Abstract
This case study of home eldercare assistance by Frances Degiuli, an Italian sociologist working in the United States, conducted in her home territory of Italy, exemplifies how the interplay between current economic, political, demographic, and societal transformation processes produces solutions to a crisis in care that are not sustainable. Hence, the book contains a central message for all social workers who are living and working under conditions of neoliberalism.
Italy is of paradigmatic relevance in this regard because here a number of factors characterize and exacerbate the situation of elderly people in need of care assistance. The decline in fertility has been particularly drastic here while social policies continue to exploit the high cultural value attributed to kinship solidarity, which has declined through the increased participation of women in the labor market. Degiuli’s central argument is that the complete breakdown of care arrangements in such a constellation could only be avoided by pulling in a large number of migrants as caregivers, specifically in their role as women. This drawing in of migrant caregivers is aided and abetted by the state granting unregistered foreign caregivers periodic amnesties. Economically, for most families, it is the only affordable alternative to either deserting frail elderly family members or sacrificing the economic function of a potential (female) family caregiver. Overall, the tapping of migrant women upholds the appearance of the family as the primary caring unit.
This complicity among different interests seems to function on the surface, and most of the migrant caregivers Degiuli interviewed work with dedication—yet the arrangement costs a high price. Caregiving by migrant women works in Italy by exploiting the foreign care assistants as cheap labor, denying them any chance of developing their skills in a professional direction, and reducing them to the traditional stereotype of women as “natural” caregivers whose labor deserves scant material recognition, particularly when performed in living-in conditions. It also works to the detriment of the elderly persons being cared for in this improvised manner particularly where the highest level of skills would be required. The alienation of elderly persons receiving care is heightened by language difficulties between migrant caregivers and aged persons and the lack of caregiver familiarity with their patients’ past living environments, dietary preferences, and other cultural habits. The grim message is that withdrawing state support and softening professional quality standards leaves markets to emerge that are driven by profit interests that easily result in exploitation.
The book briefly presents aging trends worldwide and the underlying causes of and the resulting need for long-term eldercare. It then explores “demographic, economic, political, social and cultural influences that have transformed the family unit and the gender roles within it” (p. XVII) and the changed welfare policy climate of neoliberalism and privatization. Therefore, increased global mobility of female labor results not just from push factors in their countries of origin but also from pull factors in richer countries. Cultural, economic, and political factors are shown to converge in constructing eldercare assistance required by this kind of market at an “affordable” price, one lowered by preconceived and discriminatory notions of gender, race, ethnicity, culture, and nationalism.
After providing a compact though necessarily selective theoretical and statistical introduction to the themes of eldercare and female migration, Degiuli presents her empirical findings of interviews conducted in the area of Turin, Italy, with foreign caregivers, managers of caregiving organizations, and family members of eldercare recipients. These findings portray the general willingness of those caregivers to make the best of their situation but also the serious structural limitations that affect both the hiring process in a largely unregulated market and the lack of proper skills recognition and development in care work. From a social work point of view, it is gratifying that this insight by a sociologist confirms the high level of skills that is required in such intimate care situations with highly vulnerable persons. The book also points to the enormous investment that would be required to bring about this level of skills, not just through proper training and fair remuneration of professionals but also by public recognition that caring—and all forms of purposeful human bonds—have a value that extends far beyond the price tag that can be attached to it.
The limited empirical basis of this research cannot be representative of attitudes and practices among different groupings of migrant caregivers in Italy, nor can it be generalized to the situation in other countries. The emphasis on the exploitative nature of gendered forms of labor among migrants would also have benefited from a brief parallel with the treatment of migrant women as sex workers. However, the study highlights the interlinking mechanisms that contribute to the further dissolution of the interplay between private and public social bonding activities in the tradition of subsidiarity, a systemic relationship characterized by power dynamics that lead to exploitation, a reinforcement of gender and age stereotypes, and, potentially, to neglect, disregard for human dignity, and, eventually, to the further fragmentation of societies already burdened with growing inequality, racialized divisions, and nationalistic separation trends.