There’s a certain facial expression I try to suppress when someone explains to me how they’ve developed a new app to fix the caregiving crisis. I had to do phone-only meetings for a while, until I could appropriately control my face.
They explain their calendar/to-do-list app. I open up the app store and search for calendar/to-do-list apps. Yup, there are still a couple (thousand) out there to choose from already. Is the problem really a lack of scheduling apps?
When I can get myself to listen, I always come away with something interesting from the conversation. I’m usually impressed with the developers, even if I don’t necessarily share their enthusiasm for the particular solution they’ve hit upon.
When people bring up caregiving robots sometimes it catches me off guard and I make a face before I can stop myself. It made me laugh out loud to read Lyz Lenz explain why artificial wombs aren’t the solution to pay disparity and the glass ceiling. I’m assuming this is a timeline where first they solve pregnancy, then they solve childcare, then they tackle eldercare, but that’s very normative of me. Maybe these are separate hackathons.
As much as I like to tease people for trying to “solve” the human condition with an app or a robot, that sardonic humor masks my genuine concern.
Maybe what we really need is a moral philosophy app.
Of course, I run online programs for caregivers. I wrote my masters thesis on the applicability of computational thinking skills outside of STEM professions. I went to the Rochester Institute of Technology for undergrad and High Technology High School before that. Sure, I dropped out of both, but my social circle is full of people who are very well positioned to try to solve being human with technology.
Who doesn’t love looking at a complex situation, honing in on a particular problem, and then figuring out how to solve it? It’s so satisfying.
Unfortunately, life is not the laboratory. Outside of the laboratory, all of those particular problems are connected to a whole bunch of other factors. All too often when it comes to caregiving, we misunderstand the problem entirely. Care work isn’t something you can shift to an assembly line. Care work cannot be standardized. We can’t even come up with a definition of the term or decide what it describes.
The burden of care work is far more complex than the obvious issues of providing medical care, administrative work, and ADL support. Care work is inherently intersectional. As much as it’s hilariously naive to imagine we can solve sexism with artificial wombs, there are plenty of other less obvious ways we can misunderstand the situation we’re looking to improve.
What is the problem that we’re trying to solve?
When we’re building apps, what’s the cause of the problem we’re addressing? Is scheduling difficult because of complex family dynamics? Is scheduling difficult because aspects of the medical system were designed to intentionally create hurdles to access care in order to steer us as part of cost control mechanisms? Is scheduling difficult because the system is designed to meet the needs of billing departments, rather than patients or even medical providers?
I can understand the appeal of robots to provide ADL support, which is strenuous manual labor that many caregivers are physically unable to provide in a way that’s safe for both care provider and recipient. I’m sure many people who need assistance with personal care would prefer to do it on their own with the aide of a robot.
There are many tools to assist with these tasks already. The bigger issue is the fact that medical staff are typically not concerned enough with people’s lives, rather than the collection of data they represent, to reccomend assistive devices. Even when someone identifies potentially helpful tools, they are often prohibitively expensive. Developing more expensive tools is fine and also feels a little besides the point.
The example of artificial wombs clarifies an undercurrent that can sometimes be hard to identify.
It’s the belief that reproductive capacity is the burden. That the negative effects of having reproductive capacity, ie sexism, is a natural repercussion rather than a bias that can be overcome. It’s the belief that the only way to overcome sexism is to render reproductive capacity irrelevant.
I want to ask: Have they read Brave New World? Did they read that and think, “Wow, that’s a great idea!”
At least they didn’t propose chemical sterilization as the solution.
You already know how I feel about exhortations to be positive, so you can imagine my glee when a friend sent me a link to the article Is confidence a cult? These sociologists think so.
In the interview with Rebecca Jennings, Rosalind Gill points out how corporate pseudo social justice language flattens all difference and diversity into one plane, making pregnancy and disability the same. It reminds me of the fact that, legally, they sometimes are.
There is no maternity leave in the US. Yes, yes, in all the normal ways I kvetch about, but also even people who have access to parental leave aren’t taking parental leave, legally speaking. What we refer to as parental leave is actually short-term disability insurance.
Just the other day I was confessing to Adrienne how I struggle to find ways to be less negative while still staying true to myself. My writing sounds pretty cranky for someone who is generally in a good mood.
Of course, it’s one thing for me to want myself to sound more positive. It’s another when positivity is compulsory. Rosalind Gill explains:
“It really intersected with feminism and created a very neoliberal or individualized feminism: putting it on women to turn inward, focus on themselves, and stop thinking that structural barriers are out there and start thinking that they’re just something we need to work on.”
Perhaps it’s a relief to find a group of people arguing that the problem isn’t us as individuals. Even if they believe that the problem is our (inferior?) physical bodies.
When I stop snarking long enough to think about it, it is a fascinating idea to attempt to remove structural barriers by providing us with artificial wombs and caregiving robots.
I support the use of assistive devices, of course. So why does the idea of caregiving robots sound so dystopian? Does the framing matter if it means people with care needs gain more autonomy and care workers get assistance?
Exhortations to self-care and positivity are what governments and institutions offer us when they are not making structural changes to alleviate our burdens. Burdens they have very often created.
“during the pandemic, we have witnessed the reinforcement of confidence imperatives and proliferation of self-care messages. Staying positive and practicing “self-care” became motifs throughout the pandemic, seen in everything from exhortations to exercise, breathe deeply, and sleep better; to the promotion of “uplifting” tunes, “comfort” food, and “feel-good” TV. They encouraged women to turn inward rather than encouraging action to challenge and transform the structural conditions that have affected women disproportionately. So, seemingly benign and often undoubtedly well-meaning messages of confidence, calm, and positivity during the pandemic seem to buttress the confidence culture in very problematic ways.”
Sometimes a good playlist is a distraction from the issues at hand. Sometimes it’s something that turns around your day. Sometimes it’s both.
We don’t need one big answer. If an app helps someone, that’s great. No one needs my approval and that’s good, because I don’t know what’s best for them. Maybe we do need another calendar/to-do-list app. People have different needs. People have different preferences. Options are good, even if they can be overwhelming.
Mostly, though, we need the government and industry to stop making things harder than they need to be. Even if the problem is our physical bodies, these are the bodies we’ve got. They need to build systems that work for real people, not hypothetical constituents and users.
There are lots of small things that those in power could enact that would have a bigger impact than all the apps in the world. I can rattle some off the top of my head:
Provide access to assistive devices, including maintenance and the ability to try them out and exchange them as needed.
Clear the sidewalks of snow just like we clear the streets.
Change employment law and tax structures to encourage part-time roles and role sharing, rather than the gig economy and zero hour contracts.
Create incentives for home care organizations to provide or subsidize childcare and transportation for their employees.
Incorporate universal design into the building code. Prioritize public transportation.
Decouple access to health care and retirement savings from full-time salaried employment.
Recognize non-monetized essential labor in social security schemes.
Adjust tax and business laws to encourage co-ops and mutual associations.
Hire people with access needs as co-designers, rather than harvesting their ideas and hoping for their approval of a finished product.
I’m not going to go so far as to blame the government or the medical system for caregiver burden. But I’ve noticed a pretty strong correlation between caregiving becoming a crisis and the development of our current incarnation of these systems.
I keep hearing that disability and old age are new problems because they’re new things. Sorry, I don’t buy it.
Speaking of trying to cure the human condition, I’m excited to learn that Kate Bowler has a new book coming out.
I loved her books on the prosperity gospel and accepting the limits of our agency. She’s to blame for my falling down the rabbit hole of reading the oldest copies of self help books I could find at the library.
There’s a writeup of the new book in GQ. In case you don’t click, here’s my favorite Q&A from the article:
“As a historian of self-help, what are some of the stickiest traps? What are some of the things that feel most like, "Oh yeah, that's the answer!”
The first is convincing people that they're invincible, and that all they need to do is harness that energy toward the goal. Another great lie is, "Everything you need is already inside of you.” It's such bullshit. Most of what you need is going to be outside of you. It’s structural justice and a community that holds you, and coming to terms with your own limitations and frailties. But you can't sell that. You can't sell seven principles for power thinking if your seven chapters were, "One: Accept Your Limitations; Two: Locate yourself socially to figure out what supports are being denied to you." [laughs] Wouldn't now be a great time to imagine that we are not going to be masters of our destiny? That we’ll all likely need each other in the months ahead? Instead, we have an epidemic of loneliness and a tremendous amount of shame around not having mastered that side hustle, or conquered the capitalistic self.
I guess that's why I'm so interested in uncovering the assumptions underneath self-help, because I think some of the assumptions about our selfhood, about how we're made, about what we're for, are deeply harmful to us. If we continue to promote these stories that we are these self-constituting work robots meant for invincibility and progress, we are going to find ourselves not just very tired, but really confused about our limitations.”
Health care has an incredible carbon footprint.
Staffing has been a slowly unfolding crisis at all levels of the US healthcare system for a long time now. Hospitals are turning to the courts to keep staff from switching jobs for better working conditions.
Choosing Wisely has a webinar on February 9th discussing ways to manage dementia without antipsychotic medication.
In a world where people insist being carded at the liquor store is a compliment and beauty magazines insist we can reach 60 without wrinkles if we have the right skincare routine, I find Oldster Magazine refreshing.
NPR has a lovely article on ways people are finding joy during the pandemic.
Thank you, Cori, for this thoughtful and detailed post of important issues for caregivers. Caregiving challenges for paid caregivers (as well as parents, spouses, partners, friends and others) are complex and multi-faceted. While motivational talks, quick fixes, and individual solutions may be helpful to some people, the underlying systemic barriers for paid caregivers of inadequate pay, low staffing levels in long term care facilities, lack of health insurance, absence of retirement plans, vacation and sick time, as well as lack of affordable child care and adequate public transportation are some of the problems that individual self-improvement efforts will not change.
These problems need to be addressed at the state and federal levels through increased budget allocations, both short- and long-term, and Medicare, Medicaid, and insurance policy revisions, as well as paid family leave and universal health care for all, regardless of employer.