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January saw the unveiling of the new federal government initiative for compassionate care, which provides employment insurance benefits for those Canadians who leave work to tend to sick or dying family members. The program will provide up to six weeks of paid leave for those family members (parent, spouse, child) who care for a patient who is determined by doctors to be at a significant risk of dying within a six-month period.
While this is a long overdue step in the right direction (Sweden, Germany, Austria, Norway, Portugal, Spain and Greece, to name just a few countries, already have systems in place for paid caregiving for relatives), the compassionate care program leaves too many caregivers out in the cold. In fact, those unpaid caregivers who most need a helping hand are the least likely to benefit from the new program.
Only those caregivers who have accumulated 600 insured hours in the previous 52 weeks of employment can receive the compassionate care benefit, and then they will receive only up to 55% of their average insured earnings. Automatically, this leaves out anyone who does not have full-time employment, such as seniors, stay at home parents or part-time employees, as well as all self-employed workers who are not eligible for EI benefits generally. The compassionate care program benefits also do not cover those providing homecare for the disabled, aged or chronically ill. This leaves a whopping majority of unpaid caregivers ineligible to participate in the compassionate care program.
Unfortunately, it is women who are most likely to be ineligible for compassionate care benefits, since it is women who make up the majority of stay at home parents, women who most often work part-time to juggle child-rearing and other domestic responsibilities, and women who are most often under-employed. And yet it is clear, according to plenty of good research on unpaid caregiving in Canada, that it is precisely women who do the bulk of unpaid caregiving.
Care in the home is women’s work. Women provide more than 80% of unpaid personal care for the elderly and for those of all ages with long-term disability or short-term illness. A survey found that three out of four unpaid caregivers were women between the ages of 50 and 65 -- that is, women in the prime of life who may already be juggling adolescent children, aging parents and a professional career.
For women, unpaid caregiving can mean career interruption, time lost from work, income decline and a shift to part-time work or even job loss. These costs are felt far into the future in terms of low or no pensions, and a loss of social contacts and satisfaction from paid work. But many of the costs are more difficult to see or measure
Research has also shown that the costs are especially high for women if we consider not only financial but health costs. The physical demands of care, especially combined with little training or supports and time-pressures, can lead to exhaustion and frequent injury, as well as chronic diseases and a greater vulnerability to illness.
Women unpaid caregivers also report feeling guilt—guilt about being healthy, about not understanding the illness, about not making the right choice for those receiving care, and about feeling trapped. The guilt is compounded by their role as confidante and decision-maker, and by cultural and other pressures that assume that women who care about someone must also care for them. They suffer from depression and stress. The pressures are particularly acute for those unable to afford private support services or those unable to receive public support because of eligibility rules.
Health care reforms are creating a hidden health care system, one that has high costs for the women who provide unpaid care and offers them little choice about giving this care. The combination of sending people home for care and the absence of an adequate public home care program not only reinforces notions about care work being women’s work but also conscripts women into unpaid care and limits their possibilities for paid work. If women went on strike and stopped providing care at home, home care would collapse, and the health care system would be overwhelmed.
Unpaid providers often gain considerable satisfaction from providing care at home, but unpaid caregivers – mostly women -- may have no control over when, for how long, and whether they provide care because there is no or little public support available.
The compassionate care program is a positive step in the right direction, but it is no substitute for what is truly needed: a comprehensive homecare strategy that addresses the very gendered nature of care. As it stands now, a large proportion of the very caregivers that the compassionate care program proposes to help, remain ineligible for any benefits whatsoever.
For a compassionate care program to be effective it must take into consideration both the economic and health costs borne by the women who do the bulk of the unpaid caregiving. What is at stake is nothing less than the health and well-being of those who receive care, as well as those who provide it.
To find out if you are eligible for Compassionate Care benefits visit: www.sdc.gc.ca/asp/gateway.asp?hr=en/ei/types/compassionate_care.shtml&hs=tyt or contact your local Human Resources Development of Canada office (HRDC).
We need your feedback!
Primary Health Care and Women
The National Coordinating Group on Health Care Reform and Women has a new project: exploring the primary health care needs of women. Primary health care has been a major component of recent provincial and federal health reform initiatives, yet little attention has been paid to the particular needs of women as users of primary health care services, or as paid and unpaid primary care providers.
We are circulating a discussion paper and draft definition of primary health care for women, and would love your feedback. This discussion paper is available at: www.cewh-cesf.ca/PDF/health_reform/primary_reform.pdf
Please forward any comments or queries to Madeline Boscoe at ed@cwhn.ca or (204) 942-5500 by May 15, 2004.
A major national conference on primary health care reform is scheduled to take place in Winnipeg in May 2004. Visit our website soon for details: http://www.womenandhealthcarereform.ca/