The Value of Care

Our relationship to the value of caregiving contains a paradox.  On the one hand, we hold as heroes those who care grandly:  Mother Teresa’s care for Calcutta’s poor, St. Francis’s protection of living creatures, and the Indian guru Amma’s 33 million hugs come immediately to mind.  But on the other hand, while we value the care given by parents, teachers, healthcare workers, childcare providers, custodians (and on and on) we don’t value that care financially.  The paradox is that we both value and don’t value caregiving.
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We expect caregiving to be offered freely.  I suspect that this has roots in the way our culture values hard masculine skills and undervalues soft feminine skills.  We pay the surgeon handsomely to repair us but offer far lower wages to the nurses and care aides who tend us.  This looks suspiciously like the stereotypical Western family structure in which the man receives pay for selling insurance or operating a backhoe while the woman cares for the family without pay.  We expect economic benevolence of our caregivers in ways we don’t of the truck driver or attorney.

Paradoxically, while we undervalue caregiving financially, we still celebrate its virtues.  We recognize that parental affection is the foundation of our psychological health, which is underscored by the fact that our jails are filled with people whose parents failed to care.  When we’re ill (which we inevitably will be) we want to be treated according to our preferences of care, not by a robot who’s algorithm treats everyone alike.  We fill out advanced care planning documents to extend those care preferences past our ability to speak.  And if we’re lucky enough to get old, we want to be cared for at home by family rather than placed anonymously in a facility, hoping to avoid the loneliness and isolation of abandonment.

Caregivers live this paradox: We give what is valued without receiving financial value in return.  Ultimately, we care because we choose to.  Giving ourselves to others rewards us with joys unavailable to those who merely sell their time to the highest bidder.  We recognize that society’s fee for service model fails to recognize the deep rewards found in helping others.  We see that in giving, we receive; that in loving, we are loved.  Such generosity cannot be transactionalized and exists outside the accountant’s ledger.  Yet it has real value.

This economic undervaluing creates a barrier to providing good care.  Caregivers have rent and cell phone data plans to pay just like everyone else.  Financial pressures drive many compassionate people away from helping and into more financially valuable (but less socially valuable) activities.

Caregivers didn’t create this paradox alone and can’t solve it alone.  Our work environment is the sum of many societal and individual habits, most of which began long ago and remain hidden from view.  I suspect that our best response is to change the situation with every compassionate interaction.  When we listen with kindness to the wrinkled lady with dementia, something shifts.  Our calm touch on the shoulder of the frightened young man in the ER or patient listening to an angry coworker shifts things again.  Even our hidden actions matter – in ways we may never see but that I trust will be beneficial nonetheless.

Our task, then, is to address both the present and future.  We offer care to those before us because we’re able and, at the same time, we create conditions in which the economic value of our care rises to support future caregivers.  We know from our own experience that offering care in this way – generously, yet with trust in its value – is enough.  ​