The Invisible Heart: Undervalued Care Works

© Illustration by NickPurser Design

Earlier this year in May, a caregiver for the COVID-19 patient died of an infection in a hospital of Gyeongsang Provinces. She herself was also a 77-year-old woman suffering from diabetes. Meanwhile, she had been paid less than the minimum wage, even traveling long distances to go to work. However, the death of this elderly woman garnered little attention. It contrasts starkly with the death of a confirmed doctor in early April which was mourned nationally as “the first death in the medical profession.” While it is said that every occupation is equally honorable, in reality, the most essential and risky labors seem to be ignored.

This case explicitly shows us how much care works have been undervalued in society. People admire the advent of the “Ontact” era where they can sustain their everyday lives, such as online lectures and “Untact” consumption. At the backstage, however, care workers are still taking risks for people, exposing themselves to the virus. Even before the virus, it has always been essential that they care for the elderly, children, patients, and the disabled. Nevertheless, they lack the respect they deserve and have been suffering in harsh conditions. In this sense, The Sogang Herald analyzes the background of their harsh work conditions and seeks for reform measures for a better society.

Before going on to the main issue, there is a need to set the range of care workers. Generally, care workers involve all the people engaging in nursing, elderly care, infant care, housework, and personal assistance for the disabled.

Substandard Work Conditions of Care Workers

First of all, care workers are paid minimum wage or even less. Also, they have to deal with unstable employment. They usually belong to private institutions and easily lose their jobs depending on the situation of the clients. In a crisis like the recent pandemic, such unstable employment situations are getting worse. According to the Seoul Geriatric Care Helper Association, 20.7% of geriatric care workers abruptly lost their jobs due to the pandemic. They are usually responsible for the livelihood of their families, so such a situation is very fatal for them. 37.7% of the survey’s respondents said they feel anxious about being laid off and receiving low income.

Furthermore, the care workers, especially nursing and elderly care, face hard physical labors which make them suffer from occupational diseases like musculoskeletal diseases[1]. However, a care worker is not legally recognized as “worker,” which refers to being subordinated to the employer, but instead recognized as an individual business due to the flexible employee hours. Thus, they are not protected from diseases and accidents without employment insurance being applied. In addition, sometimes they are afflicted with violence. According to a survey conducted by the Korea Institute for Health and Social Affairs (KIHAS) in 2019, one fourth of care workers experienced verbal violence from service recipients or their families. The people who were subject to physical violence accounted for 16%, and sexual harassment 9.1%. Even in this situation, many of them continued to work for their livelihood. In this way, care workers encounter severe work conditions, which also imply how much their works are undervalued.

Then, Why Are Care Workers So Socially Undervalued?

The main reason is the gender stereotype[2]. Since women traditionally have been in charge of care working at home without pay, people tend to think care works are not professional and are negligible tasks that any woman could do “inherently.” Of course, it is true that most care workers at present are low-educated women.

However, it is not inborn that they do the work well. They become proficient over a period of time. In fact, the skills for taking care of people are complex, requiring emotional as well as physical skills. As for nursing the elderly, for example, changing the urine tube of the patient requires emotional skills to commune with the patient not to make them feel ashamed, along with the physical skill. As for childcare, it is necessary to have not only physical but also emotional skills to reach out to the child, getting down to the child’s level. Such learned emotional skills have been disregarded and underpaid despite the importance. It is only when people recognize the wrong perceptions towards care works that they will treat the care worker as “worker” and make efforts to train the acquired skills to them, which is going to increase the quality of care services. However, the government has overlooked such properties of care work in implementing care services.

Care Industries Built on the Sand

In the phrase of the book The right not to be lonely[3], it has not been long since care was recognized as a national task. For a long time, women were responsible for taking care of the family. When that was impossible, the government had taken minimum responsibility by letting people live in facilities, deprived of freedom and dignity. The need to ensure a decent human life has only recently arisen. The demand for care started to surge at the same time, encountering aging, family restructuring, and increasing economic participation of women. In this urgent situation, the government has provided care services indiscriminately without deep consideration of how to raise the quality of care.

As a result, now the side effects of the care industries built on the sand are being witnessed. The first is in elderly care. Ever since 2008 when long-term nursing insurance was introduced, the government lowered the entry barrier to run geriatric care facilities. Consequently, lots of private service providers started to appear and struggle for their survival instead of good care within infinite competition. Professor Yang Nan-ju[4] of Daegu University (Dept. of Social Welfare) said, “Current elderly care services are working according to profitability. As care workers have been underpaid and the elderly have become business targets, the quality of care services deteriorates and their dignity is humiliated.”

There is another side effect in childcare services. Earlier in 2019, there was an incident in which a worker in childcare service supported by the government abused a 14-month-old infant. The worker said, “I did it just to discipline the child.” Looking into the background of this case, the government did not recognize the care workers as “workers,” so they were not given the professional training that could have corrected their wrong upbringing habits from the start. Furthermore, the government has only provided financial support and depended on private institutions, so it could not properly manage the service and the workers’ conditions. Nevertheless, most care workers are doing well with high responsibility bearing devaluation, as the survey in 2018 demonstrates 96% in satisfaction rate of approximately seventy thousand families using the service. However, when individual care ethics collapse, the government’s policy would expose its hole.▲ An incident where a caregiver had abused 14-month-old baby for 3 months was disclosed in the national petition in April, 2019. (© YTN)

Both cases in common imply that the fast-growing care services depending on private institutions have lacked the quality, as the work conditions of care workers deteriorate. If these side effects continue, the Korean society will not be able to deal with low birth and aging in the crisis of care blank.

For Now, Fundamental Measures Should Be Taken

First of all, it is necessary to reinforce the publicity of care services so that the care workers work in better conditions and provide high-quality services. Actually, the care institution run by the government has far better facilities and work conditions. An example is the Seoul Sanatorium, the only sanatorium run by the National Health Insurance Service (NHIS) and built as a role model of elderly care service. Since a public institution does not have to save proceeds and take the burden of building rents, it spends most of the proceeds for labor cost (72%) and facility operation. As a result, the care workers here are receiving additional pay along with the minimum wage. Also, they enjoy welfare such as childcare leave and an additional salary for long service. It contrasts to private institutions where they used to be dismissed before long service. In addition, they take more pride in working at a public institution, and better treatment and recognition lead to more sense of responsibility to care for the elderly. Currently, very few government-established sanatoriums exist in the entire country (2.1%, 110 of total 5326). The government should arrange more finances to install national care centers.

▲ The Seoul Sanatorium provides Pilates classes twice a week for the elderly caregivers suffering from musculoskeletal diseases. (© Hankyoreh)

Along with the reforms, the Korean society should gradually change the sex-biased care culture. If the care works still remain solely as women’s jobs and the gender stereotype remains uncorrected, the care workers would still be socially undervalued despite the diversified efforts to improve their work conditions. A caring culture in which men also participate together in the home should be fostered. The policy on parental leave in Sweden is the best reference that changed the sex-biased system through policy. Since the government of Sweden introduced the system for the first time in 1974, it continued to inform people about the new paternal image participating in care works and convinced that fathers have the “right” about infant care. After several years of trial and efforts, it finally came to increase the usage rate of parental leave up to about 80% in 2017. Korean society also could change like Sweden with continuous efforts to break away from stereotyped gender roles in caring.

▲ In Sweden, the usage of parental leave is universal, so the fathers caring their children are easily found. (© KyeongGi Ilbo)

Conclusion

Nancy Folbre, an American feminist economist, called care work “the invisible heart” in her book. Adam Smith overlooked that people should take into account the value of the invisible heart with goodwill apart from “the invisible hand” with selfishness to make the society work. Individuals also need to look back on if they have discounted the true heart in care works with academic elitism and gender bias. Now it is time to make efforts to improve the harsh work conditions of care workers. Such efforts are also necessary to deal with the crisis of the care blank in the low birth and aging Korean society. The high quality of care services is not a matter of others, but the matter of our parents and our children in the future. Following the fundamental measures, the Korean society could make the world where men and women together, family and society together take responsibilities for the care works.

By Choi Ye-song (Int’l & Social Reporter)

dpthd159@sogang.ac.kr