This piece is part of Apolitical’s spotlight series on the care economy, in partnership with the Wilson Center. It also appears in our public health newsfeed.
According to a number of alarming headlines, an army of robotic baby seals will soon be looking after our children and elderly. But the debate over whether robots will steal jobs has detracted from the ways in which new digital technologies are already reshaping the care sector.
Ani, from Lithuania, has been working as a carer in Glasgow, UK, through an agency for 9 years. She regularly works unpaid overtime and experiences racist abuse from patients but is afraid to complain. In her first year, she missed her own father’s funeral because if she went back she would have broken her contract.
New technologies offer opportunities to improve conditions for workers like Ani — from reassigning carers’ time away from repetitive tasks, to providing automated checks and enabling carers to log their hours.
However, there is also potential for technology to amplify the inequalities and precariousness that characterise both care work and existing gig economy platforms. What will matter is who owns, funds and monitors these technologies and whether they are designed to maximise profit or wellbeing.
There are two main trends to pay attention to: the automation of tasks with “carebots”, or assistive devices, and the rise of on-demand platforms. Made up predominantly of migrant or ethnic minority women, the care sector is characterised by informality, insecurity and in many cases the exploitation and abuse of workers without legal recourse to justice.
Care-bots and assistive technologies
Countries around the world are facing a social care crisis as people live longer. According to the UN, the number of people aged 60 or older has tripled since 1950. Meanwhile, austerity and debt crises around the world have led to massive cuts in care provision and increased marketisation of the sector .
At the same time, the supply of care workers is limited by high turnover in the field, and also the complex caring responsibilities many of them have outside of work.
The situation is particularly bad in Japan, where there is a projected shortage of one million caregivers by 2025. As a result, the Japanese government is developing “carebots”: artificial intelligence machines designed to help the elderly complete simple daily tasks, move them around or simply offer companionship.
“Care and empathy make humans distinct from machine”
But in other countries, there is significant resistance to the idea. A study by the Pew Research Centre found that 65% of respondents in the US agree it would be a “change for the worse” if robots became the primary caregivers for the sick and elderly.
There is an emerging consensus, backed by studies from McKinsey, PwC and the University of Oxford, that the core processes at the base of care require face-to-face human interaction in order to respond appropriately to what the other person is going through. Care and empathy make humans distinct from machines, the argument runs, and so the sector is highly resistant to automation.
Crucially, however, not all parts of care work involve care and empathy. If such tasks were taken over by machines, augmenting human work, it might actually improve conditions for workers.
Repetitive, menial tasks such as filling in questionnaires are exhausting for carers. Remote monitoring and wearable electronic devices take the pressure off workers, so they don’t have to rush through checking patients’ blood pressure or whether they have taken their medication.
The “Uberisation” of Care
Whether or not new jobs in the care sector are of a high quality will depend on far more than the automation of particular functions. Another major change for the sector is the “Uberisation” of Care Work as it is brought within the framework of the gig economy.
In the US, online marketplaces such as UrbanSitter and Care.com operate in over 30 cities, and the past few years have seen the proliferation of on-demand care apps such as Honor, Carelinx and Hometeam. In the UK, the most popular of these, CeraFlex, offers on-demand, 24/7 access to care workers.
Platforms offering domestic work services more broadly are also emerging in countries in the Global South: MyDidi in India, Domestly in South Africa and Alianda in Mexico.
Studies by the Data and Society Institute and Overseas Development Institute (ODI) have argued that so far, the shift in these jobs to on-demand platforms has only entrenched existing inequalities in the sector. However, it is not too late to raise the standards.
In many ways, the term “Uberisation” cannot be applied to these platforms. Uber intervened in a sector where formal employment was the norm and has been criticised for casualising work and degrading working conditions. For carers, however, informal conditions have always prevailed — from exclusion from basic labour protections to forced flexibility and low wages.
“Major disruptions offer an opportunity to reassess the value of supposedly ‘low-skilled’ jobs”
New care work apps have been promoted as an opportunity to formalise the hiring process and employment relationship.
Platforms have built-in features to regulate qualifications and background checks. Many also have software which enables workers to record and precisely monitor their hours worked and money earned for each client. Low wages for domestic workers are often a result of earnings not being tied to actual hours worked, particularly for live-in workers or arrangements where the pay is task-based.
However, as with many other work platforms, these also engage domestic workers as “independent contractors”, rather than as full employees.
This risks undoing progress in the formalisation of domestic work by diminishing legal rights and protections where they currently exist. In South Africa, for example, there is a relatively advanced legal framework regulating domestic work with provisions for minimum wage, overtime payments and a prescribed termination process.
However, on-demand platforms in the country could bypass these regulations by stating in their terms and conditions that they are not employers or an employment service. According to the ODI, even if they were made to comply with employment laws, enforcing compliance would be near impossible.
A spokesperson for Care.com described how it has prioritised “the safety of our community” with on-platform messaging that helps to “protect workers from inappropriate or fraudulent contact”. It also has a longstanding relationship with the National Domestic Workers Alliance (NDWA) advocacy organisation.
However, research by Alexandra Mateescu and Julia Ticona suggests the transparency and accountability offered by platforms do not reduce incidents of abuse and harassment.
The rating systems on all the platforms they studied were only one-way: clients could rate carers, but not the other way around. Carers they interviewed therefore avoided complaining in case a bad rating jeopardised their pay or number of jobs. The reporting process also didn’t consistently result in problematic clients losing access to the site.
Instead of just making carers “visible” to prospective clients, platforms could make them visible to other workers, building networks of support and solidarity through community forums where care workers can share anecdotes or arrange meetups.
There has also been progress towards platforms providing traditional protections such as benefits. Care.com’s spokesperson explained that the platform has sought to improve the conditions of carers by launching a program based on pooled, portable, peer-to-peer benefits. It “provides care workers direct access to purchase health and dental insurance through a portal we launched with Stride Health”, the spokesperson said.
One problem with public debates on technology and the future of work has been their lack of engagement with the vulnerable workers whose lives and livelihoods are directly affected.
But one more radical proposal which has gained traction is the development of “platform cooperatives” as an alternative to existing platforms.
These worker-owned platforms are decentralised and democratically governed. Google have recently devoted a $1 million grant to a “platform co-op development kit”.
Equal Care, the UK’s first platform cooperative for social care, is launching in April. Set up by Emma Adelaide Black to address a crisis of low pay and staff shortages in the industry, it will “use the platform as a tool to achieve enough efficiencies so that more of it can go to the worker,” she said. Carers receive a choice of what kind of employment contract they want to be on, while users can co-design their own care plan to tailor provisions to their needs.
Cloud-based technologies have also resulted in the growth of digital “time banking” schemes. These enable seniors or people with disabilities who are receiving care to also offer their own skills and talents to others and be rewarded. The “Share and Care” platform prototype in Singapore aims to restore “kampung” (community spirit) and address social isolation for seniors by allowing users to swap “Care Credits”.
There are therefore exciting opportunities to harness new technologies and ensure that the rapidly growing number of care jobs will be good jobs. Neither automation nor the rise of on-demand platforms will drive change in themselves. However, these major disruptions offer a significant opportunity to reassess the value of these supposedly “low-skilled” jobs and think about how they could be arranged differently to support the wellbeing of both carers and users. — Miranda Hall
(Picture Credit: Wikimedia/Aaaron Biggs)