Older women caring for others and needing care

The articles in this focused issue of the Journal of Women & Aging focus on the caring work of and for women. Historically, women have been associated with caregiving and assumed to be ‘natural’ caregivers. In the opening paragraph of her book, Notes on Nursing, Florence Nightingale wrote: “Every woman is a nurse.” She went on to assert, “Every woman, must at some time or other [in] her life, become a nurse (Nightingale, 1860, p. 1). Catherine Beecher’s book, A Treatise on Domestic Economy (1841), offers another perspective on the history of women’s role in caring for others. It gained prominence as a handbook on the ‘cult of domesticity’, a phrase coined by historians to name what became, and arguably still is, a cultural standard for women (Tindall & Shi, 1992). This positioned women, at least those who were White and upper or middle class, as properly belonging in the home where their work entailed nurturing others and providing a comfortable environment away from the hustle and bustle of public life. The transformations in everyday life in the western world brought about by industrialization in the late 1800s and early 20th century, such as electricity, indoor plumbing, and store-bought food, often made the individual tasks of caregiving easier. Yet other trends, like urbanization and mobility, brought about the weakening of family and community, structures that, in many ways, sustained women as they cared for others (Abel, 1991). For example, contemporary women are left to shoulder the blame when judged as failing to successfully meet the demands of the ‘intensive’ mother (Hays, 1996). Of course, women’s caring extends beyond care of children, and there are various types of care needed by individuals across the lifespan, which have also changed over time. During the late 19th and early 20th centuries, many infectious diseases, such as cholera and typhoid, came under control and acute conditions were replaced by chronic disease as the major causes of death (Abel, 1991; Rosenthal, 2015). This allowed the life expectancy for men and women in the United States (U.S.) and other developing countries to increase, although not always for people of color and indigenous populations (Ho & Hendi, 2018; Medina et al., 2020). Widespread improvements in disease prevention and medical care means that millions of older adults are living with chronic, life-threatening diseases that require ongoing care (Boersma et al., 2020; National Center for Chronic Disease Prevention and Health Promotion, 2022).

Although the role of women in families and society has changed tremendously over the last 150 years, at present, women are still responsible for much of the care work done in families and communities. Three out of five caregivers in the U.S. are women and on average, caregivers of adults are 49.4 years old (AARP & National Alliance on Caregiving [NAC], 2020). Likewise, in Europe and Australia, more women than men provide unpaid care to relatives and friends (Australian Bureau of Statistics, 2016; Tur-Sinai et al., 2020). In the United Kingdom, 58% of caregivers are women, and 42% are men (Tur-Sinai et al., 2020). Further, women are more likely to provide care for two or more people, caregivers of a spouse/partner are more often providing care to a man, and care recipients who are older are more likely to be women (AARP & NAC, 2020). Clearly the experience of caregiving is not the same for a woman as for a man, and care work is a central issue for women and their experience with aging.

The meaning of caring has long been of interest to feminist scholars, who have grappled with what constitutes care and its place within our socio-political worlds, but who also have resisted the notion that being a good woman means always putting care work on behalf of others before all else (some “classic” contributions include Gilligan, 1982; Held, 2006; Noddings, 1984; Tronto, 1993). Thus, the meaning of caring is contested and of interest to those who focus on women’s experiences. A thread that connects the articles in this special issue is the meaning of caring as a human practice – that is, the personal and social significance of the caregiving experience, whether that be caring for grandchildren, individuals in adult foster care, or peers. These articles also reflect diversity in the caring experiences of older women across relationship contexts, settings, and populations. While caregiving is a normative event for many women, especially in mid and late life (AARP & NAC, 2020), the actual experience differs for every woman and every caregiving relationship. Additionally, differences in social location (e.g., gender, race, class, physical ability) create overlapping and interconnected systems of inequity or advantage (Crenshaw, 2014) that have implications for the care work involving older women. Thus, attention to the commonalities and differences in care experiences is needed.

In our reading of the articles, we identified two over-arching themes that we would like to highlight. Although we touch on each article only once, it is important to note that some articles exemplify both themes. One aspect of caregiving featured in these articles is that caring for others, and being cared for, has both positive and negative qualities which occur simultaneously. Thus, the experience of caregiving creates contradictions – both/ands – that must be continually negotiated (and re-negotiated) by those involved. One example where this is evident is the Munly et al. article, which focusses on black women in North Carolina who provide foster care for aging adults. Intersectionality and feminist theories underpin this study, as well as the first author’s firsthand experience as a care provider. The authors highlight that care work, whether paid or unpaid, is work and lay out how systemic constraints and power relations affect care providers and have consequences for the older adults requiring care. Although focusing on the strengths and resourcefulness of the care providers, the study also showed contradictions that can emerge in caregiving. The care providers who participated in the study described a “close and reciprocal” relationship with their residents (Munly et al., p. 702), a benefit for the care provider. Nevertheless, the care providers also experienced losses in their personal lives, a cost of their care work. Further, some of the deficiencies in the assistance provided by institutions relevant to this care work seem related to a failure to sufficiently value the work of these care providers.

The article by Sneed et al. also sheds light on the concurrent positives and negatives that can occur in caregiving – this time through the intersecting systems of gender and class. Using data collected from the 2018 Flint Women’s Study, Sneed and team explored perspectives on intergenerational relationships among women living in Flint, Michigan, an economically vulnerable community. While at least some of the intergenerational relationships involved care work on the part of older women, the importance of others caring for them was also noted. Benefits of intergenerational relationships included social connection, feeling valued, and generativity (“giving back to others”, p. 706). Challenges, particularly in the context of caring for grandchildren, included financial burdens, an impact on workforce participation (sometimes requiring them to work beyond their anticipated retirement age and sometimes interfering with employment), putting the needs of others before their own, and difficulties inherent in caring for multiple generations. The two sides of care work are particularly evident here.

A second aspect of caring seen in the papers in this issue is that caring is enacted within relationships and thus constitutes what is often referred to as ‘social support’. Caregiving is also not always one sided, but may involve mutuality and reciprocity. Compared to women, men tend to have weaker social ties and may not feel the need for social connection, because they have their partners (i.e., often women) to care for them. The article by Nakash and colleagues, focused on gender differences in Israeli older adults’ social circles, highlights this. These authors found that number of strong social ties was related to an increased sense of tangible support, but only among women. Many of the women were widows, and men in the study likely had partners on whom they relied for tangible support. This study reminds us that women, across many societies, are primarily responsible for care work and men are often the beneficiaries of this. So, while women engage in care work throughout their lives, they cannot count on reciprocity from those they care for. Women may need to be resourceful in ensuring that they are cared for and receive support when they are older by establishing a number of strong relationships with others. As noted by the authors, an important implication is that social support is too broad a concept to adequately encompass the experience of caregiving and fails to capture the gender-related differences identified in their study and the literature in general.

In the article by Hamiduzzaman and colleagues, we see what happens when there is low investment in older women, and their relationships within family, the community, and health services fail them. The consequences of gender inequality and cultural devaluation of women is writ large in this study, which focused on the reasons why older women with multimorbity living in rural Bangladesh may have difficulty accessing adequate health services and homecare. Among the challenges the women faced is male domination in decision-making, which meant that husbands, who were not always understanding of their health needs, made the decisions about their health care. When widowed, this authority was transferred to another male family member, who might be equally unsympathetic. Financial dependency on husbands or other male family members exacerbated the situation and meant that they lacked the resources to seek medical care outside the home on their own volition. A broader failure encountered by the older women is a healthcare system that does not recognize the right of older women to appropriate health services. This study draws attention to a rather extreme case where older women’s relationships do not support their care.

Rascon and colleagues’ study on Mexican American women managing Type 2 Diabetes Mellitus (T2DM) highlights the two-sidedness of care work. They noted that while caregiving involved self-sacrifice among study participants, it was also a source of motivation for self-management of their T2DM. For grandmothers in this study, tending to their own disease was important for the health and well-being of their families, and not simply for their own benefit. Additionally, care work entailed being more physically active than they might have been otherwise, which benefited their overall health. Thus, caregiving is not always just one person giving, and one person receiving. It is much more complex and nuanced, often involving reciprocity and mutual benefit.

In their study of grandmothers raising grandchildren, Tracy and team draw attention to the web of relationships within which caring work may occur. The authors speak to the “compounding complexity” (Tracy et al., p. 758) in the efforts of grandmothers to manage, balance, and maintain relations with the grandchild’s parents, their own partners/spouses, their other children, and other relatives – all while attending to the grandchild in their care. The grandmothers who participated in this study constituted a somewhat diverse, national sample obtained in the U.S. who artfully tried to balance their relationships with their grandchild and others in their lives. In so doing, these grandmothers confronted the need to negotiate the distribution of their labor, deal with jealousy from partners, and manage disagreements about discipline.

Finally, we want to draw readers’ attention to an article published in an issue of the Journal of Women & Aging earlier this year. Reugemer and Dziengel (2022) explored the experiences of 10 “childfree” midlife women living in a rural area of the US Midwest. This article offers insight into societal expectations pertaining to women as caregivers and shows how they must negotiate their “non-normal” lifestyle with others. Study participants reported feeling judged negatively by others for their decision to not become mothers; their status as women was questioned. Thus, consistent with the notion that care is work within relationships, the women had both their relational capacities and their work ethic called into question. The lives of study participants contradicted the assumptions that they disliked children or were uninvolved in caregiving. In fact, many participants worked in schools and were engaged in other care-type work. In short, their care work was simply overlooked by virtue of their violating the norm that all women are destined to be mothers. Most of the women were satisfied with their lives, which provides an important contrast with the accounts of women heavily engaged in caring for others who expressed the self-sacrifice involved. This study is worth considering alongside the ones in this focused issue because it prompts us to critically question the assumption that all women must do care work as “official” mothers and grandmothers and broadens the category of care work beyond traditional family relationships.

The articles referenced here highlight the historically significant role of women as caregivers, as well as older women’s need for care as they age. We hope these articles counteract the reductionist images that present women as “natural” givers of unpaid care by shedding light on other dimensions of caregiving including paid assistance provided for adults in foster care and reciprocity present in caregiving relationships. Thus, through documenting multiple facets of the caregiving experience, this issue supports a central aim of critical feminist gerontology, “encouraging the development of more complete and more complex interpretation” of women’s lives (Freixas et al., 2012, p. 46). An intersectional perspective on caregiving is essential in revising our gendered stereotypes of care work. The contexts, and more specifically the power relationships, that individuals negotiate in caregiving are not the same for everyone. These papers highlight research with older women, who in their older years, care for others but also have particular needs for care themselves. Each paper offers insights into the significance of care work for older women and contributes to understanding how the positive and negative aspects of care work play out in their specific circumstances and relational contexts. They also point to the need for well-resourced services aimed at improving the wellbeing of older women by recognizing the importance of older women’s care work—for themselves, their families, and society in general—and supporting that care work while not having the older women’s needs neglected. It is indeed remarkable that so many women continue to labor at caring in the face of widespread undervaluing of their work.