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Counting the costs of caregiving: Is there a better way forward?

<p><em><strong>Leah Ruppanner, Lecturer in Sociology, University of Melbourne and Georgiana Bostean, Assistant Professor of Environmental Science, Health and Policy, Chapman University, count the costs of caregiving.</strong></em></p> <p>In Australia, the question of how to provide care for ageing family members is largely an individual one. Most care is provided by family members. In 2012, 2.7 million Australians were <span style="text-decoration: underline;"><strong><a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4430.0" target="_blank">providing</a></strong></span> some type of informal (unpaid) family caregiving. Some are “sandwiched”, caring for children and older adults simultaneously. Yet caregiving is not shouldered equally by the entire population: women and minorities are much more likely to provide care.</p> <p>Those with <span style="text-decoration: underline;"><strong><a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/5968BE956901DD79CA257D57001F4D89?opendocument" target="_blank">disabilities themselves</a></strong></span> are also more likely to be primary dependent carers in Australia. These families are shouldering a high level of carework.</p> <p>Finally, moving family members into the home is often motivated by the <span style="text-decoration: underline;"><strong><a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/12524494B6372EDFCA257D57001FA8C7?opendocument" target="_blank">poor quality of paid care</a></strong></span>. This suggests that there are limited options in the market. These trends are mirrored in many countries – adult children in Europe are increasingly providing care as a substitute for formal care, and informal care is normative in the United States as well.</p> <p>All told, we have a “care-adox” in the Australia. People are living longer, yet the systems to provide care for older adults are informal and inadequate.</p> <p>Because family caregiving is embedded within broader family experiences, the answers to the social, political and ethical questions that caregiving raises are not simple. Caregiving can be a rewarding experience, providing a sense of meaning and fulfilment, and improve the relationship with the care recipient. In multigenerational households, the older adult may help ease childcare burdens.</p> <p>Importantly, caregiving can be <span style="text-decoration: underline;"><strong><a href="http://link.springer.com/chapter/10.1007/978-1-4614-4776-4_3#page-1" target="_blank">stressful and damaging</a></strong></span> to well-being. For example, it impairs immune function and accelerates immune system ageing. Caregiver experiences vary widely, but caregivers who experience chronic burden or stress tend to have the most severe health consequences.</p> <p><strong>The ‘coercive caregiving’ phenomenon</strong></p> <p>Research suggests that when people are expected to do something but do not have the resources to fulfil expectations, they experience health-harming role strain. Caregiving therefore should be most harmful to health when individuals are expected to provide care but lack the resources to do so effectively.</p> <p>In Australia, caregiving has historically fallen to women and ethnic minorities due to their social statuses. Individuals are thus <span style="text-decoration: underline;"><strong><a href="http://ethnicstudies.berkeley.edu/faculty/profile.php?person=6" target="_blank">“coerced” into caregiving</a></strong></span> through social norms and lack of institutional support. In these contexts, when alternate options are unavailable, women may step into caregiving roles despite lacking the support needed to fulfil those expectations.</p> <p>The gender bias in these experiences is clear. Caregiving daughters report <span style="text-decoration: underline;"><strong><a href="http://www.ncbi.nlm.nih.gov/pubmed/8557205" target="_blank">greater depression</a></strong></span>, but this is not the case for <span style="text-decoration: underline;"><strong><a href="http://www.ncbi.nlm.nih.gov/pubmed/16960238" target="_blank">caregiving sons</a></strong></span>. These studies suggest that coerced care can be damaging to caregivers’ well-being, particularly for female caregivers.</p> <p>We addressed these issues in our recent <span style="text-decoration: underline;"><strong><a href="http://esr.oxfordjournals.org/content/30/5/655.short" target="_blank">research</a></strong></span>. We asked whether caregivers in countries with greater societal “pressure” for informal family caregiving – in the form of strong social norms for familial care or limited public transfers for old-age programs – have lower well-being than caregivers in countries with weaker familial care norms and more old-age public transfers.</p> <p>We found substantial country variation in familial care norms – that is, people’s attitudes about whether care for ageing parents should be provided by adult children in-home. Support for familial care norms ranged from 4% in Sweden and the Netherlands to 59% in Poland and 74% in Turkey.</p> <p>Do country differences in familial care norms impact individual well-being? We expected that caregivers would report worse well-being in countries where caregiving was expected to be done in the home. We found, however, that only female caregivers suffer from stronger familial care norms.</p> <p>The extent of public transfers is also associated with female caregiver well-being. Female caregivers have worse well-being in countries with stronger norms for in-home familial care, and fewer public transfers to support ageing care.</p> <p>These findings suggest that women in countries where market or government subsidies for old-age care are not readily available may be more severely disadvantaged by caregiving responsibilities. This is consistent with previous research finding that female caregivers are more likely to be stressed, depressed, drop out of the labour force, and be sandwiched.</p> <p><strong>The way forward</strong></p> <p>That caregivers in ostensibly coercive contexts report worse well-being may reflect role strain, including a lack of financial, social, emotional or other resources.</p> <p>Consider what it takes to provide care, particularly long-term, for an older adult. In Australia, long-term care requires a complete reorganisation of a person’s family and employment patterns. With approximately 12% of the Australian population (and counting) providing care, the current system is unsustainable. As the burden of care and number of caregivers increase, so too will societal economic and health impacts.</p> <p>Middle-age adults who are beginning to experience their own health issues face compounding health effects of caregiving, leading to health problems earlier in life. This will certainly impact the health care system as the number of caregivers grows.</p> <p>But this bleak story can become one of hope. Two potential starting points include:</p> <ul> <li>Broad policies to support caregivers through paid home care, community-care services, and more equitable sharing of care work in society; and</li> <li>Facilitation of a larger discussion about the difficulties of caregiving so that we have more realistic expectations.</li> </ul> <p>Comprehensive policy changes would provide caregivers with more consistent support. Family policy and caregiving policy are intertwined, so extending family leave policies and adopting broader definitions of “family” will also address the needs of caregivers for all types of dependents.</p> <p>Caregivers provide a valuable service to their loved ones and to society. Providing support for them is a pressing social problem that demands broad policy action to break the chains of coerced care. There is no better time to begin planning for this immediate future.</p> <p>Do you agree with this advice?</p> <p><em>Written by Leah Ruppanner and Georgiana Bostean. Republished with permission of <a href="http://www.theconversation.com" target="_blank"><strong><span style="text-decoration: underline;">The Conversation</span></strong></a>.</em><img width="1" height="1" src="https://counter.theconversation.com/content/33181/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation"/></p>

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The 90s – why you had to be there

<p><em><strong>Sally Breen is a Senior Lecturer in Writing and Publishing at Griffith University.</strong></em></p> <p>Van Gogh shot himself in a wheat field. Kurt Cobain in a greenhouse. Van Gogh took <span style="text-decoration: underline;"><strong><a href="http://www.vangoghgallery.com/misc/death.html" target="_blank">two days</a></strong></span> to die. Cobain’s shot was more effective. On a chilly, wintry morning in Melbourne, there are far more people lining up at the NGV for the Van Gogh exhibition than there ever will be for an exhibition on the 1990s. This is only fitting. A world travelling exhibition – <span style="text-decoration: underline;"><strong><a href="http://www.ngv.vic.gov.au/exhibition/van-gogh-and-the-seasons/" target="_blank">Van Gogh and the Seasons</a></strong></span> vs the press call for <span style="text-decoration: underline;"><strong><a href="https://www.ngv.vic.gov.au/exhibition/every-brilliant-eye/" target="_blank">Every Brilliant Eye: Australian Art of the 1990s</a></strong></span>. Outside, the line for Van Gogh snakes in a well ordered fashion onto the causeway. In the other gallery up the road, there’s only me and one other guy. Perfect. I wouldn’t expect anything less because it’s not possible for it to be less. A reality a 90s kid like me has learnt to deal with.</p> <p>Some movements travel in ubiquitous ways. Others explode like fireworks in a black sky and then creep into the rest of your life influencing far more than they’re ever acknowledged for. And here I am caught in the moment. The Impressionists vs the DIYs. The Starry Starry Nights vs the <span style="text-decoration: underline;"><strong><a href="https://www.amazon.com/Gangland-Cultural-Elites-New-Generationalism/dp/1864483407" target="_blank">Gangland</a></strong></span> freefall. A generational condition author Mark Davis described in 1997 as a “virtual gerrymander” of the ideas market. The 1990s alternative cultural movement creeps through my brain. In many ways it has defined me. My sensibility (resilient); the way I operate (untethered); my morality (questionable). The 1990s is the forgotten decade of the 20th century. The Lost Decade, as it is fittingly referred to by burnt out Japanese economists. But perhaps the resurgences are becoming more frequent.</p> <p>Every Brilliant Eye is certainly contributing to a wave of recognition of this decade. Since 2015, nearly every major global media outlet has run an article declaring a revival of 1990s pop culture, articles less centred on ideas than the easy symbolic markers of drugs and <span style="text-decoration: underline;"><strong><a href="https://www.theguardian.com/fashion/2016/mar/11/90s-are-back-how-to-get-the-look" target="_blank">fashion</a></strong></span> – ecstasy is back, flannos are back – the headline of “They Might be Dad’s Now” an exemplar of completely missing the point.</p> <p>Nevertheless, this move from NGV curator Pip Wallace is timely. Before I left my hotel on Swanston Street to visit the show, Double J announced it was dedicating the whole week to 90s music. Online, someone who clearly lives in the suburbs now too described Courtney Love, as “totally committed but easily distracted. Fiercely intelligent and painfully self-aware”. Middle finger down my throat. Is this the best musical decade of all time? Next question.</p> <p style="text-align: center;"><iframe width="400" height="300" src="https://www.youtube.com/embed/cH_rfGBwamc?feature=oembed" frameborder="0" allowfullscreen=""></iframe></p> <p>The first thing I want to do once I’m inside Every Brilliant Eye is make something. Mash something up. Scratch something out in a piece of plastic, stitch my name in an old dress, slap a slogan down just to undo it. There are good reasons for this. The exhibition appears to be loosely split into a series of rooms. The first is about being rowdy and unpopular, the political stuff people wanna say but usually don’t: grunge, happenings, the collision between art and performance and music.</p> <p>The second space is quieter and more about feel; abstract emotions, textures, tactility, and the last – a supersonic blast of room, the gay nightclub of my dreams, an in-your-face contemplation of the beauty and danger of who and how and why we might like to fuck. In all three stages, there’s work from some big names – the moody, muted photography of Bill Henson, Patricia Piccinini’s surreal brainscapes featuring twisted 90s sister Sophie Lee, the intricate botanical plumbing of Fiona Hall and Scott Redford’s unco babes chopping up surfboards. Names synonymous with contemporary Australian art, all producing rich and varied work in the 1990s, even if they were not really young Gen Xers but their big brothers and sisters.</p> <p><strong>Mix tapes, Bic pens and zines</strong></p> <p>The first room comes at me like someone’s upended all the drawers in an inner city share-house and maybe transported it in go karts or the dirty boots of <span style="text-decoration: underline;"><strong><a href="https://www.cargurus.com/Cars/1990-Ford-Escort-Pictures-c299" target="_blank">Escorts</a></strong></span> to whatever collective happening space was scraping together the ability keep to its doors open. No one much cared about all this detritus in the 1990s but now it’s on plinths.</p> <p>Vinyl and limited edition zines encased in glass and worshipped like the lovely, fragile artefacts they are. A single mix tape marked “For Starlie” conjuring late night drives through suburban streets where the faint flicker of Neighbours glowed on every telly and we glided past with the lover of that week, listening to the Jesus and Mary Chain or Died Pretty on loop.</p> <p style="text-align: center;"><iframe width="400" height="300" src="https://www.youtube.com/embed/07oZHDgPiqo?feature=oembed" frameborder="0" allowfullscreen=""></iframe></p> <p>Even the titles of the artworks and the written language appearing sometimes within them appeals to the twentysomething girl in me, reading like psalms I’ve forgotten how to say. “Love and Death Are the Same Thing” reminding me of how our days in the 1990s were heavily punctuated with poetry and song lyrics – guys in bands quoting Rimbaud while pulling cones, friends scrawling out their minds and hearts in public diaries, one of my poems printed on the inside cover of a CD.</p> <p>It’s as if I’ve been thrust back into the language of a time by a team of demented phenomenologists armed with Bic pens and ink jet printers, VHS players and tape recorders – innocuous phrases that could be refrains from David Lynch movies or Nick Cave and Bad Seeds album covers, notes left to me on the fridge by my flatmates, the kind of statements that only make sense when I’m staring at the ceiling or a dripping tap for a really long time and am really, really out of it. “The Artists Fairy Floss Sold on the Merry Go Round of Life” and “Someone Looks at Something”.</p> <p>Model for a Sunken Monument is a highlight. Ricky Swallow’s brilliant, giant melting pot of a head, Darth Vader looking like he’s made out of Lego and rising out of (or disappearing into) the floor – depending on your equilibrium or perspective. Swallow is one the youngest artists in the exhibition and his preoccupations with pop culture reflect that difference. Nearly every other artist featured here was born in the 1950s or 1960s.</p> <p style="text-align: center;"><img width="499" height="353" src="https://oversixtydev.blob.core.windows.net/media/40309/1_499x353.jpg" alt="1 (198)"/></p> <p align="center"><em>Ricky Swallow, Model for a sunken monument 1999. synthetic polymer paint on composition board. Image credit: National Gallery of Victoria, Melbourne Purchased through The Art Foundation of Victoria with the assistance of the Joan Clemenger Endowment, Governor, 1999 © Ricky Swallow, courtesy Darren Knight Gallery, Sydney</em></p> <p>Most weren’t in their twenties in the 1990s but edging towards or making a living out of being established. In liner notes written elsewhere about Swallow’s work (he’s also made art out of BMX bikes and playful nods to ET), there’s a kind of reluctant nod to his ability – but of course, they say, here Darth Vader is empty, hollowed out. A defeated vessel. Not really. If you graduated high school in 1990 you know Darth Vader is never vacuous. It’s the same kind of misconception levelled at another featured artist Kathy Temin, who visual arts commentator Jeff Gibson once described as “the worst nightmare” of conservative critics because her preferred sculptural medium was soft fur.</p> <p style="text-align: center;"><img width="500" height="334" src="https://oversixtydev.blob.core.windows.net/media/40310/2_500x334.jpg" alt="2 (190)"/></p> <p style="text-align: center;" align="center"><em>Kathy Temin at the show. Image credit: Tom D. Watson.</em></p> <p>Kathy credits her break and her ability to keep showing work in her formative years in Melbourne in large part to curator and gallery owner Rose Lang and the now infamous Gertrude Contemporary arts space. And it’s the work on loan from this gallery that really gets me.</p> <p>Two pieces shot on dodgy hand held video. Punchline by the so-called DAMP collection of artists and Player Guitar by A Constructed World - both staged for the first time in 1999, as if in a desperate effort to ward off Prince’s prophecy about the end of the world.</p> <p>In the Punchline video, a series of interventions occur in a gallery when a meltdown between two lovers gets out of hand and the punters are not sure what the real story is. This is pre-9/11 art, where everyone gets into it and no one goes default anti-terrorist. Player Guitar gives the exhibition some much needed audio muse – people live are invited to play the double barrel electric guitar while watching the people who did it last time. Yeah. Everyone’s in a band. Everyone’s made it.</p> <p style="text-align: center;"><img width="500" height="334" src="https://oversixtydev.blob.core.windows.net/media/40311/3_500x334.jpg" alt="3 (163)"/></p> <p style="text-align: center;" align="center"><em>A Constructed World, Jaqueline Riva and Geoff Lowe, Player guitar, 1999, 2017. electric guitar, amplifiers, sensor, chair, video camera, colour video, sound, duration variable Collection of the artists, Paris. Image credit: Tom D. Watson.</em></p> <p>The Gertrude Contemporary scene as featured here is emblematic of underground movements of a kind everywhere from Tokyo to Seattle to New York. The interesting thing about the 90s is that the DIY aesthetic mashed up against developing technologies. The advent of the internet meant such movements were as much about pressure cooker of geographical isolation in the first half of the decade until they absolutely weren’t in the last.</p> <p>In the 90s, you didn’t necessarily have to survive on the trickle down effects, the half-hearted drip feed, of bigger more powerful arts and cultural machines in major cities. People got into making shit and playing in bands and writing poetry on pokies in small towns and spaces off the beaten track, in small pockets all over the world. Hire a video camera that weighs a ton – send it to a party instead of yourself. Check. Crash a rich friend’s party and steal an amplifier. Check. Start a multi-arts centre above a fish and chip shop on the Gold Coast. Check.</p> <p>The 1990s alternative artistic ethos was infectious because you didn’t need an address or rich parents to fund your warehouse space or your magazine. All you needed was will and creativity and attitude and maybe a good survival instinct. Because, of course, many of these individual forays and collective ventures were ill fated but even when they did die, as some people and places sadly did, they’d contributed in ways we’re only just beginning to understand. That arts centre that smelled like overcooked calamari came and went but some of the names you now know walked through the door there, just like they did at Gertrude.</p> <p>Even if, when I visited the latter place this week, they were preparing to <span style="text-decoration: underline;"><strong><a href="http://www.gertrude.org.au/news/" target="_blank">move out to the sticks</a></strong></span> (well Preston South). Apparently not even a good combination of nostalgia and relevance can save you from sky rocketing real estate values and a street in Fitzroy reeking of bespoke custom made furniture and high end, high shine homewares. In an article for <span style="text-decoration: underline;"><strong><a href="http://www.artnews.com/2015/01/29/90s-art/">Art News</a> </strong></span>on the enduring influence of the 1990s on contemporary art, Linda Yablonksy says,</p> <p><em>In fact, the Nineties took place on what now seems an intriguing distant planet, when the art world didn’t cater to money in the same way that it does today.</em></p> <p><strong>Striped Ts and Drugstore Cowboy hair</strong></p> <p>A week before I found myself in the bird’s nest of the NGV, I’d schlepped up the Pacific Highway to a 1990s reunion in Brisbane’s West End - the first time I’d hung with many of the people I’d spent the formative part of that decade with in over 20 years.</p> <p>The artwork in Every Brilliant Eye reminded me of the scratchy non-digi photos we posted on the Facebook event page to mark the reunion. We look comfortable clumped on roadsides, backs up against the walls of buildings, sprawled on lounge room floors or other people’s beds. We’re obviously waiting for things. Daybreak, trains. The future. The delivery of mates or sticks. Burnt toast. Unhurried. Half bored and poor.</p> <p style="text-align: center;"><iframe width="500" height="281" src="https://www.youtube.com/embed/puXEHhZgXaY?feature=oembed" frameborder="0" allowfullscreen=""></iframe></p> <p>We wanted to be in Wim Wenders’ movies without realising we were Wim Wenders movies, everyone impossibly beautiful only because we were impossibly young. <span style="text-decoration: underline;"><strong><a href="http://www.imdb.com/title/tt0097240/" target="_blank">Drugstore Cowboy</a></strong></span> hair. Striped T’s and unlaced Docs. The kids in <span style="text-decoration: underline;"><strong><a href="http://www.imdb.com/title/tt0363589/?ref_=nv_sr_2" target="_blank">Elephant</a></strong></span> even though it hadn’t been made yet. Grunge back then was retro and futuristic because it didn’t know it was – grunge was retro with a ripped edge, the future, in a tripper’s eye. The 1990s – the stuff that had already happened or was about to happen – with holes in it.</p> <p>And I guess that’s the beautiful charm and familiarity of this exhibition. Everything feels like you did it, like you might have seen it before, and you drift around with your mouth open, grateful, like a big blue whale everyone’s forgotten about in a sea of lovely plankton. Yes, I think my friend Karen made fur balls and crazy mobiles out of Spotlight knocks offs and pill packets too. Yes, it seems someone has made an artwork out of my friend Peta’s tights. And if you don’t recognise all of this where the hell were you?</p> <p><em>Every Brilliant Eye is at NGV Australia until October 1</em><em>.</em></p> <p><em>Written by Sally Breen. First appeared on <strong><span style="text-decoration: underline;"><a href="http://www.theconversation.com" target="_blank">The Conversation.</a></span></strong><img width="1" height="1" src="https://counter.theconversation.edu.au/content/79105/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation"/></em></p>

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