Walking the Line: Navigating Market and Gift Economies of Care in a Consumer-Directed Home-Based Care Program for Older Adults

Original Investigation

Policy Points:

  • Policies that cut or restrict formal long-term services and supports for older adults can either push caregivers to provide uncompensated care or leave older adults with unmet needs for care.
  • Increased pressure to provide uncompensated care to older adults in the aftermath of cuts in formal services can have negative economic and health consequences for both related and nonrelated caregivers.
  • Policies that assume (implicitly or explicitly) that related caregivers can readily fill gaps in care (and that unrelated caregivers will not) should be reassessed. Both related and unrelated caregivers face financial and health-related barriers to filling gaps in formal services for older adults.

Context: Paid caregivers of low-income older adults navigate their role at what Hochschild calls the “market frontier”: the fuzzy line between the “world of the market,” in which services are exchanged for monetary compensation, and the “world of the gift,” in which caregiving is uncompensated and motivated by emotional attachment. We examine how political and economic forces, including the reduction of long-term services and supports, shape the practice of “walking the line” among caregivers of older adults.

Methods: We used data from a longitudinal qualitative study with related and nonrelated caregivers (n = 33) paid through California’s In-Home Supportive Services (IHSS) program and consumers of IHSS care (n = 49). We analyzed the semistructured interviews (n = 330), completed between 2010 and 2014, using a constructivist grounded theory approach.

Findings: Related and nonrelated caregivers are often expected to “gift” hours of care above and beyond what is compensated by formal services. Cuts in formal services and lapses in pay push caregivers to further “walk the line” between market and gift economies of care. Both related and nonrelated caregivers who choose to stay on and provide more care without pay often face adverse economic and health consequences. Some, including related caregivers, opt out of caregiving altogether. While some consumers expect that caregivers would be willing to “walk the line” in order to meet their needs, most expressed sympathy for them and tried to alter their schedules or go without care in order to limit the caregivers’ burden.

Conclusions: Given economic and health constraints, caregivers cannot always compensate for cuts in formal supports by providing uncompensated time and resources. Similarly, low-income older adults are not competitive in the caregiving marketplace and, given the inadequacy of compensated hours, often depend on unpaid care. Policies that restrict formal long-term services and supports thus leave the needs of both caregivers and consumers unmet.

Author(s): Jacqueline M. Torres, Kathryn G. Kietzman, and Steven P. Wallace

Keywords: caregivers, long-term care, policy, older adults

Read on Wiley Online Library

Volume 93, Issue 4 (pages 732–760)
DOI: 10.1111/1468-0009.12163
Published in 2015