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To cite this article: Clare Ungerson (2003): Commodified care work in European Labour Markets, European Societies, 5:4,
377-396
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European Societies
5(4) 2003: 377–396
© 2003
Taylor & Francis Ltd
ISSN
1461-6696 print
1469-8307 online
Clare Ungerson
Division of Sociology and Social Policy, School of Social Sciences, University of Southampton
ABSTRACT: This paper considers the reasons why a form of commodified care
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EUROPEAN SOCIETIES
their wages are ‘routed’, in much the same way as trains along a railway line,
from the state, through the care consumer, to the endpoint of the caregiver.
It is the purpose of this paper to outline, somewhat speculatively, the
trends that have driven this policy innovation, and then to speculate as to
how far these policies are likely to remain in place or atrophy. The paper
draws on preliminary analysis of a cross-national study of elder care users
who have been given cash for care, and points to the way in which different
funding regimes generate different types of care relationship and different
kinds of politics of care. The conclusion suggests that despite similar
impulses underlying these policies, they have rather different outcomes in
terms of their impact on the labour market for care work, and ultimately
for the care relationship.
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1 Origins
The fact that ‘routed wages’ have developed so commonly, and, for most
of the European countries, within a rather similar time period (the late
1990s), indicates that similar trends may be driving them. We know quite
a lot about the way these policies work (Evers et al. 1994; Weekers and
Pijl 1998), but the history of their various origins remains to be written.
Nevertheless, one can speculate as to the general impulses that underlie
these developments. Interestingly, some of these impulses seem, at least
at first sight, contradictory. For example, one can argue that these policies
emerge out of a critique of the welfare state that developed in the 1980s
and 1990s – that the welfare state is an unwieldy and clumsy responder to
‘need’ and that ‘need’ is all too often defined by professionals intent on
self aggrandisement and hegemony. This critique, which argues for the
‘empowerment’ of care users, such that their needs are more directly heard
and responded to, is clearly part of a more general trend towards consum-
erism and individualism identified by many commentators on late moder-
nity (Beck 1992; Giddens 1992). Hence one can see, and most easily with
hindsight, how the provision of cash rather than services to care users is
heavily influenced by this consumerist and individualistic discourse.
At the same time, however, another impulse – the move to the expan-
sion of the concept of ‘citizenship’ such that it moves away from a male
breadwinner dominated model (Pateman 1988), and towards a model that
takes into account the contribution of citizens, particularly female citi-
zens, to ‘care’ (Fraser 1994; Lister 1997) – has also driven a much less
consumerist discourse, but rather a discourse that emphasizes and
broadens out some of the older ideas of collectivism and social responsi-
bility. It can be argued that this expansion of concepts of citizenship to
take on board ‘care’ has also had its own impact on policies to give cash
to care users. If care users are funded to employ their own care directly,
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this demonstrates a form of trust by the state that its citizens know best
as to how to resolve their own needs (in much the same way as most
welfare states – but noticeably not the USA welfare system laced, as it is,
with food stamps – trust their citizens to spend their benefits in the way
they think best). At the same time, if care users are given carte blanche to
employ whoever they want – and, as we shall see, many welfare states do
precisely this – then, should care users choose to pay their relatives who
care for them, such payments to care constitute a recognition of the care
that informal carers deliver and provides them, very directly, with a sense
of the presence of the state in the care relationship. Thus the notion of a
partnership between welfare state and its caring citizens and its citizen
care users is, at least notionally, developed.
Two further impulses towards such policies can be identified. They can
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also be understood within another trend of the 1980s and 1990s: namely
the trend towards the marketization, in the sense of introducing quasi-
markets, of the welfare state, and its wholesale privatization. Both these
trends took place on the grounds of increasing efficiency of allocation of
resources, and also to allow for the development of consumer choice. The
development of purchaser/provider splits within the quasi-market model
always begged the question as to why the ‘purchaser’ need necessarily be
an arm of the welfare state. Indeed, both the discourses of consumerism
and of citizenship referred to above, rather indicated that the purchaser
could indeed be the individual citizen, trusted to choose the form of care
that he or she authentically needed. Moreover, once the presence of care
delivery organizations was guaranteed through the process of welfare state
privatization then, in theory at any rate, a market supplying caring labour
was available for participation by the individual citizen purchaser. So it is
arguable that once the quasi market systems were in place, it was only a
matter of time before the logic of market ideologies drove towards the
direct purchase of services by their users.1 At the same time, other
responses to marketization and individualization paradoxically drive a
more communitarian and conservative impulse which in its own turn also
feeds into the development of ‘routed wages’. In response to the process
of individualization and fragmentation that takes the form of the break-
down of the traditional family based on marriage and a gendered division
of labour, some governments come to emphasize policies that attempt to
pull the traditional family back into shape. The payment of cash to care
users, where care users are able to use the monies to pay whoever they
want, including their relatives, is seen to be a means of reinforcing inter-
generational and intragenerational familial obligations.
One important aspect, common to most of the countries that have
1. This is probably a particularly British version of the logic and sequence of develop-
ments. In some countries, the quasi market stage is not an essential prerequisite for
‘routed wages’ since they are driven by more powerful other impulses.
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care. However, it is not always the case that nations overtly pursue the
route of commodification of informal care: in France for example, as we
shall see, the development of routed wages has taken place within the
context of a proliferation of care organized by private agencies which
employ workers paid at least the minimum wage. In these cases, the
provision of cash paid to care users limits the care time that care users can
purchase, and the provision of care within the care user’s home means that
the overheads and hotel costs of care are covered, invisibly, by the past
and present expenditure of the care user’s household.
While these are general reasons as to why there appears to be conver-
gence among so many nations of Europe in the development of ‘routed
wages’ as part of the process of care commodification, there are also
particular reasons that pertain to particular nations. In the UK, for
example, the early development of the allocation of funds by the state to
people in need of long-term care in order for them to buy in their own
caring labour was restricted to disabled people of working age. The
extension of ‘routed wages’ or, as they are called within the UK legislation,
Direct Payments, to people over working age was the result largely of
campaigns by lobbies representing elderly people who argued that
refusing elders the option to purchase their own services was ageist and
implied that the state did not trust elderly citizens to use state monies
sensibly and in their own interests. In France, the decision to fund the
purchase, by elderly people, of their own care was much more closely
related to a general policy, adopted in the 1990s, of trying to bring the
invisible and largely grey labour market of the domestic domain into the
formal economy and to create employment. In Austria, where a social
insurance-based welfare state similar to that of Germany had led to a long-
term care system that was driven by an expensive medical model of elder
care funded by health insurance, the long-term care system had been
overhauled within a context where cash transfers are the tradition of the
Bismarkian welfare state. In Italy, the payment of monies to care users was
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provide additional evidence that their care workers are trained to execute
health related tasks. Hence embedded in this type of care work develop-
ment is a logic of growing credentialism, and the acquisition of occu-
pational hierarchies and status.
Thus the labour market impacts of these policies are complicated,
potentially contradictory, and dependent, at least to some extent, on the
funding regime adopted by the particular welfare state. We currently
know very little about how these impacts are working out in practice, and
it is for this reason that I have undertaken, with my colleague Sue Yeandle
(Sheffield Hallam University) and research teams working in four other
EU nations,2 a qualitative study of the employer/employee relationship
that emerges out of a selection of these various systems. The study is
funded under the British Economic and Social Research Council (ESRC)
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routed wages has been more and more subject to regulation until it has
moved into a directly opposing model of commodified care management
to that which prevails in Austria. In France, the allowance known as
‘Prestation Specifique Dependance’ has, since 1997, been available to
elderly care users. The allowance was means tested, but enough to employ
a care worker on a part-time basis. The allowance could be used to pay
relatives but not spouses, and was specifically directed towards pulling
informal economic activity into the formal labour market, and workers into
the social security system. At the end of 2001, approximately 150,000
elderly care users were in receipt of this benefit. The benefit has now been
extended and renamed as the ‘Allocation personnalisée à l’autonomie’
(APA) and the expectation is that 80% of the dependent elderly population
will be in receipt of this more generously allocated benefit, amounting to
about 600,000 recipients in total (Martin 2003). A somewhat similar system
has recently developed in the UK, where the right to choose cash rather
than services has been steadily extended to disabled people of working age,
culminating in the Community Care (Direct Payments) Act 1996. This
option was made available to elderly care users in 2000. At present, very
few elderly care users are in receipt of direct payments, certainly in
comparison with the high number of recipients of cash for care in the other
countries described in this paper. In 2002 there were just over 1000 elderly
care users in receipt of direct payments – and this low take up is in contrast
to the continuing stream of policy documents emanating from the UK
government in support of direct payments (see, for example, Milburn
(2002) and the current extending provisions of the Health and Social Care
Bill) (Yeandle 2003). Careful regulation is used to oversee the system and
ensure that care users do not pay their relatives or anyone living in their
household (except a formally employed personal assistant). Payment of the
cash is contingent on the presentation of full documentation and evidence
that the workers are locked into the social insurance system.
The data collected in this project has been largely qualitative and
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with Vienna and Milan being cities with incoming populations, particularly
internationally, while Sheffield has a very stable population with little
inmigration, particularly from abroad. Both the studies in The Nether-
lands and in France were conducted in largely rural hinterlands of urban
concentrations, and this means that it is likely that the labour markets in
these areas are much less diverse, and local networks rather more solidar-
istic than those of the urban areas. The outlining of the differences between
the areas of origin of our sample populations remains a task for the project
as a whole. However, we do know that if we had attempted to hold the
variables constant by, for example, using a triangulated method, the entire
project would have been prohibitively expensive. So what we have emerged
with is data from qualitative interviews conducted in five different coun-
tries of Europe (and five different languages) which has been selectively
translated into English. In each country interviews were conducted with
ten elderly care users in receipt of ‘routed wages’. They were then asked
to name and grant access to their care givers and these care givers were also
interviewed in depth. In each country, about 30 interviews were conducted
overall. The analysis so far has concentrated on the countries other than
the United Kingdom, so this paper omits the British data and concentrates
on Austria, Italy, The Netherlands and France.
Both the Austrian and Italian funding regimes are unregulated. Amongst
the Italian sample, the needs tested cash subvention that elderly care users
received was commonly in the region of 700 to 1,000 euros a month (about
£500). It became clear, in the course of the interviews, that a full-time non-
resident carer employed within the ‘grey’ market could command an
income of about 750 euros. Live-in paid carers in Milan appeared to be
paid somewhat less. Hence the amount that is available to elderly care
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users through this cash payment is enough, should they so wish it, to
employ full-time help. Nevertheless, a number of our respondents
referred to the money as an essential subsidy to their low pension income.
They did not see it as a form of cash that should leave the immediate
household: rather they welcomed it as a means with which they could cope
with daily living expenses and, in particular, pay for essential drugs. Hence
the subsidy could be construed as an anti-poverty measure for pensioners
on low incomes, and a subsidy towards the costs of health care, rather than
a policy designed to promote the employment of care workers.
However, amongst those elderly care users who did ‘employ’ a care
worker in the Italian sample, it is absolutely striking that not a single one
of the elderly care users had approached a care agency to provide them
with a care worker. Among those who had decided to use a paid carer from
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outside the immediate kin network, only ‘grey’ labour was employed. Three
of these workers were immediate neighbours who provided small amounts
of care – one hour in the afternoon, for example, while a carer husband did
the daily shopping – and were paid in cash and small presents for their care
tasks. All of the five paid carers who lived in the same dwelling as the care
user and provided 24-hour care, in some instances for 7 days a week, were
non-EU nationals. In this small sample, careworkers of the following
nationalities were either referred to in the interviews with elderly care users
and/or were subsequently interviewed themselves: Peru (three), Ecuador
(two), Romania (one), the Philippines (one), Mauritius (one), Sri Lanka
(one). It is clear from the interview material that only one of these non-
EU nationals had residence rights in Italy, and indeed for some of them
the acquisition of residential rights had become something of an obsession.
In Milan there is clearly a culture of, as one respondent put it, ‘taking
a foreigner’ to provide care. It was also clear that local networks worked
very well in the recruitment of these workers: workers were passed from
neighbour to neighbour, from sister to sister, and some were found by the
concierges of apartment blocks. A foreign appearance seems to be the
defining characteristic of availability to enter paid care work. A Mauritian
described graphically the casual process by which she was recruited:
One day when I was hanging out the washing on the balcony I was seen by a
neighbour who asked me who I was, how it was that I was there, and whether
I already had a job . . . she told me that a friend of hers was looking for a girl
to look after her mother . . . the next day she had already spoken to her friend
. . . and very soon the lady took me on and I went to live in her mother’s house.
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personal care tasks was available to Milanese who wished to employ paid
care. At the same time, the payment of the cash subsidy gave some care users
and their informal carers the financial headroom to fund very small amounts
of additional care – typically the payment of a neighbour to provide very
small amounts of regular companionship, or the employment of a cleaner,
for 2 hours a week, to help an elderly spouse carer. Nor did these cash
payments commodify kin relations. All elderly care users cared for by their
spouses thought the questions concerning whether or not they paid their
wives or husbands to care quite absurd. There were some more complex
relations between care users and their children, but again, the issue of
commodification of care did not arise. Payments to children were rare and
construed, not as regular payments, but rather as ‘tips’ and presents.
Thus, judging from this small sample, the labour market for care had
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not been radically affected by the Italian cash for care subsidy. Far more
important was the decision, among most of the care users in this small
sample, not to use the money to pay carers at all, but rather to rely on pre-
existing informal care arrangements from spouses, daughter and sons, and
to use the cash to supplement their own incomes. Where they did use the
monies to pay for paid care work, they tapped into a pre-existing market
and maintained pre-existing paid care relationships. This ‘routed wage’
system had enhanced the effective demand of elderly urban Italians to
consume a range of products, from food and drugs to neighbourly compan-
ionship. Such payments are more likely to be defended by a politics of
income maintenance for elderly people rather than by a politics of care.
In certain respects, the Austrian sample was similarly engaged, either
with informal care arrangements which pre-dated the introduction of the
cash allowance to care users, or with the use of undocumented, foreign
labour. However, there were some crucial differences. First, it became
clear that the routes into the recruitment of foreign labour were entirely
different, in the sense that the Viennese labour market for care was being
specifically orchestrated by agencies that are recruiting caring labour in
the bordering transition economies of Hungary and Slovakia. Hence this
was unlike the Milanese labour market for undocumented labour in two
senses: first it was not a global market drawing in permanent migrants
from the South, but rather was a labour market located across a permeable
border, allowing for transition from one economy to another over tem-
porary and brief periods. Second, the Austrian recruitment of foreign
labour was specifically directed towards finding care workers for elderly
care users. A further major difference between Austria and Italy is that,
although we found, just as in Italy, the classic informal care relationship
between co-residents, where questions of commodification of the care-
giver were regarded as profoundly absurd, we also found instances of
direct commodification of co-resident relatives. Again, in these instances
of commodified care between kin, an agency was acting as intermediary.
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lived with their employers for their fortnight ‘on’ were in their late teens
to mid-twenties. (Every one of the Austrian carers in this sample was
female.) Interestingly, the only older workers who commuted across
boundaries did so on a daily basis, and the only one of the workers who had
started off on the ‘two weeks on/two weeks off’ routine and who was in her
forties was now engaged to be married to her employer (he had, as a result,
stopped paying her – an interesting example of refamilialization!).
The careworkers thus engaged were highly satisfied with their work. It
constituted a means of working part-time and leading a transitional life
between two economies and two homes, in a way that generated a reason-
able income. As one of them put it:
Well, it’s good pay for me and he gains as well – it isn’t too much for him either.
He would have to pay more for an Austrian woman. It’s quite a good deal.
Most of the employers of such labour were also apparently satisfied with
the round-the-clock care that they managed to find at relatively cheap
rates. However, not all reported total satisfaction. As the employer of the
young woman quoted above said:
It’s like this: a person who needs someone round the clock can’t manage. I have
to take on a foreigner, because otherwise I can’t manage financially. I just
couldn’t manage. That’s sad. I have to employ someone from abroad because
those in our country are so expensive.
It was also clear that most of these workers were actually being recruited and
placed by a cross-border agency which was specifically advertising for care
workers to work in Austria in the Hungarian and Slovakian press. Only one
worker had been found through an independent route, and in that case the
employer had conducted comprehensive telephone and face-to-face inter-
views before employing the workers. Thus, it appears to be the case that the
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£290 a month.4 In return for the care work undertaken, Mrs S receives a
monthly wage of £562, plus cover for social security contributions, holiday
rights, and holiday and sickness pay. Not only does Mrs S say that this rate
of pay for care work is better than the pay she received before she started
caring for her mother when she worked in a factory, but the wage from
Caritas means that the household income of this dyad of mother and
daughter has increased by £272 a month. All the paid kin working within
the Caritas scheme were satisfied with it. As Mrs S herself said:
It’s marvellous. To be at home, do the housework and get paid for it.
We’re very satisfied. Yes, very. We’ve never had a single complaint. We’ve
always sent in the money that had to be paid.
Not only did it increase the income of caregivers and their co-resident care
recipients, and provide them with social security rights, it also provided
them with a sense of self esteem. One carer, who had previously cared for
her father-in-law outside the Caritas scheme, described how she felt when
she discovered she could be paid for caring for her mother-in-law:
You can only say that I simply felt as if I had been promoted. Society also saw
it totally differently then. Suddenly it was: ‘Aha, you’re doing a job’. Although
I didn’t do anything differently from before, it was suddenly seen as self
3. This policy innovation by a voluntary organisation needs some further investigation,
in order to understand the aims and objectives of the scheme, and its funding.
4. All the care receivers in our sample paid Caritas a little more than their care allowance
– thus they supplemented their expenditure on care from their other income especially
from their pension. Two paid kin caregivers reported that they themselves contributed
to the Caritas fee from their own income from Caritas.
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EUROPEAN SOCIETIES
evident. But if you then say that you’re working for Caritas, people say to you:
‘Wow, you’re working now’ . . . As soon as you’re in employment and can say
to the doctor that you have your own health insurance, it appears you are a
better type of person. From the point of view of society, this type of employ-
ment is very good for women.
It is noticeable, and the quote above demonstrates this, that the caregivers
who had entered the Caritas scheme and become commodified, had, in
almost all the cases in our sample, been the primary caregivers before they
entered paid employment as care workers with Caritas. Hence there was
no direct impact of this scheme on the labour market: it was not, at least
according to this evidence, persuading individuals to give up paid work and
take on caring ab initio. However, there was some evidence that the fact of
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Both the Italian and Austrian funding regimes pay cash to care users
according to an assessed level of disability. The Dutch system pays cash
according to the amount of care work time that is judged to be necessary, in
conjunction with an assessment as to how much ‘domestic’, ‘personal’ and
‘nursing’ care is required within the total amount of care hours allotted to
the care user. Thus the amounts of cash provided to the respondents in our
survey varied considerably. In the Dutch sample in this study, a paraplegic
man was assessed as needing 19 hours of nursing care per week, and 3 hours
domestic help. For this care his wife received, through the Social Insurance
Bank which administers the ‘personal budget scheme’, the considerable sum
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of £21,828 a year. Rather more common were smaller sums, in the region
of £300 a month with which to pay for a combination of personal and
domestic care. However, there are striking differences in the amounts of
money received through the Dutch personal budget scheme reported by
our respondents; moreover, some of them were very confused themselves
as to the amount they had received and could expect in future, so the figures
they gave our interviewer have to be treated with caution.
The confusion of our respondents was not surprising. The Dutch system
is highly regulated, and administered by the Social Insurance bank. More-
over, apart from a very small sum of so-called ‘free’ money, these care users,
who are known as ‘budget holders’, never actually receive the full personal
budget themselves. Their ‘employees’ receive their cash payments directly
from the Social Insurance Bank. The regulation of the system had created
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the support it can command from those who directly benefit – the care
users and the care givers. So long as the scheme remains relatively
generous, and if it can become less confusing and bureaucratic to its users,
then that support will probably remain in place.
The French sample in this study had all been found through a care agency
which was used by elderly care users in receipt of the means tested Presta-
tion Specifique Dependance (PSD). Seven of the ten care users in this
sample were in receipt of the means-tested PSD, and a further three were
in receipt of tax allowances on the grounds that they needed care. A typical
amount of PSD received by these elderly care users was in the region of
£350 a month, which was certainly not enough to employ someone full
time, or even for many hours. It is possible that there is a ‘grey’ sector filled
with migrant labour, as in Italy and Austria, active in the French labour
market for care, who might have been willing to work for an income of this
level. However, given that the French sample was found through contact
with a formal care agency, and the fact that the study took place in a part
of France where there is very limited international migration, it is not
surprising that these features did not emerge in this part of the study.
However, there were two particularly striking features of care work
explored in the French interviews: first, the care workers employed through
the agency were engaged in multiple care relationships, a number of them
working for up to 13 clients whom they visited at least once a day. Second,
most of these workers had a basic care qualification known as the CAFAD,
which had provided them with training, and also, as we shall see, a reflexive
perspective on the work they undertake. In both these features, they are
very different from the workers in Italy, Austria and The Netherlands.
The fact that these care workers were employed by numerous
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‘employers’ meant that they were engaged in a constant battle with time.
Many of them complained about the difficulty of dealing with so many
employers at once, and how difficult they found it to combine holistic care
(see below) with the exigencies of having to deliver care work at speed:
I asked the question, ‘Until what time are we to work in the evening?’ I was told
‘Usually you should be home by 7.30 at the latest’. Yes, but when I have both
clients . . . Like this evening: I have Mr Morin first. Friday is griddle cake night,
the night on which he eats best . . . so the griddle cakes have to be heated up,
the egg has to be placed on top and everything. . . . I don’t know where he puts
it all! He eats three of them! . . . But it makes him happy. On Friday he treats
himself. You cannot do it in five minutes! Afterwards there is the washing up,
and then he has to be undressed. As I have shopping to do this evening I will
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take a quarter of an hour to go to the nearest grocers, it’s more expensive but
what can you do? On Fridays, instead of half an hour it takes a good three
quarters of an hour, plus a quarter of an hour for shopping, that makes one hour’.
These workers are engaged, as we can see from the above quote, in a wide
variety of tasks, including cooking and shopping. They are constantly
moving from client to client, delivering services to them in short bursts.
Their bureaucratically determined time frequently runs contrary to the
body times and the preferences of their elderly ‘employers’. At the same
time, this is a group of workers who have a carework qualification, and
who are highly reflexive on the contradictions of, and boundaries between,
the tasks they undertake:
We cannot, when the person asks us, takes us by the arm and says ‘come and
see my granddaughter . . .’ you drop everything and go to see her. The rela-
tionship is important. Touch . . . it must not go to extremes but I think that a
slight caress or a pat on the back is important. If you do not have that instinct
to feel things, there is no point, you should find another job.
Such reflexive commentary on the nature of the work was typical of this
group of workers, and it was also clear that, as a group, they are engaged
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a credentialism which acts as a surrogate for the embedded trust that exists
in care relationships that pre-exist ‘routed wages’. These French care
workers are, I suggest, at the start of the development of a new creden-
tialized occupation. Their claim to unique holism will not be an easy one
to maintain, but it may also be one that manages, eventually, to overcome
the classic health/social care divide that so many of these care worker
respondents refer to. The politics and stability of this system of ‘routed
wages’ is founded on the willingness of the French welfare state to
continue policies of subsidising care users as part of a more general policy
to stimulate low paid employment for women. And the future of that form
of employment and its status lies in the politics of workers who are already
beginning, collectively, to reflect upon the nature of the tasks they do, and
the meanings of those tasks for their employers.
6 Conclusion
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As far as the care relationship is concerned, one thing is clear from our
data: successful, intimate care relationships occur within a variety of
managed and unmanaged settings. Both commodified informal carers (as
in The Netherlands) and agency care workers with multiple clients (as in
France) reported high levels of satisfaction and deep levels of frustration.
The provision of care, within the domestic domain provides opportunities
for intimacy and the development and reinforcement of affect; at the same
time, the invisibility of the domestic domain and its enclosed nature can
lead to boredom at best, and exploitation and abuse at worst. The intro-
duction of the cash nexus, sometimes with accompanying occupational
status and hierarchy, into this mesh of risk and opportunity creates a new
context for care, and it remains to be seen, in further analysis, how this
impacts on the care relationship itself.
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Acknowledgements
The research on which this paper is based was funded by the Economic
and Social Research Council within the Future of Work Programme,
grant number: L212252080. The author is very grateful to her colleague
Sue Yeandle with whom she co-directed the project as a whole and to
Cristiano Gori and Marja Pijl, who commented on an earlier version of
this paper, and to the research teams listed under Footnote 3 who, through
their commitment to this project, generated the rich data, some of which
is analysed here.
References
Beck, Ulrich (1992) Risk Society: towards a new modernity, translated by Mark Ritter,
London: Sage.
Evers, Adelbert, Pijl, Marja and Ungerson, Clare (1994) (eds), Payments for Care:
a comparative overview, Aldershot: Avebury.
Fraser, N. (1994) ‘After the family wage: gender equity and the welfare state’,
Political Theory, 22(4): 591–618.
Giddens, Anthony (1992) The Transformation of Intimacy: sexuality, love and eroti-
cism in modern societies, Cambridge: Polity.
Gori, Cristiano (1999) Contrasted Situations at the Local Level: the Italian case, paper
presented at the international seminar on ‘Policies towards the frail elderly in
Europe’, ENSP, Rennes, France.
Gori, Cristiano (2003) Payments for Care in Italy, background briefing paper for
the International Conference on the Direct Employment of Domiciliary Care
by Older People, ESRC Future of Work Programme, Policy Studies Institute,
London, UK.
395
03_REUS1461669032000127651.fm Page 396 Monday, October 20, 2003 3:10 PM
EUROPEAN SOCIETIES
Pijl, Marja (2003) The Dutch Care Allowance, background briefing paper for the
International Conference on the Direct Employment of Domiciliary Care by
Older People, ESRC Future of Work Programme, Policy Studies Institute,
London, UK.
Ungerson, C. (1997) ‘Social politics and the commodification of care’, Social
Politics 4(3): 362–81.
Ungerson, C. (1999) ‘Personal assistants and disabled people: an examination of
a hybrid form of work and care, Work, Employment & Society 13(4): 583–600.
Ungerson, C. (2000) ‘Thinking about the production and consumption of long-
term care in Britain: does gender still matter?’, Journal of Social Policy 29(4):
623–43.
Weekers, S. and Pijl, M. (1998) Home Care and Care Allowances in the European
Union, Utrecht: Netherlands Institute of Care and Welfare/NIZW.
Yeandle, Sue (2003) ‘Cash for Care’ policy in England and Wales, background briefing
paper for the International Conference on the Direct Employment of Domi-
ciliary Care by Older People, ESRC Future of Work Programme, Policy
Studies Institute, London, UK.
Clare Ungerson has been Professor of Social Policy in the Department of Sociology
and Social Policy at the University of Southampton, UK, since 1994. She has
conducted research in the area of paid and unpaid care, always within a feminist
perspective and sometimes within a comparative perspective, for the past two
decades. She has become interested in the way in which cash is entering the
informal care relationship, such that policy change is shifting and dissolving the
boundary between paid and unpaid work. This process she has named as the
‘commodification’ of care. The empirical data on which this data is based were
generated in an ESRC-funded project within the ESRC Future of Work Programme
for which she was the principal applicant.
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