The first article in this series mapped out the need to plan for long-term care of older persons since relying on female familial caregiving, with limited support, is unsustainable. There are other social changes taking place in families that need to be considered when planning support and interventions for family-based care. 

The first is the increase in female labour force participation, which means that women’s unpaid care work is increasingly combined with paid work. The second consideration relates to the ways in which caring for older persons coexists with the care that is required due to the impact of HIV, Covid and high levels of unemployment and poverty. 

Read Part 1 in Daily Maverick here: “Caring for the elderly — an age-old burden that rests heavily on the shoulders of women”

Costs of care

This article unpacks the findings from 50 interviews with co-residential employed female family caregivers of older persons in Cape Town and Johannesburg. The findings show that female family caregiving for older persons contributes to economic poverty as well as time poverty.

This is experienced by not just one primary caregiver, but by other related caregivers who support care in the household. We gain these insights by listening to Joy’s experience: “I work and my social time is gone; there’s laundry, ironing… I don’t have fun… there’s nothing I do. So what money am I going to socialise with, because when you go out you must have money?

“Even now I’m supposed to buy clothes for kids and I haven’t got money for my hair but I’m still doing the laundry. It’s difficult and it’s not nice.” Joy is a 39-year-old teacher who took on the primary care of her 70-year-old aunt who was not being looked after properly by her brother.

When Joy moved into the family home, she took over responsibility for the household. She earns over R11,000 but has nothing left at the end of the month after covering the household costs.

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Many women described how they took on the responsibility of caring for an older family member as well as others who that person had been taking care of.

For example, Zandile is a 37-year-old nurse. She has two children and recently moved back into her family home after her 71-year-old mother, Joyce, had a stroke and required full-time care. Prior to her stroke, Joyce was looking after four grandchildren. When Zandile moved in, she took on the primary care of her mother and her nieces and nephews, in addition to her own two children. She eventually had to pay a cousin to help out.

In Zandile’s case, like most of the women in the study, taking on the financial cost of caring for the older person included taking on the costs of the household. While there are multiple financial costs linked to food, funeral policies, medical insurance (where possible) and the cost of a carer, who may or not be a family member and may or may not be paid, these were not the only costs. 

Other costs incurred included the loss of time and opportunities in engaging in other work, social or educational activities. Many of these costs are hidden and unfold over time, such as the inability of a caregiver and the household to move beyond barely meeting monthly costs; impact on caregivers’ wellbeing and on her employment opportunities and the impact of unpaid caregiving on women’s educational activities.

Invisible layers of inequality

So how do employed female caregivers manage? 

Most women in the study requested support from cousins, daughters, sisters, ie female kin. In some cases, this was paid. While this system of family care supports other women, it creates another invisible layer of inequality, as this underpaid work is not regulated and goes largely unrecognised.

The findings from the research showed that family members who were being paid for care work were receiving between R500 and R1,000 per month for full-time work. This is far below the minimum wage and it also shows how some family caregivers are kept in poverty by earnings that fall between the food poverty line (R624 per month in 2021) and the lower-bound poverty line (R890 per month in 2021). 

Moreover, women who care for older persons may be asked to work long hours and may be further marginalised when their work is exploited by family members. The unequal distribution and remuneration of care work is a major challenge to women’s full and equal participation in the labour force. 

The care needs of older persons are filled by relying on the low pay or unpaid work of female kin. The women supporting other women with kin care are unable to seek employment or fully support themselves or their children, and in the absence of state recognition, they engage in this form of precarious work as a way of sustaining a livelihood. 

The research focused on families where there is a female employed family member. Our findings show that concerns about an ageing population, while it is a health concern, the care crisis currently experienced is a gender, race and class issue and is not limited to households that rely exclusively on social grants. 

Exploiting a moral obligation

The research found that the important nature of care work prevents many women from walking away from such work – women are unlikely to hand over these responsibilities to others, either because they can’t afford to or because it is their moral obligation. 

The fact that women take on the responsibility for caring makes their contribution to care in society and households more likely to be exploited. Gender equality will not be reached unless issues around unpaid care work are recognised and reduced. 

Care economies are currently built on the unpaid work of women, but the state needs to consider its responsibilities.

The economy and healthcare system is being propped up by the unpaid care work of women. It is the work that female kin undertake that allows other women and men to participate in the labour force. But care work also supports the health system as carers, who meet the care needs of older persons, may prevent older persons from having to access costly institutional, medical care or intervention. 

As the number of older persons doubles over the next 25 years, the cost of not paying attention and supporting family caregivers will be felt by society and the economy. State investment is critical to reducing the amount of work that women do.

In the final part of this series, we will explore how the lack of material resources are central to family caregivers’ decisions to care for older persons and shape care choices and arrangements.

We will ask questions about the types of support available at community and family level and reflect on the poor uptake of the grant-in-aid, a social grant designed to assist caregivers. DM/MC