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"Jämställdhetens blinda fläck" - om anhöriga som vårdar äldre

Katzin, Mirjam LU (2012) JURM02 20122
Department of Law
Abstract (Swedish)
Enligt 2 kap 2 § socialtjänstlagen (2001:453) har kommunen det yttersta ansvaret för att de som vistas i kommunen får det stöd och den hjälp som de behöver. Det innebär bland annat att vård och omsorg är en offentlig angelägenhet och ett offentligt ansvar. Trots det är den vård som utförs av anhöriga och andra närstående personer en betydande och, till följd av nedskärningar i den kommunala omsorgen, växande del av äldreomsorgen i Sverige. Idag står anhörigvården för minst 70 procent av den totala äldreomsorgen i Sverige. År 1998 infördes ett kommunalt ansvar för att ge särskilt stöd till anhöriga och andra närstående som vårdar långvarigt sjuka eller äldre. Kommunernas skyldighet stärktes genom en lagändring 2009. Denna uppsats tar sin... (More)
Enligt 2 kap 2 § socialtjänstlagen (2001:453) har kommunen det yttersta ansvaret för att de som vistas i kommunen får det stöd och den hjälp som de behöver. Det innebär bland annat att vård och omsorg är en offentlig angelägenhet och ett offentligt ansvar. Trots det är den vård som utförs av anhöriga och andra närstående personer en betydande och, till följd av nedskärningar i den kommunala omsorgen, växande del av äldreomsorgen i Sverige. Idag står anhörigvården för minst 70 procent av den totala äldreomsorgen i Sverige. År 1998 infördes ett kommunalt ansvar för att ge särskilt stöd till anhöriga och andra närstående som vårdar långvarigt sjuka eller äldre. Kommunernas skyldighet stärktes genom en lagändring 2009. Denna uppsats tar sin utgångspunkt i dessa två lagärenden och undersöker huruvida de signalerar förändrade ansvarsfördelningar mellan det offentliga och det privata på äldreomsorgens område.

Flera forskare har visat att anhörigomsorgen följer ett tydligt könsmönster, där kvinnor tar ett större ansvar än män. Man har också sett skillnader mellan kvinnor och män med olika social bakgrund. Samma sak har Socialstyrelsen konstaterat i ett antal rapporter. En ökning av det ansvar som anhöriga tar för omsorgen om äldre innebär alltså framför allt ett ökat åtagande för kvinnor, speciellt i vissa grupper. Den stora jämställdhetspolitiska utredning som initierades av regeringen 2004 konstaterar att ”situationen för anhöriga som ger omsorg till äldre inte uppmärksammats inom jämställdhetspolitiken. Frågan om stöd till denna grupp har blivit belyst och problematiserad ur ett jämställdhetsperspektiv i alltför liten utsträckning.” Intentionen med uppsatsen är att bidra med ett sådant perspektiv på anhörigomsorgen.

Frågor om omsorgsarbete – såsom vems ansvar det är, om och hur det fördelas, hur det kompenseras och vad det får för konsekvenser – har länge betraktats som viktiga feministiska frågor, med utgångspunkt i att omsorgsansvaret historiskt har betraktats som en kvinnlig uppgift. Ett grundproblem har varit att kategorin arbete, i en traditionell samhällelig förståelse av begreppet, inte inkluderar den obetalda omsorg som sker i familjen. Detta leder till att omsorg på olika sätt blir undervärderat. Det blir obetalt eller lågavlönat och dess värde erkänns inte fullt ut i samhällsekonomiska modeller. Feministiska forskare har också visat och kritiserat hur den nordiska välfärdsstaten har formulerats primärt kring den avlönade, manlige, heltidsarbetaren, genom att de viktigaste sociala rättigheterna förvärvas genom lönearbete och inte genom obetalt omsorgsarbete.

Den äldreomsorg som tidigare i hög grad betraktats som en familjeangelägenhet och varit döttrarnas ansvar, blev under välfärdsstatens utveckling alltmer ett offentligt ansvar, där vård- och omsorgsfunktioner primärt skulle bäras av samhället. Samhällskontraktet har sedan 80-talets början åter förhandlats om. I de analyserade texterna ser man hur det nu talas om ett gemensamt ansvar för äldre, delat mellan familj och det offentliga. I praktiken är vården allt oftare åter en familjeangelägenhet. Omsorgsansvaret har inte formellt förändrats, men det har omtolkats, vilket synliggörs genom lagstiftningen om stöd till anhörigvårdare. Det har skett en diskursiv förskjutning, en omförhandling av vad det allmännas omsorgsansvar innebär.

De främsta orsakerna till att lagstiftningen om kommunal skyldighet att ge stöd till anhörigvårdare införs och senare förstärks, anses i förarbetena vara att gruppen anhörigvårdare har osynliggjorts, men att de behöver erkännas och ges stöd för att kunna tillvaratas som resurs. Anhörigvårdarna ska inte avlyftas, och förväntas inte heller vilja bli avlyfta, ansvaret för vården, de ska bara ges understöd i denna vårdsituation. Läsningen av förarbetena visar att det problem som man vill lösa genom anhörigstödet inte är existensen av anhörigvårdare. Den framställs som generellt oproblematisk och önskad. Detta går dock på tvärs med de studier som finns om anhörigvårdens frivillighet, forskning som talar för att de flesta inte vill ha anhörigvård men ändå behöver förlita sig på anhörigas omsorg till följd av en begränsad offentlig äldreomsorg.

Empiriska undersökningar har visat att den anhörigvård som ges av personer inom det egna hushållet (av en partner) har blivit mer jämställd. Den vård som ges av personer utanför det egna hushållet (av barn och andra närstående) följer däremot tydliga kön-, klass- och etnicitetsmönster. En ökning av anhörigomsorgen innebär en ökad omsorgsbörda för medelålders kvinnor, speciellt de med arbetarklassbakgrund eller annan etnisk bakgrund än nordisk. Det ökade anhörigvårdandet har negativa fysiska, psykiska, sociala och ekonomiska effekter, vilka drabbar orättvist då anhörigomsorgen inte är ett jämlikt fördelat ansvar.

Stödet till anhörigvårdare är primärt utvecklat efter föreställningen om att anhörigvårdaren är en partner, vilket innebär att en stor grupp anhörigvårdare inte nås av lagstiftningen. Något som kan visas såväl i förarbetena som i det faktiska anhörigstödet är att flera av de negativa konsekvenser som anhörigvårdandet innebär, inte heller blir avhjälpta till följd av lagstiftningen, eftersom förarbetenas problemformuleringar bara fokuserar på vissa aspekter av att vara anhörigvårdare. Att anhörigomsorgens könsbundna orättvisor har kunnat uppstå trots att lagstiftningen på området är könsneutral, visar att bristen på könsperspektiv i lagstiftningen kan reproducera ojämställda villkor. Även om lagstiftningen inte behöver formuleras i könsspecifika termer är det viktigt att välfärden regleras med ett könsperspektiv i åtanke. Välfärdsstaten bör, för att förhindra orättvisa strukturer, bygga på ett socialt medborgarskap som inte förutsätter lönearbete för tillträde till välfärden och som ger en bred tillgång till sociala tjänster för alla. På det viset förutsätter den inte en obetald, eller underbetald, feminiserad vård inom familjen men straffar inte heller privat omsorg i relation till offentligt lönearbete. (Less)
Abstract
Article 2 § 2 in the Social Services Act (2001:453) declares that the municipality has the ultimate responsibility to see to that the individuals in the municipality receive the support and help they need. This means that health care is a public concern and a public responsibility. Despite this regulation, the care provided by relatives is, as a result of cuts in municipal care, a significant and growing proportion of the Swedish elderly care. Today, relatives accounts for at least 70 percent of the total elderly care in Sweden. In 1998, a municipal responsibility to provide aid to relatives who care for chronically ill or elderly was introduced in article 5 § 10 in the Social Services Act. This municipal obligation was strengthened by an... (More)
Article 2 § 2 in the Social Services Act (2001:453) declares that the municipality has the ultimate responsibility to see to that the individuals in the municipality receive the support and help they need. This means that health care is a public concern and a public responsibility. Despite this regulation, the care provided by relatives is, as a result of cuts in municipal care, a significant and growing proportion of the Swedish elderly care. Today, relatives accounts for at least 70 percent of the total elderly care in Sweden. In 1998, a municipal responsibility to provide aid to relatives who care for chronically ill or elderly was introduced in article 5 § 10 in the Social Services Act. This municipal obligation was strengthened by an amendment in 2009. This paper is based on these legislations and examines whether the amendments signal changes in the division of the responsibility for elderly between the public and the private.

Several researchers have shown that family care follows a gendered pattern, with women taking more responsibility than men for the elderly. Differences between men and women from different social backgrounds can also be seen. The National Board of Health and Welfare has noted the same in a number of reports. An increase in the families’ care responsibilities means, therefore, mainly an increased commitment for women, especially in certain groups. The Gender Policy Committee stated in 2004 that the situation of families that provide care to the elderly have not been given sufficient attention within the gender equality policy. The issues connected with this group have not been problematized enough from a gender perspective. The intention of this paper is to provide such a perspective on family care for elderly.

Questions about care work - such as whose responsibility it is, how it is distributed and how it is compensated – have since long been regarded as important feminist issues, since care work responsibility historically has been regarded as a female task. A basic problem has been that the category “work” in a traditional societal understanding of the term, does not include the unpaid care work that takes place within the family. The effect of this is that care work in different ways becomes undervalued; it is unpaid or low-paid and its value is not recognized fully in socio-economic models. Feminist scholars have also demonstrated and criticized how the Nordic welfare state has been formulated primarily around the male wage worker, so that most important social rights are acquired through wage labor and not through care work in the family.

The elderly care that previously was regarded as a family matter and was the responsibility of stay-at-home daughters, became with the welfare state's development increasingly a public responsibility. Health and social care functions would primarily be defrayed by society. The “social contract” has, since the 1980’s, once again been re-negotiated. The analyzed texts shows how the discourse now is formulated around a mutual responsibility for elderly, divided between the family and the public. In practice, elderly care has increasingly become a family matter. The care responsibility has not formally changed, but it has been reinterpreted, which can be seen through the legislation on municipal aid to family caregivers. There has been a discoursive shift, a renegotiation of the care responsibilities.

The main reason that the legislation on the municipal obligation to provide aid to caregivers is introduced and subsequently amplified, is considered to be that the family caregivers as a group has been made invisible. The legislator wants them to be recognized and supported so that they can be fully utilized as a resource. The legislation is not created to lift family caregivers off the responsibility for the care of the elderly, rather to support them in the care situation. The reading of the legislative history shows that the problem the legislator wants to solve by the municipality aid for family caregivers is not the existence of family caregivers. The existence is generally seen as unproblematic and desired. This is however at odds with research on family caregivers, which suggests that most people do not want to receive or give family care if they could choose public care instead.

Empirical studies have shown that the informal care provided by people within the elders’ own household (by partners) has become more gender equal. The care given by people outside their household (children and other relatives) has however clear gender, class and ethnicity patterns. An increase in family care therefore means an increased burden of care for middle-aged women, especially those with a working class background or ethnic background other than Nordic. The increased care work has negative physical, psychological, social and economic impacts, which is unevenly distributed as an effect of the uneven distribution of care responsibilities.

Aid for family caregivers is primarily developed from the notion of family caregivers as partners, which means that a large group of family caregivers are not reached by the legislation. Many of the negative consequences that family care for elderly entails are not eliminated by the legislation, which only focuses on certain aspects of caregiving. The legislation is gender neutral, but the fact that gendered injustices has arisen despite of this, shows that a lack of gender perspective in legislation can reproduce unequal conditions. Although the legislation does not need to be formulated in gender-specific terms, it is important that welfare is governed with a gender perspective in mind. The welfare state should, in order to prevent unjust structures, be based on a social citizenship distribution principle that does not require wage labor as a qualification for welfare and that provides broad access to social services for all. In that way it does not require an unpaid or underpaid feminized care within the family. (Less)
Please use this url to cite or link to this publication:
author
Katzin, Mirjam LU
supervisor
organization
alternative title
The blind spot of gender equality policy - family caregivers in the Swedish elderly care
course
JURM02 20122
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
äldrerätt, socialrätt, genusrättsvetenskap, jämställdhetspolitik, äldreomsorg, anhörigvård
language
Swedish
id
3160160
date added to LUP
2013-01-14 09:39:50
date last changed
2013-01-14 09:39:50
@misc{3160160,
  abstract     = {Article 2 § 2 in the Social Services Act (2001:453) declares that the municipality has the ultimate responsibility to see to that the individuals in the municipality receive the support and help they need. This means that health care is a public concern and a public responsibility. Despite this regulation, the care provided by relatives is, as a result of cuts in municipal care, a significant and growing proportion of the Swedish elderly care. Today, relatives accounts for at least 70 percent of the total elderly care in Sweden. In 1998, a municipal responsibility to provide aid to relatives who care for chronically ill or elderly was introduced in article 5 § 10 in the Social Services Act. This municipal obligation was strengthened by an amendment in 2009. This paper is based on these legislations and examines whether the amendments signal changes in the division of the responsibility for elderly between the public and the private.

Several researchers have shown that family care follows a gendered pattern, with women taking more responsibility than men for the elderly. Differences between men and women from different social backgrounds can also be seen. The National Board of Health and Welfare has noted the same in a number of reports. An increase in the families’ care responsibilities means, therefore, mainly an increased commitment for women, especially in certain groups. The Gender Policy Committee stated in 2004 that the situation of families that provide care to the elderly have not been given sufficient attention within the gender equality policy. The issues connected with this group have not been problematized enough from a gender perspective. The intention of this paper is to provide such a perspective on family care for elderly.

Questions about care work - such as whose responsibility it is, how it is distributed and how it is compensated – have since long been regarded as important feminist issues, since care work responsibility historically has been regarded as a female task. A basic problem has been that the category “work” in a traditional societal understanding of the term, does not include the unpaid care work that takes place within the family. The effect of this is that care work in different ways becomes undervalued; it is unpaid or low-paid and its value is not recognized fully in socio-economic models. Feminist scholars have also demonstrated and criticized how the Nordic welfare state has been formulated primarily around the male wage worker, so that most important social rights are acquired through wage labor and not through care work in the family.

The elderly care that previously was regarded as a family matter and was the responsibility of stay-at-home daughters, became with the welfare state's development increasingly a public responsibility. Health and social care functions would primarily be defrayed by society. The “social contract” has, since the 1980’s, once again been re-negotiated. The analyzed texts shows how the discourse now is formulated around a mutual responsibility for elderly, divided between the family and the public. In practice, elderly care has increasingly become a family matter. The care responsibility has not formally changed, but it has been reinterpreted, which can be seen through the legislation on municipal aid to family caregivers. There has been a discoursive shift, a renegotiation of the care responsibilities.

The main reason that the legislation on the municipal obligation to provide aid to caregivers is introduced and subsequently amplified, is considered to be that the family caregivers as a group has been made invisible. The legislator wants them to be recognized and supported so that they can be fully utilized as a resource. The legislation is not created to lift family caregivers off the responsibility for the care of the elderly, rather to support them in the care situation. The reading of the legislative history shows that the problem the legislator wants to solve by the municipality aid for family caregivers is not the existence of family caregivers. The existence is generally seen as unproblematic and desired. This is however at odds with research on family caregivers, which suggests that most people do not want to receive or give family care if they could choose public care instead.

Empirical studies have shown that the informal care provided by people within the elders’ own household (by partners) has become more gender equal. The care given by people outside their household (children and other relatives) has however clear gender, class and ethnicity patterns. An increase in family care therefore means an increased burden of care for middle-aged women, especially those with a working class background or ethnic background other than Nordic. The increased care work has negative physical, psychological, social and economic impacts, which is unevenly distributed as an effect of the uneven distribution of care responsibilities.

Aid for family caregivers is primarily developed from the notion of family caregivers as partners, which means that a large group of family caregivers are not reached by the legislation. Many of the negative consequences that family care for elderly entails are not eliminated by the legislation, which only focuses on certain aspects of caregiving. The legislation is gender neutral, but the fact that gendered injustices has arisen despite of this, shows that a lack of gender perspective in legislation can reproduce unequal conditions. Although the legislation does not need to be formulated in gender-specific terms, it is important that welfare is governed with a gender perspective in mind. The welfare state should, in order to prevent unjust structures, be based on a social citizenship distribution principle that does not require wage labor as a qualification for welfare and that provides broad access to social services for all. In that way it does not require an unpaid or underpaid feminized care within the family.},
  author       = {Katzin, Mirjam},
  keyword      = {äldrerätt,socialrätt,genusrättsvetenskap,jämställdhetspolitik,äldreomsorg,anhörigvård},
  language     = {swe},
  note         = {Student Paper},
  title        = {"Jämställdhetens blinda fläck" - om anhöriga som vårdar äldre},
  year         = {2012},
}