunities and the allocation of resources within society generally. But, as she points out, communities which are based in shared cultural and personal experiences also offer refuge and solace in a hostile society:

Talking to men and women of colour, I felt that their need for family and community networks in a society still so racially exclusive was much stronger and that the reality often matched their high expectations. It was in the Asian, Turkish and other ‘eastern’ groups that I found the most flourishing children.
(Alibhai-Brown, 2000, p. 253)

The powerful meanings which ‘community’ evokes have led to its direct involvement in shaping government policies. Indeed ‘communitarianism’, the idea that communities are ‘social webs of people who know one another as persons and have a moral voice’ (Etzioni, 1996, p. ix), with its emphasis on shared responsibilities is thought to have had a profound influence on the emergent policies of the Labour Government elected in 1997. Across the political spectrum there was renewed interest in reviving what seemed to have become a meaningless term and in challenging the idea that communities couldn't ‘care’.

Activity 2: Implicit ideas of community

0 hours 25 minutes

Click on the document below to view Reading 1, ‘A child's view of care in the community’, where writer and actor Meera Syal describes an episode from the childhood of Meena Kumar. The story, Anita and Me, is set in a small industrial village, ‘Tollington’ near Wolverhampton, where Meena is the only Asian child locally as well as being the only daughter of a school teacher and an accountant at a local factory. Meera Syal was born and brought up in Essington near Wolverhampton so it's more than likely that this is an autobiographical novel. You won't find the word ‘community’ mentioned in this extract, but that's not to say it doesn't play a big part in what Meera Syal is writing about. As you read it through, note down all the ways you think she uses the idea of community.

(PDF, 8 pages, 0.07MB)

View document

Discussion

Meena Kumar has some perceptive comments to make not just about her English neighbours but also about her own Asian relatives. The physical environment in which she grew up, the backyards, outside toilets, the local fields and her neighbour's kitchen and living room are clearly drawn in just a few words. Those few houses and streets which made up the community she grew up in had a lasting effect on her it seems.

What kinds of community does her writing evoke? She mentions:

The village community of terraced houses; her family's Punjabi community with its particular beliefs, food, clothing and attitudes to older people; the outside community to which Meena says she aspired; a community among women, English or Asian, which she identifies as being characterised by ‘resistance’ and ‘resignation’; the cultural community to which her neighbour, Mrs Worrall, belongs with her flowery dresses and aprons, her jam tarts and lemon puff biscuits.

These many different evocations of community might helpfully be organised into three main meanings or definitions:

community as the basis for personal relationships and support (Meena's parents and Mr and Mrs Worrall, though not, it seems, the Worrall's own family)
community defined by geographical boundaries – a local, national or international entity (‘Tollington’, the Wolverhampton area, England, Europe, the Commonwealth)
community based on identity – some of these may be quite locally based while others may cross international boundaries and others again may draw on generational, class, cultural and spiritual differences (Meena's Punjabi family and the occasions they get together; Mr Worrall's identity as a disabled ex-serviceman; Meena's mother's professional links to the school where she teaches; Meena's desire to acquire what she sees as an English, or more specifically Tollington, identity).

Perhaps what all these have in common is a sense of belonging, though as we've seen from the extract, differences of identity and power can exist within and between communities. Meena's parents manage to move between different identities in Tollington and it's clear that there are other differences within the community as a whole: there's the particular situation of the women and then there are pensioners like Mr and Mrs Worrall, whose lives are restricted by poverty and impairment.

While it's useful to see community used as a way of identifying similarities it's important to realise that people also occupy more than one community at the same time. Meena's father is a member of his work community as well as a celebrated singer in his Punjabi community. Meena's mother is a teacher, a mother and a Tollingtonian. She also has membership in a number of different communities. And of course the main story in Anita and Me is Meena Kumar's attempt to be accepted on her own terms into the ‘community’ of the person she sees as the most streetwise and exciting girl in Tollington, Anita Rutter.

Communities are where care is given and received, so thinking about what community means to different members, how members of a community differ from one another and what all those differences mean may be important when care is being planned or organised. It's clearly important not to make too many assumptions about the make up of the communities in which people live. And, with all these differences in mind, welfare policies will need to allow for inequalities of access and of personal resources if people are to be included and inequalities in support and care are to be compensated for.

While community has been awarded a key role in contributing to care and support, it's as well to remember that, in practice, those policies may come to have a very different feel. So, for example, the phrase ‘care in the community’ has a very particular meaning and resonance for mental health services. Conflicting evidence and experience over appropriate treatment has frequently been distorted by unhelpful press coverage, with the result that policy makers declared ‘care in the community’ policies as being no longer suitable for people with severe mental illness. It's worth acknowledging again the many and varied meanings attached to ‘community’.

Top right, middle left and bottom left:; top left: John Birdsall Photography; bottom right: BBC; BBC London Live and BBC London Live Chatroom word marks and logos are trade marks of the British Broadcasting Corporation and used with kind permission. All logos © BBC. ©

Top right, middle left and bottom left:; top left: John Birdsall Photography; bottom right: BBC, BBC London Live and BBC London Live Chatroom word marks and logos are trade marks of the British Broadcasting Corporation and used with kind permission. All logos © BBC.

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Figure 1 Communities can have very different meanings and appearances

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3 Welfare

The Open University — Mon, 25 Jul 2011 16:35:15 GMT

Earlier, in Activity 1, some contrasting associations with the word ‘welfare’ emerged. Just to remind you, they were:

Positive: concern, happiness, prosperity, wellbeing, success, profit, support, safety-net, sharing, goodwill, concern, benefit, provision.

Negative: needy, failing, controlling, labelling, deserving, denying, official, not managing, stigma, shame, poverty, idleness, fecklessness, scrounging, hand-outs, charity, demeaning, benefits.

From one set of meanings, it might be supposed that welfare is something which is done to people who have problems, and is associated with failure, exclusion and a need for help in managing lives. A more positive interpretation suggests that welfare is something everyone aspires to have and should have the right to expect. After all, most people want to feel they can successfully manage their lives without having to worry about such basic needs as food, clothing or shelter. There's the need to feel secure against any possible accident or change in circumstances which might threaten a person, their family, friends or where they live. There's also the need to be included in what's going on around you and to have the same chances at succeeding or doing what you want to irrespective of age, sexuality, impairment, gender or ethnicity.

Welfare

Welfare was originally the phrase wel fare, mE, from well in its still-familiar sense and fare, primarily a journey or arrival but later also a supply of food. Welfare was commonly used from C14 to indicate happiness or prosperity (cf. wealth): ‘thy negheburs welfare’ (1303); ‘welfare or ilfare of the whole realm’ (1559). A subsidiary meaning, usually derogatory in the recorded instances, was of merrymaking: ‘such ryot and welfare and ydlenesse’ (1470); ‘wine and such welfare’ (1577). The extended sense of welfare, as an object of organised care or provision, came in eC20; most of the older words in this sense (see especially charity) had acquired unacceptable associations. Thus welfare-manager (1904); welfare policy (1905); welfare work (1916); welfare centres (1917). The Welfare State in distinction from the Warfare State, was first named in 1939.

(Williams, 1981)

Beyond the level of welfare as a personal goal, you'll also be aware of welfare as a system of organising ways to meet needs which people can't organise on their own. The Welfare State is an example of such a meaning and one which most people in the UK are familiar with. As well as state organised welfare provision, there's also the voluntary sector with its many organisations providing help and support, in part dependent on state funding, in part dependent on charitable and other sources – organisations like Mind, Age Concern, Mencap and its equivalent, Enable, in Scotland and Northern Ireland. Beyond that again, it's also possible to think about welfare as the philosophy attached to a particular kind of political endeavour which attempts to transform society itself, perhaps challenging ways of thinking about what is meant by need. Marxists, who have argued for fundamental changes in the way society is organised, and feminists, who have pressed for an end to society's oppression of women, have been at the forefront of such challenges (Hewitt, 1998, pp. 65–7).

However, there are other issues, central to people's lives, which also need to be taken into account if welfare policies are to be fully inclusive. The stigma of being in need may mean that for people of some cultures, welfare has no positive connotations. Waqar Ahmad and Karl Atkin suggest that this may account for low benefit take up among some Asian people. Fear of stigma may join other, perhaps more realistic, fears of links between welfare claims, control of immigration and the splitting up of families. In addition, long-standing institutional racism, including inappropriate assumptions, lack of translation and interpretation facilities, as well as experience of racist attitudes held by some Benefits’ Office staff, means that welfare has a quite different set of meanings for some black and Asian people (Ahmad and Atkin, 1996, pp. 131–3, p. 141).

People want to be reassured that their welfare, their needs, are taken care of in some way. How this is organised has long been a matter for debate. Should people fend for themselves, leaving a few welfare services only for those who can't manage their lives, or is welfare too important, too central to the quality of everyone's life to be left to individuals on their own? Taking the narrow view of welfare, developed by more right-wing commentators and politicians, leads to arguments which call for only the smallest safety net of support for the most poor or most marginal in society, with the rest providing for their own security privately (Burchardt et al., 1999, p. 2). Is it really possible that people can live in society without some kind of organised support? Let's pause for a moment and think about an ordinary activity like buying milk.

Activity 3: Joined up living

0 hours 10 minutes

When you go out to buy milk from your local shop, who and what else gets involved? Just write down what comes into your head.

Discussion

I thought of my trip down to the local shops and these were some of the things that occurred to me:

Having the money to buy some milk; my local council who employ the street sweepers and subcontract the tarmac gangs; the shop I go to – how clean it is and when it's open; the milk there on the shelf, the delivery van that brings it, the organisation of dairy farmers that gets the milk from the farms to the town; I could go on …

Put together, there are all sorts of ways in which my needs interconnect with the people and systems I count on to maintain my welfare. I feel pretty secure in my short shopping trip because I'm not aware as I walk down the street or buy my milk that I am anything other than an accepted member of the community and a valued customer at the shop. What if I was also known to be a regular user of the mental health day centre a few doors down, or someone who finds working out change difficult? I've not yet tested my local community for all its attitudes.

Could I expect more? Well, if I lived on the edge of a city on an estate where my only local shop was in danger of being closed down, or if the owner of my local shop was being subjected to racist attacks, I might want more direct intervention to make sure I can buy my milk – action by my local council and the police. If I were a single parent with a child with a chronic disabling illness I might be looking for help with daily transport to get to that shop, or to find someone to come in while I get out to do my shopping.

Right: The Independent/Syndication; left: Popperfoto. ©

Right: The Independent/Syndication; left: Popperfoto.

Figure 2 What do you expect to find down at your local shop? Right: Mal Hussein's shop in Rylands, Lancaster, after repeated racist attacks; left: shop in Broadway in the Cotswolds

I've used this example to show the interlocking nature of the many systems which together guarantee support, even care, in a society. At one level, welfare just happens as people look out for each other, taking turns, accepting differences, anticipating needs. At another level it's a range of organisations with policies which may provide, among other things, benefits, free prescriptions, payments for carers, regulation, housing, information, befriending, social activities and advocacy. These two levels of welfare together guarantee that when people need to do something like going down to the shops they don't also have to sort out how the street is cleaned or negotiate in advance about how to stop the traffic to cross the road or whether they'll be recognised and accepted at the local shop. We simply expect these things to be organised or to happen for us. We pay our local and national taxes and that's enough. But what about other aspects of our welfare, what about the things that can't be predicted, like losing a job, or having an accident, or becoming a single parent? What about someone who works in a low wage industry and can't afford to pay for all the things they need for their family's wellbeing? What if my neighbour decides that her parents need to move from their home in Nigeria to live with her, their only daughter, in the UK? What about people who live in areas where unemployment is high and jobs are few? Are these events and situations which need to be included and paid for in everyone's system of welfare? Or is it preferable, perhaps, to target welfare so the majority can choose how to provide for themselves while the minority who are at risk from poverty or misfortune, or simply a change of responsibilities, are looked after when they want to be?

The post-second world war Welfare State was just one way in which the government of the time tackled the problem of how to make sure that people who are disadvantaged in some way did not sink into destitution. William Beveridge, whose 1942 report initiated much of the public debate and some of the legislation which followed the end of the second world war, identified what he saw as the five ‘giants’ which society needed to deal with. These were: ‘disease, ignorance, squalor, idleness and want’ (Beveridge, 1942). Put into the language of 60 years later this might read as: illness and disability, lack of information, urban decay, unemployment and poverty.

At the time of the Beveridge report, there was continuing concern that the scope of the post-war changes, which saw the state take over responsibility for large sections of welfare provision, including health, housing, education, personal social services and social insurance, would still fail to include the most needy and those most at risk. Feminists, then and more recently, pointed out how those post-war changes were rooted in assumptions about a domestic role for women which locked them into a non-wage earning, dependent status while benefits and insurance were paid to husbands and fathers (Williams, 1989, Lister, 1998, pp. 309–10). Other critics have drawn attention to the ways in which the new system targeted people seen as problems or failures, rather than dealing with underlying causes such as low pay, attitudes to disability, poor environments and underfunded education and housing (Hadley and Clough, 1997, p. 13) and how a system built on means-tested benefits deterred substantial proportions of old and disabled people from claiming their entitlements (Phillipson, 1998, p. 71 and ff.). Yet others argue that the idea of a state-funded welfare system is demeaning and dependency creating, and hark back to notions of self-sufficiency and the need for policies which discriminate between the deserving and undeserving poor (Green, 1999).

Activity 4: Witnesses to welfare

0 hours 50 minutes

Click on the document below to view Reading 2, ‘Witnesses to welfare’, where you'll find a selection of writings by people who, from the period between the two world wars up to the turn of the present century, have had personal experience of welfare systems, or the lack of them. The selection also includes people who have views on what welfare means. The excerpts begin with a brief history by Herbert Gans, a US sociologist, of the language used to describe who poor people are.

Read through these excerpts and, as you do, make a note of:

why it may sometimes be difficult to become a welfare recipient;
why welfare systems sometimes don't help the very people they are supposed to be helping;
any changes or continuities in the experiences of the people whose accounts you have read.

(PDF, 15 pages, 0.12MB)

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John Birdsall Photography ©

John Birdsall Photography

Figure 3 Growing up on Tyneside in the 1930s, this little boy, whose leg was amputated when he was two, was helped to walk and play with help from his parents, despite doctors' predictions. How will his later life have been affected by subsequent policy changes in welfare systems and changing attitudes? What support will society be offering him as he approaches his seventies?

Discussion

There's quite a range of experience and opinion here among the experts. Gans lists the many derogatory labels which have been used to stigmatise and blame poor people over the centuries. You might have wondered if there is continuity with the excerpt from the writing of the right-wing political theorist, David Green, who argues for an end to welfare rights and the promotion of individual responsibility. The people who remember their disabled childhoods in the 1930s and the account from the woman who worked as an investigator for the Unemployment Assistance Board (UAB) between the wars offer evidence of continuity with the people from later decades quoted in the pieces by Peter Beresford and his co-authors and by Cliff Prior. Again, stigma and prejudice play their part, but it's important also to note the resilience and resistance which welfare recipients showed, and still show. It's this resilience, together with the experience of stigma and judgement by others, which explains why the people quoted in the Peter Beresford and Suzy Croft piece tend to distance themselves from welfare services. Finally, the philosopher Michael Ignatieff points to some reasons why welfare systems are needed and yet may fail the very people they are supposed to help. He argues that welfare systems must meet needs beyond the most basic but that they won't be able to identify what these are if they don't guarantee a voice, ‘ the democratic requirement of informed consent’, for people who may be different to ourselves, ‘strangers’ as he puts it.

The social policy theorist, Peter Taylor-Gooby, points out how unemployment, the worldwide movement of people and businesses, rising divorce rates and single parenthood combine to make life different in terms of predictability and security compared with 60 years ago. At the same time, he suggests, there's a tendency to assume that people want less control and interference from government, even one which is committed to welfare. They want to organise and manage their own lives (1999). For this reason, some people suggest that the idea of a welfare state now no longer seems appropriate. They argue that all that is needed is for the state to work out what the risks are and then deal with the fall-out from that risk (Dean, 1999, p. 274).

There's a difficulty, however. The two trends, greater insecurity and a push for a lighter touch by the state, can sometimes contradict or cancel each other out. Quoting research from families in the 1990s, Taylor-Gooby goes on to suggest that people who are unemployed or living in single parent families are worst off in all social groups, that ‘risk … affects some people harder’ (1999). And some groups are consistently hit harder than others. There is evidence that members of some minority ethnic groups experience high levels of social and economic deprivation. So, for example, while older Indian people show similar levels of deprivation to white older people, just below half of older Pakistani and Bangladeshi, two-fifths of older African Caribbean and a quarter of Irish elders experience medium or high levels of deprivation. Poverty in later life for these people stems directly from not having worked long enough in the UK to have built up sufficient years of national insurance contributions and having worked in low wage occupations (Evandrou, 2000, p. 17).

John Birdsall Photography ©

John Birdsall Photography

Figure 4 Friendship at the mosque can mean help and support, but many older people from black and minority ethnic groups also face poverty in retirement

While work and self-management, as advocated by the right-winger David Green (1999), may be solutions for some people, they can't answer the needs of everyone at all life's stages, nor can they ensure protection against the unwanted effects of unexpected events and accidents. It may be that our systems of welfare have to be tailored and organised around the recognition that while society may have changed, those basic needs – food, shelter, mobility and support – are still the same.

That mid-twentieth century attempt by William Beveridge and the post-second world war Labour government to resolve the dilemma of balancing individual need and rights with collective state-funded welfare has been modified over the years. Arguments about who is entitled to be cared for, under what conditions and for how long have led to some changes. At the same time attitudes towards cohabitation, single parenthood, disability and old age have changed the basis on which many judgements as to rights, entitlements and participation are made. Nevertheless, looking back over the last hundred years it's interesting to see how some attitudes persist. For example, the views of those who are defined as welfare recipients have not changed greatly. Whether they're called ‘paupers’, ‘recipients’, ‘the underclass’, ‘destitute’, ‘claimants’, ‘service users’, ‘scroungers’ or ‘poor people’, the welfare system may seem much the same from the receiving end, especially when the deterrence of the workhouse is echoed a hundred years later in an approach which has been characterised as ‘work for those who can, welfare for those who can't’ (Guardian, 1999).

Now we're going to move on to look at the third word being explored in this unit and, in so doing, you'll be able to identify the links between the three words ‘care’, ‘welfare’ and ‘community’.

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4 Care

The Open University — Mon, 25 Jul 2011 16:35:15 GMT

‘Care’ is a word which summons up positive and highly moral meanings for many people. It has associations with giving, sacrifice and feelings of empathy. However, Activity 1 suggests that things are not perhaps quite so straightforward. One way of understanding how and why there may be contrasting ideas of what care means is suggested by Joan Tronto, a social scientist. She has pointed out how care is both ‘universal’ and ‘particular’. She argues that caring is an activity which everyone is likely to have been involved in. At some point, all of us need to be cared for. As babies and in late old age we are likely to have needs which can only be met with help and support. In adult life there may be times when we are dependent on the help of others. In all these ways, care is a universal experience. However, Tronto also points out that the meanings people associate with care vary from society to society and through historical time (Tronto, 1994, pp. 109–10). Care, therefore, can also have different and specific meanings which relate to particular situations and places. For example, while some frail older people are happy to accept meals-on-wheels and a weekly bath, others may prefer to be in a position to be given a payment so that they can choose what services to buy for themselves. And while it might have been expected until the mid-twentieth century that the appropriate care for someone with a severe learning disability was in a hospital, this is now no longer seen as appropriate or indeed as care at all. Individual preferences shape the meaning of what is meant by care and, over time, attitudes towards certain groups in society determine what is seen as appropriate care.

Top left and right: Ulrike Preuss/Format; bottom left: John Birdsall Photography ©

Top left and right: Ulrike Preuss/Format; bottom left: John Birdsall Photography

Figure 5 Care is universal and it is particular

Stereotypical views of how Asian families care have led to the under-provision of help and support by service providers. The assumption that they ‘look after their own’ is ‘simplistic’, as Ahmad and Atkin point out. Although the extended family is common, it is by no means universal, and ‘a significant proportion’ of Asian people live on their own and have few relatives in the UK. In addition, job mobility and the lack of appropriate housing make it difficult for extended family networks to carry out what they feel strongly are their obligations. Ahmad and Atkin point out that these changes in role expectations mean that for some older Asian people, care may be seen in terms of disappointment, shame or loss (1996, pp. 76–7). If only one set of ideas about what care means is used we risk ignoring differences within, as well as between, groups of individuals.

You might like to pause and think about this for a moment for your next activity.

Activity 5: Meanings of care

0 hours 10 minutes

Here are two examples of caring. Read them through and then, putting yourself in the place of each person, note down any words which come into your head which might suggest how that person feels about the caring that's involved.

Clare lives alone and is a wheelchair user. She needs help to get dressed in the morning to be ready for work. She has also organised help at night to get her to bed. Andrea comes in at seven o'clock every weekday morning and when Clare calls her in the evening. Andrea is paid by the hour and visits two other disabled people during the day. Someone else takes over from Andrea at the weekends.
Michael is worried about how his 85-year-old mother is managing since she recently became a widow. Clarice came to England from Jamaica to work as a nurse in the 1950s and, although she and Michael have no relatives in England, she has many friends. He's arranged to take her to visit a couple of sheltered housing developments on the other side of the city where he lives. Clarice is pleased to be spending a weekend out and about with Michael but she's worried about how her dog is getting on with her friend's cat while she's away.

Discussion

There are some differences between these two examples. Andrea might be said to care for Clare. She also cares for other people during her working day. She is a professional – caring is a job of work for her. What Andrea does for Clare might be described as care, but it might also be described as a service, a set of actions which needs to be done in order for Clare to be able to do her work and manage her life independently. Seen from the other side, Clare might prefer to call what Andrea does assistance, or a service. She may not like to think of herself as someone who needs care, in fact sometimes she feels quite angry about having to rely on other people. For Andrea, Clare is just one person on her list of people to visit. Of course, if Andrea were not to do her job carefully, with sensitivity and awareness of how Clare likes things to be done, then she would be unlikely to keep her job. She doesn't just have to be able to care for Clare, she may need to care about her as well. This is a distinction which a social policy analyst, Roy Parker, drew over 20 years ago (Parker, 1981, p. 3). Feminists later took this distinction further, pointing out that the expectation is that caring is always linked to love, so that even when love falters caring must continue. This of course has particular implications for women who tend to be assumed to be natural carers (Graham, 1983, p. 16).

Michael clearly cares about his mother and it seems he's also keen to make sure that she is cared for, though not by him directly. The problem is that he and Clarice may not see her situation the same way. His expectation is that she needs to be cared for, but is that necessarily hers? It sounds as if she's also involved in caring relationships in her own neighbourhood and she might be worried about a move into a sheltered unit where possibly she'll be the only black resident. This might bring back mixed memories of their early years in England, and on top of all that she might have to find another home for her dog as well.

Care as an activity is now established in law as policy, defined in the statute books under such legislation as the 1990 NHS and Community Care Act and the 1995 Carers (Recognition and Services) Act, and well established in public debates following the activities of Carers UK which campaigns for the rights of carers. In this way, care has recently come to be identified, organised, regulated and costed (Johnson, 1998). This move opens up the possibility that caring for family members or friends need no longer be viewed as exclusively the unpaid responsibility of mothers, daughters and daughters-in-law. It could be something people get paid to do.

Figure 6 How can ‘the values of care’ be integrated into our ‘social institutions’?

In keeping with this, some feminists have shifted the argument about care away from the idea of care as women's burden towards recognition that care should be acknowledged as a universal activity. Selma Sevenhuijsen, a Dutch feminist and professor of the ethics and politics of care, argues that the state's role should be to support and maintain care as basic to social relations in a democratic society. She highlights the extent to which everyone is dependent on care at some point in their lives, and points to the ‘privileged irresponsibility’ of those powerful people in society, at all levels, from family to top management, who do not acknowledge that they are dependent on the caring work of others. She suggests that care should be included as a starting point in debates about society, not as an add-on or separate from other activities. She argues:

Democratic societies should take it as their responsibility to guarantee their citizens an equal share in processes of care giving and care receiving. This not only pertains to ‘family life’; on the contrary, the politics of care have for too long been marked by patterns of domestication and privatisation of care. When we take care as a lens to evaluate different social practices, it can have extensive consequences for better integrating the values of care in a variety of social institutions, like health care, education, city planning or business management, and also family practices.
(Sevenhuijsen, 2000, p. 29)

She makes a powerful argument but the problem remains that care has not always had a good history and it may continue to be experienced as something which is controlling, even abusive. Many disabled people resist the word entirely, arguing that it conjures up oppressive and disabling practices. From time to time, press exposures give some support to this view, showing how care is also a word which has been much corrupted.

Figure 7

Long description

Key points

The words ‘care’, ‘welfare’ and ‘community’ are part of everyday speech and yet evoke different meanings.
Identifying these meanings involves acknowledging individual and social difference in experience.
Exploring the meanings of ‘care’, ‘welfare’ and ‘community’ helps to identify how people support each other at interpersonal and societal levels.
Awareness of why and how these different meanings are evoked makes a positive contribution to meeting need and supporting people in ways which they find acceptable.

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References

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Ahmad, W.I.U. and Atkin, K. (eds) (1996) ‘Race’ and Community Care, Buckingham, Open University Press.

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Dean, H. (1999) ‘Citizenship’ in Powell, M. (ed.) New Labour, New Welfare State? The ‘third way’ in British social policy, Bristol, Policy Press.

Etzioni, A. (1995) The Spirit of Community: Rights, responsibilities and the communitarian agenda, London, Fontana Press.

Evandrou, M. (2000) ‘Social inequalities in later life: the socio-economic position of older people from ethnic minority groups in Britain’, Population Trends, vol. 101, p. 11–18.

Graham, H. (1983) ‘Caring: a labour of love’, in Finch, J. and Groves, D. (eds) A Labour of Love: Women, work and caring, London, Routledge and Kegan Paul.

Green, D.G. (1999) An End to Welfare Rights: The rediscovery of independence, London, Institute of Economic Affairs.

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Johnson, J. (1998) ‘The emergence of care as policy’, in Brechin, A., Walmsley, J., Katz, J. and Peace, S. (eds), pp. 139–53.

Lister, R. (1998) ‘Vocabularies of citizenship and gender: the UK’, Critical Social Policy, vol. 56, no. 18 (3), pp. 309–31.

Parker, R. (1981) ‘Tending and social policy’, in Goldberg, E.M. and Hatch, S. (eds) A New Look at the Personal Social Services, London, Policy Studies Institute Discussion Paper No 4.

Phillipson, C. (1998) Reconstructing Old Age: New agendas in social theory and practice, London, Sage.

Sevenhuijsen, S. (2000) ‘Caring in the third way: the relation between obligation, responsibility and care in Third Way discourse’, Critical Social Policy, vol. 62, no. 20 (1), pp. 5–37.

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Taylor-Gooby, P. (1999) ‘Opportunity's knocks’, Guardian, 28 September.

Tronto, J. (1994) Moral Boundaries: A political argument for an ethic of care, London, Routledge.

Williams, F. (1989) Social Policy: a critical introduction, Cambridge, Polity Press.

Williams, R. (1983) Keywords: A vocabulary of culture and society, London, Flamingo.

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Acknowledgements

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The content acknowledged below is Proprietary (see terms and conditions) and is used under licence (not subject to Creative Commons licence).

Grateful acknowledgement is made to the following sources for permission:

Illustrations

Figure 1 (top right, middle left and bottom left): www.britainview.com; (top left): John Birdsall Photography; (bottom right): BBC, BBC London Live and BBC London Live Chatroom word marks and logos are trade marks of the British Broadcasting Corporation and used with kind permission. All logos © BBC.

Figure 2 (right): The Independent/Syndication; (left): Popperfoto

Figure 3: John Birdsall Photography

Figure 4: John Birdsall Photography

Figure 5 (top left and right): Ulrike Preuss/Format; (bottom left): John Birdsall Photography

Extracts

The following extracts are taken from Chapters 5 and 15; Understanding Care, Welfare and Community: A Reader (Blytheway et al, 2001) published by Routledge in association with The Open University © The Open University

5.1: Herbert J. Gans, ‘Ways of Labelling the Poor’, from The War Against the Poor, pp. 14–18, Basic Books, 1995. Copyright © 1995 by Herbert J. Gans. Published by Basic Books, a member of Perseus Books, L.L.C.

5.2: David G. Green, ‘An End to Welfare Rights: the Discovery of Independence’, Institute of Economic Affairs, pp. 67–9, Civitas, 1999.

5.3: Gladys Gibson (in the voice of). ‘An Unemployment Investigator in the 1930s’ from © Nigel Gray, The Worst of Times, Wildwood House, 1985, pp. 60–1, Ashgate Publishing Limited.

5.4: Cliff Prior, ‘Disabled People and Disincentives to Work’, published from ‘Swallowed up by the system’, Community Care, pp. 26–27, 29 July–4 August 1999, Community Care.

5.5: Peter Beresford and Suzy Croft, ‘Who Are Social Services For?’ from Whose Welfare: Private Care or Public Services, Lewis Cohen Urban Studies Centre, pp.42–44.

5.6: Michael Ignatieff, ‘The Needs of Strangers’, from The Needs of Strangers, Viking, 1984, pp. 9–12, first published by Chatto © Windus. Reprinted by permission of The Random House Group Ltd, (Territories, British Commonwealth) Sheil Land Associates Ltd for remaining territories.

15: Meera Syal, an extract from Anita and Me, pp. 57–68, Flamingo, 1997, © Meera Syal 1996. Reproduced by permission of the Author, C/o Rogers, Coleridge & White Limited, 20 Powis Mews London W11 1JN

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