Madam Chair, I'm very honoured to be speaking to such an important committee. My specialization is care work for seniors, both in its paid and unpaid forms, and that's what I'll focus my comments on today.
The conversation about unpaid work is current and it's critical. What it isn't, however, is new. The quintessential Canadian book on gender and unpaid work, The Double Ghetto, was written nearly 40 years ago. It used Statistics Canada data to look at women's and men's segregated work inside and outside the home. A recent second printing highlights some of the gains women have made in educational attainment and labour force position. However, it scathingly reveals the persistent segregation all these years later, particularly when we consider care work.
The debate is increasingly showing up in popular media. For instance, following on the heels of Anne-Marie Slaughter's Atlantic Monthly piece, Melinda Gates used her 2016 annual letter to focus on unpaid work. She wrote:
Unpaid work is what it says it is: It’s work, not play, and you don’t get any money for doing it.... You can think of unpaid work as falling into three main categories: cooking, cleaning, and caring for children and the elderly. Who packs your lunch? Who fishes the sweaty socks out of your gym bag? Who hassles the nursing home to make sure your grandparents are getting what they need?
Child care is most often the focus of debates about unpaid work, while care for seniors is less visible. Care work for seniors in both its paid and unpaid forms can involve help with body care, dining assistance, and organizing, such as with medical appointments and finances, providing transport, and assisting with the home, such as cleaning and maintenance.
Importantly, family care work and private companion care provided in communal and publicly funded dwellings like nursing homes are less often discussed. My comments will highlight paid and unpaid care work and note when it is publicly funded or privately paid.
Care work is gendered, with women generally providing greater quantities and performing tasks that are more time-consuming and less flexible than care work than men provide. For instance, women provide more housekeeping, meal preparation, and personal as well as medical care. Men provide more transport and home maintenance such as snow shovelling.
According to a Statistics Canada, in 2012 there were 5.4 million Canadians who provided care work to a senior with a chronic health condition, a disability, or a problem related to aging.
The location where care work is provided is also an important consideration. More than two-thirds provided care work to a senior living in a private household. An additional 16% provided that care work to a senior who lived in a private household with them. Another 14% provided care work to a senior who was living in a care facility.
It is most often daughters and spouses who provide this work to women who live in residential settings. The 2016 census data show that about 70% of those who live in nursing homes as well as seniors residences are women.
Many Canadians are also providing substantial amounts of care work in terms of time. More than half of family or friends who lived with a senior provided more than 10 hours per week of care. Nearly one-quarter are doing more than 10 hours of care per week for a senior living in a nursing home where publicly paid care is available and provided.
We also cannot ignore the impact of providing care work. Strain on family relationships was reported by just over one-third of those helping seniors living in a care facility and about one-third of those who shared a home with a senior needing care. This compared with about one-fifth of those who provided care work to seniors living in a separate household and about one-quarter of those who help seniors living in supportive housing.
Women also experience greater negative impacts resulting from their care work, affecting areas as wide-ranging as their finances, their health, and their social lives.
The care needs of people with dementia are particularly important to consider. There are more than half a million people currently living with dementia in Canada, with estimates that this figure will nearly double by 2031. The unpaid care required to aid people living with dementia is an estimated 19.2 million hours per year. That's unpaid care, and a conservative replacement cost of this is $1.2 billion. Experts warn that care work time is also expected to double in accordance with the numbers of those living with the condition. A very large proportion of the costs of unpaid dementia care work is borne by families because the public system only covers a fraction of the total cost of dementia.
More attention is required to attend to the diverse needs of diverse women. For instance, due to cultural challenges, most immigrant families provide care work in private homes, even when dementia is a factor, and they don't, therefore, place families in nursing homes. More attention is also required to look at unmet needs. Families are dispersed geographically. In addition, the family unit has changed over time, with fewer children available to provide care work.
According to Statistics Canada, nearly half a million Canadians required care for chronic health conditions but did not receive it. One-quarter of those with unmet needs were over the age of 65.
Paid care work is also a key consideration. It is a feminized occupation. Overall, 80% of the paid care workforce is composed of women, and women make up over 85% of paid care workers in nursing homes. There is a large proportion of women from diverse racialized and immigrant populations who provide care work to seniors in communal settings. Immigrant and racialized women are often streamed into this care work, especially when other women are unwilling to do the work.
Care work is also among the riskiest of workplaces. Our research shows that care workers in Canada are frequently exposed to high rates of illness, injury, and violence. Conditions in Canada are far worse than in the Nordic countries, for instance. About two-thirds of the nursing and residential workforce is unionized across Canada, but it ranges from a low of 40% in Newfoundland and Labrador to a high of 65.9% in British Columbia. Despite this, most of the work remains low paid, part-time, and lacking in benefits.
There is an insufficient amount of publicly funded care available in home care and residential settings. Our research in nursing homes shows that increasing numbers of families are paying out of pocket to hire private companions to provide one-on-one care in nursing homes. This is largely due to insufficient staffing levels afforded by publicly funded care. Importantly, this care work is precarious, often paid under the table, and lacking in employment standards.
As the care often completely overlaps with the roles of the care aides who are on staff, it is also risky for the residents, the paid staff, and families. Most facilities lack even basic rules about care work that is paid privately, including about basic but important issues such as ID badges, duties to report to staff, or compliance with vaccination or infection control procedures. This private payment also creates a huge economic burden on families.
To conclude, paid and unpaid care work is one of the most important issues affecting the everyday lives of women across this country. While many seniors require care work, an increasing number have needs that are unmet. Paid and unpaid care work comes with risks. Families and friends are bearing an increasing financial and physical burden to provide care. There is an insufficient amount of publicly available care, and this mostly affects seniors who are women. Families are paying privately to compensate for insufficient levels of publicly funded care in nursing homes.
Thank you very much for this opportunity to raise these points with you today.