Researcher: U.S. health care policies not family-friendly
LAWRENCE – University of Kansas sociologist Mary K. Zimmerman charges that U.S. health care policies in the past 30 years have challenged, disrupted and in some cases have derailed a large number of family lives.
In a recent talk to the 75th meeting of Midwest Sociological Society in Minneapolis, Zimmerman called for policy makers, educators and the public alike to recognize that U.S. health and social policies don’t serve to keep work and family in balance.
“Reconciling work and family may be the most difficult and preoccupying challenge of daily life in America,” said Zimmerman, who is the outgoing president for the regional Society.
Yet few U.S. health or social policies support families confronted with a major or chronic illness or disability requiring home or constant care. Researchers describe the combination of a long-term illness or disability, a lack of child care and social services and job inflexibility as a toxic mix for U.S. families, Zimmerman said.
A major exception is the Caregivers and Veterans Omnibus Health Services Act passed by Congress in May 2010, Zimmerman said. This law provides compensation for caregivers of returning soldiers who need may need long-term rehabilitation and cannot care for themselves.
“The country has risen up for veterans and passed a law that allows the state government to take some of the burden of care work by proving $1,600 a month for a family caregiver,” Zimmerman said. “That money may allow a family caregiver to cut back on hours of a paid job, but it also helps keep the family budget intact.”
Much more needs to be done.
Zimmerman is not suggesting new legislation or a one-size-fits-all solution, but rather fresh attention to the mix of health and social policies and how they can help families dealing with long-term illnesses or disabilities.
“This is something we don’t think about until we’re confronted with it,” Zimmerman said. “Too often a wage-earner in the family, often a woman, must chose between a job and family.” Or, if a family member attempts to balance both a paid job and the work of giving care, then she or he can sacrifice personal good health trying to do both.
Health-related stress on families increased significantly in the 1980s when health care came to be regarded as a commodity. Because Medicare paid only a fixed amount for medical care, hospitals had an incentive to shorten patient stay periods to make a profit. U.S. health policies emphasis shifted to cost reduction and market forces.
“A key consequence affecting families was a drop in the average length of hospital stays from around seven to around five days. This did not mean that patients were getting well faster, but rather that they were returning home sicker than in the past,” Zimmerman noted.
At home, family members or friends – mostly women – rather than professional hospital staff took on the work of caring for the patient. The options to handle caregiving fall to the market, government services or the family or to charity.
The popular perception is that the care work at home is free, “but we know it is caregiving is not free, and it is not a gift. It takes a lot out of a person to do the work.”
This country has a strong system of charitable service, Zimmerman said, “but it is not consistently available for caregiving – making it a more precarious option.”
She uses the term “care work” to describe health care provided by families or friends. The term evolved largely due to feminist researchers who pointed out the work was hidden or invisible because it is neither paid work nor part of the GDP.
Even the Family and Medical Leave Act, which protects an employee’s job if a parent or adult needs to care for a new baby or a sick family member, may not go far enough. Under that policy, fathers or mothers may take up to 12 weeks away from their paid work to care for a new baby, but they aren’t paid for the care work at home. Moreover, not all employees are eligible for the leave.
At KU Zimmerman directs the doctoral program for health policy and management and researches comparative health and welfare systems as well as inequalities and health and gender roles. She has taught study abroad seminars in Scandinavia on comparative health care systems.
Northern European countries do have health care and social policies that support families confronted with major illness or disability and help compensate for care work. Compensation may not be direct payments, but may provide social security pension credit for time away from a job to do care work, for example.
Zimmerman’s address will be published in the Sociological Quarterly following editorial review.