Working Across Borders: Care and Caring in a Complex World

The language of care and caring is widely used in both formal and colloquial communication. Despite this, or perhaps because of it, the meanings attributed to care may be varied and contextual (Fine, 2007; Fisher & Tronto, 1990; Twigg & Atkin, 1994). Social workers might encounter very different understandings of care in acute health, disability, child protection, and aged care settings, for example; this mirrors the diversity of organisational and policy approaches that confront service users, in addition to the ways that they experience care within their families and communities. The papers that make up the July 2019 Issue of Australian Social Work indicate the breadth and richness of care as it is understood and enacted across diverse fields of social work practice.

In what has become a foundational reference point for debates about care and caring, Fisher and Tronto (1990) framed care in four ways: caring about (identifying a need), caring for (accepting a responsibility to meet that need), care-giving (acting to meet the need), and care-receiving (presented as an element of reciprocity). Tronto extended this framework to add caring with, addressing issues of power and democracy in care relationships (Tronto, 2013). Fisher and Tronto’s approach was situated in an understanding of care across personal, interpersonal, and environmental domains. Expanding on this earlier work, Tronto (2015) emphasised that such an understanding of care is relational, complex, and non-linear: it “starts in the middle of things” (Tronto, 2015, p. 4). Importantly for social workers, she also stressed the political nature of the allocation of care responsibilities.

Domains of care occurring elsewhere throughout the literature can be categorised as individual, relational, social, instrumental, and ethical, but despite this conceptual diversity, formal definitions of carers and caregivers in practice are often based primarily or exclusively on the provision of care tasks (Nolan, Keady, & Grant, 1995). Such task-based interpretations enable concrete and quantitative measurement, but carers themselves tend to offer far more complex and nuanced accounts, incorporating invisible as well as visible aspects of their caring roles, identities, and relationships (Bowers, 1988; Burridge, Winch, & Clavarino, 2007; Joseph, 2017).

In their wide-ranging definition of care, Yeandle, Chou, Fine, Larkin, and Milne (2017) identified six conceptual axes:

Care is both a public and a private concern; it affects family members and paid workers; it concerns labour and love; it involves intimate practices, technical skills and challenging tasks that must respect a care recipient’s dignity and comply with externally determined quality standards; and it is delivered “in the moment” but may be the product of a lifetime of interactions. (p. 9)

Meanwhile, in a neoliberal environment the commodification and marketisation of care in sectors such as residential aged care and the health sector raises additional issues around care as a financial burden, not only on individuals and families, but on communities and the wider system. This is particularly evident when considering the financial costs of high-level health care (Srivastava, Downie, Hall, & Reynolds, 2016), echoing Tronto’s (2015) observation that debate about the responsibility for care has at its heart a political concern.

The political and power-laden nature of care is particularly evident in contestations about the relationship between care and disability. This was illustrated towards the end of the last century, when language that presented care as a unilateral transaction (such as between caregiver and care recipient or, even more explicitly, “dependent”) was strongly contested by the emerging disability rights movement. Morris (1997), for example, questioned whether the co-existence of care and empowerment was possible.

More recently, authors including Fine and Glendinning (2005) and Milne and Larkin (2015) developed ideas of interdependence and reciprocity. The sometimes fraught relationship between care and disability re-emerged in Australia with the implementation of the National Disability Insurance Scheme, which represented a policy change that not only stressed an individualised approach to funding services for people with disabilities, but altered support avenues available to carers through, for instance, access to respite programs. Although this situation remains fluid, recent developments in the Integrated Carer Support Scheme (Australian Government Department of Social Services, 2018) illustrated the possibility of a more relational and reciprocal understanding.

Care is also highly gendered, in both the paid workforce and the private domain. Women accounted for 68.1% of all primary carers in Australia in 2015 (Australian Bureau of Statistics, 2017), while in 2001, 88.4% of care workers in Australian community services were female (Meagher & Healy, 2005). The strong relationship between gender and care raises questions about the role of women in care sectors, and its impact on their health, wellbeing, and participation in other paid workforces, but it also hints at attitudes towards care in Australian contemporary society generally. At the same time, the development of a deeper understanding of the experiences and identities of men who care remains an area for further research.

Parents who care for a child of any age with high-level support needs (“parent carers”) interact with providers, programs, and policies across sectors as diverse as education, health, disability, community services, and others. The experiences of these parents illustrate the many and varied ways in which care is conceptualised and enacted through policy and practice (Joseph, 2017). The nuanced relationship between parent carers and service systems is powerfully illustrated by a parent’s description of her relationship with systems as akin to that between a spider and its web: the web supports the spider and is a vital source of nourishment, but must be maintained and repaired constantly, as connections between different threads become disrupted. Further, it constrains the spider’s movement within the extent of the web’s borders (this family had relocated from their home community in order to access specialist services) (Joseph, 2017).

Parents are required to navigate and interact across service systems that are often fragmented and siloed. However, each of these systems also represents a social work workplace, highlighting the unique potential for social work as a profession to gain insight into the breadth of service users’ perspectives. Furthermore, it demonstrates the opportunity for social work to speak to injustices and oppressions that arise when care is undervalued or, perhaps conversely, valorised as a primarily private responsibility.

Social workers are active in caring about, caring for, and caring with the world in which they live and work. The articles in this (July, 2019) Issue illustrated this diversity, both in content and context. In working across, rather than within, disciplinary understandings of care, and in engaging at individual and systemic levels, social workers are perhaps better positioned to align with the people who interact with these multiple service sectors than our colleagues in other professions. Given the ubiquity of concepts of care, in some form, in every area of human interaction, this is a complex and contested but critical area of social work endeavour.

There is much still to be learned about the ways that care is experienced and enacted in Australia and beyond. In addition to a deeper exploration of care and masculinity, as suggested above, there are several areas that warrant attention if social workers are to meet their commitments to social justice most effectively. Dominant understandings are likely to be enriched and challenged by Indigenous knowledges about care of country and of community, for example. In addition, global population movement indicates the importance of understanding and accommodating the diverse experiences of service users whose language, culture, or literacy affect their interaction with the dominant culture of service providers.

Perhaps most urgently, there is scope to extend our understanding of what reciprocity looks like in a neoliberal context. This highlights the importance of coproduction of knowledge, through the active involvement of those whose experiences and perspectives are being studied and who are most affected by the outcome. It is through this shared development of knowledge that we can most effectively work across the personal, professional, disciplinary, and global borders that confront us as social workers and as citizens of a complex world.