Carers’ agency: Power, professionalization & decommodification (part I of V)

Summary

This essay is about how care work might come to be professionalized, and how such a process of professionalization might fits with a wider process of social and economic progress in the current UK political context.

Part I is a personal ‘testimony’, written back in the first phase of pandemic, about what it’s like to work in care, and what motivates care workers, along with some early reflections, also written at that time, about what professionalism actually is, the professionalism latent in care work and the barriers faced by care workers when it comes to such a process of professionalization.

Part II delves further into concepts of power and powerlessness as it relates to careworkers, using the seminal work of radical psychologist as guide, before moving towards the core argument of the essay: that a way to resolve the powerlessness wrought by decommodification in the care ‘industry’ is to initiate a conscious, reflexive project of professionalization. The argument is underpinned by the insights from a recent Novara Media podcast, in which careworker testimony is balanced with analysis of what decommodification means.

Part III takes a step back, and looks back at the rise and partial fall of nursing as a profession. The central claim here is that, while a nursing elite professionalized quickly in favourable conditions, this professionalization was underpinned by the racial and class prejudices of the time which, because they were not challenged, have led to lack of solidarity within the profession under the more recent managerial assaults, although more recent moves from Nurses United offer promise of a brighter future. The experience of nursing, it is suggested, should inform the development of an inclusive and reflective caring profession.

Part IV grapples with the tasks of professionalization. Seeking to rise to the challenge of the RSA’s Anthony Painter & Joanne Choukier on the need to instil a “sense of agency” for the building of a new convivial future, I set out how ‘progressives’ might help facilitate the agency of careworkers, such that the latter are in a position to carry forward their own professional emancipation. Then, following a ‘pan out’ to review the challenges and opportunities offered by a new phase of Conservatism, in which a new ‘dual polity’ now offers more scope than widely envisaged for the building of alternatives to a commodified economy, I focus in on how careworkers as a profession can lead the development and embedding of new models of care.

Finally, a shorter Part V offers some reflection on how a process of professionalization and decommodification in care might act as a model for wider attempts to develop post-capitalist economy structure and convivial modes of living even within the interstices of the body capital, before a final afterword on my own agency, with the suggestion of a moral imperative to personal activism on the part of those who would have others deploy their agency for the wider good.

Part 1: Testimony

Riding home

In the frazzled days of May, as the first pandemic wave reached its peak, I finished a shift at the care home and started the ride home.

As I rode, the idea of a short ‘testimony’ started to fill my mind, and when I got home I battered out, at quite a rate of knots, some words about what care work was like in a locked down dementia unit, what I made of what my colleagues did and said, and some reflections on where I thought carers and care work might end up after the pandemic.

Some of what I wrote ended up on a mainstream news outlet website, but nobody read it, partly because the outlet didn’t get round to plugging it, and partly because the way the more political content had been edited out made me feel it wasn’t mine anymore, and made me draw back quickly from promoting it myself.

To meet the word limit for that publication, I had stripped out some of the more flowery bits, and shortened the more political reflections in the latter half of the piece to create a more general aspiration to the professionalization of care work. When the edited version came back for my approval, all the politics had been stripped out. I sighed, approved it, and moved on, acknowledging to myself that this publication — though the journalist was very nice — had little interest in anything more than a feel good take on the quiet virtues of care work, and certainly no interest in the idea of carers having or developing an ‘agency’ of their own.

Here is that May testimony, warts and all (numbered notes as in the original).

Good skills!

At work the other day, my colleague Jean swayed her head back gracefully, and avoided being butted in the face by Alf. [1]

‘Good skills!’, I said, continuing the running joke among the staff team that you need the boxing know-how of Joe Calzaghe to deal with Alf’s tendency to go for your face with the most readily available tool given that his arms are being held gently but firmly by two other carers while you tear of the incontinence pad, wipe around, and get a new one on.

I was reminded of this bit of repartee, all part of the regular jollying along we do together as part of seeing us through the 12 hour shift, when I saw Fiona Bruce getting a bit of a pasting for calling carers low-skilled.

Alf is one of the residents living with deep dementia on the 40 bed unit where I currently don’t earn much of a living. He’s one of the more aggressive, especially at the times you need to attend to his bodily needs. A lot of the time he wanders, and will allow you to take back off him items he’s picked up along the way. He eats well, though a bit messily.

About a third of the residents are ‘wanderers’. Another third are more or less immobile and range between the largely silent, buried deep in whatever world they now inhabit, and those who express their views in what can be quite colourful language. A few are wanderers with colourful language. Another third are moving towards the end of life, at different paces; some twist into small tangled knots of sinew and bones, heads contorted but rhythmic in the nodding, while others are, well, heavy.

Forty very different people with very different needs require very different skills. There is of course the physical dexterity — how to sway your head from the butt, how to arrange the hoist paraphernalia to minimize panic, which angle to use with a teaspoon feed when Irene’s knees are up by her chest.

But more than that, there’s the problem solving and constant re-prioritization. For twelve hours, you’ve got to be on your game: ready to spring to a colleague’s assistance when one resident goes for another, ready to stop doing someone’s hair, moving all the sharp stuff, to help with an incident in the day room involving poo that can’t really wait.

But most of all, there’s the skill that goes into making a resident smile, even laugh, even if just for a second. Dementia, for most people, is a dark and deeply troubling world, most or all of the time; even before the masks came, people can often be there to get you. Breaking through, just for a moment, with a memory of the old life — “you were a bus driver, weren’t you Alf? What was your route?” — is the most important thing you can do in a day, even if the next moment you’re a frightening, masked spectre, and the bus route is gone.

I could go on, but if you’ve read this far you’re probably sympathetic to the idea that carers have skills. The question is why Fiona Bruce thinks they don’t.

The obvious answer is that’s because it’s mostly ‘women’s work’; care is not seen as a skill because it’s what comes naturally to a woman. And if care is not generally in life a thing that’s paid for and is therefore not of value, then even when it is paid for, the same rules are likely to apply.

That’s the structural answer, and of course it’s right. But there is another answer: care work is not regarded as skilled workers because carers never claimed it was. Or at least have not claimed in a way that’s been properly heard yet.

Because I listen to stuff, I’ve heard the claim.

Vows

“Why the hell do we do this?”, or something similar, is a regular enough expression of frustration I hear on the unit, or at one of the three treasured breaks you get on the 12 hours shift (15 mins, 30 mins, 15 mins).

It’s an expression of frustration at how tough the job can be, especially when the unit’s run out of proper wet wipes again, but it’s a rhetorical one, because everyone on the unit knows the answer. When the answer does get said, it’s something like “Well, nobody else gives a shit” or, from the gentle late middle-aged Nora “Who else would look after these poor souls?” Or it’s in that near-end-shift sigh, and the “We can’t leave her like this”, as you help 97 year old Alice retain the shred of dignity her 97 years still accords her, so you clean her up, tidy her hair, give her a sip from the beaker, even though it’s past 8 now and you’re being picked up.

In the end, the carers I work with do what they do because they give a shit. And they do what they do, day in day out, in quiet solidarity with each other, because they’ve made a quiet vow, between themselves, that what they do matters, even if no-one else gives a shit. [2]

And making a vow, even if quietly, that you’ll use your skills and that you’ll keep meeting your standards is what makes you a professional. That’s what professional means — someone who makes a vow (fesses) in public (pro).

Or maybe semi-professional. The vow is there, but it’s not yet public, and if it’s not public then the public doesn’t know about your standards, and if the public doesn’t know about your standards, it can’t be sure you’re holding to them, and if the public can’t be sure you’re being professional, then you’re not a professional. That’s how professionalism works. It’s about earning legitimacy and then maintaining it.[3]

Dues

So what do we do about it? How do we get carers to claim their professional dues?

The first step is to recognize what I’ll call the “just a carer” structure-agency paradox, which goes something like this.

Care workers themselves tend to reject the idea, in public, that their work is of value, or skilled, but this very fact that their work is so undervalued can actually be a factor in the solidarity they need to keep in order to get through the day.

This coping process/self-empowering also helps beyond work. The realities of working class female life require that paid work be set aside when it is done. One of the features of professionalism for those living in more material advantage is that you get to embody your professionalism the whole time, and this gives you pride, which is a nice thing to have. When you get home from a long shift and nobody gives a crap how your day went, or what new skills you learned, because you’re “only a careworker”, then you have to repress any pride you might have lurking. There’s just no time for that kind of thing.

Instead, there are ‘life projects’, which are actually lived through the lives of your family and kids. These take over any space you might have had for professional development. The third of your life you spend at work becomes incidental. You sometimes surprise yourself at work at how much you actually care, but that’s for work. Once you’re out of work, it’s forgotten, as best you can. You feel a bit guilty about thinking of work when you’re out of work. It’s only a job.

The structure of late capitalism crushes professional agency, when you’re not in the bourgeoisie, and especially when you’re just doing woman’s work.

And so this is the paradox.

Women who actually act in a way legitimate professionals are expected to act are reluctant to seek professional status because it will make their lives worse, at least in the short term, while others with the material resources to take pride in being part of the ‘professional class’, despite potentially never having been within a country mile of a professional standard, are free to use their agency to become even more secure in their unearned social status.

But still, I’m hopeful.

In a time of revaluation of the value of what work matters, and who’s really got skills, there are opportunities to crack open the structures.

I think there are two main ways to do this — one promote agency, one about creating conditions in which that agency might flourish — evidence to date suggests we have to have multi-faceted route

First, alongside general recruitment drives amongst carer, trade unions should be looking to establish specific sections within their own structure for carers and other female-dominated professions, and encourage the development of new professional standards, set by new professionals, with all this incorporated into a new focus on the establishment of new local level Trades Councils (section 5 for details).

Will this work? Probably not on its own, and the danger is (section 8) that the demand for more agency on the part of women becomes just another burden, associated with a socialist politics that seeks only to impose common identities on people who were promised individual freedoms.

A reflexive balance will need to be struck between working to open up opportunities for a new professional voice, and demanding that that voice sounds like the one we recorded earlier on the leftie media podcast as an example of working class collaboration. Real empowerment is messier than that, and it takes a while. [4]

But still, I’m hopeful. Here’s why.

One of the unit’s cleaners (another profession-in-the-making) told me on one of my first shifts: “Don’t worry about it, Paul. They’re a protective bunch; it takes a while for them to trust new people. You’ll be like family when you’ve proved you’re up to it.”

That’s the essence of the guild. And from the essence of the guild can spring a new sense of professional agency, not based on class, gender, or both, but on our standards and our skills.

Notes

[1] Not his real name, obviously, and nor are any other names real, other than mine.

[2] If you want to get all Marxian about it, a good care worker, like Hegel, “grasps the self-generation of [wo]man as a process, objectification as de-objectification, as alienation and the overcoming of that alienation” (Critique of Hegel’s Philosophy in General)

(It’s just a shame that Marx repressed this understanding in his early of the human capacity to reflect communicatively in favour of a more instrumental theory of labour which excludes the capacity of reflection to act as an agential force in history. But that’s another story.)

[3] Or it’s how professionalism should work, if it hadn’t got all tangled up with class.

It’s not the key issue here, but my hackles rise a bit when I hear media lefties use the phrase ‘middle-class professionals’ as they have been doing in relation to crowded public transport, and assume it all fits together like that. You can be middle-class and have a well-paid job and not be professional, if you don’t abide by standards. And you can be working class as they come, but be thoroughly professional at what you do. That’s obvious enough, I think, but the left does need to start reclaiming the idea that status should go with social value, not with wealth.

But while the media lefties can do their bit, care work will only become a profession if care workers make the claim that it is. That’s the main point.

[4] As Seyla Benhabib says:

In entering the public, every new social, cultural and political group presents its point of view to others, or it re-presents itself to others, in the sense of refashioning itself as a presence in the public. This process of self-representation and articulation in public is still the only means through which the civic imagination can be cultivated….. The ability of individuals and groups the take the standpoint of others into accent, to be able to reverse perspectives and see their world from their point of view, is a crucial virtue of moral and aesthetic imagination in a civic polity.