Providing Care To Others Can Be A Gratifying Experience

The normalization of segregating the old and disabled represents a significant marker in the development of structural ageism and a considerable shift in thinking about the roles and responsibilities of caregiving. Structural ageism excludes or deprioritizes specific age cohorts through laws, policies, and practices.[4] It also incorporates ageist principles into formal and informal rules and procedures. Structural ageism is reflected in the legal system, health care provisions, economic practices, and the built environment. Regardless of age, those with any sensory challenges would find themselves at a disadvantage in this type of environment. In the nineteenth century, caregiving occurred primarily in the home and was confined to a relatively short duration due to a lack of medical knowledge and of interventions to extend the average life span. [5] Both formal and informal caregiving encompass the act of providing help and support to individuals who are unable to function independently. Interestingly, within the family context, the expectation of providing care for children remained intact, and we view parenthood as a responsibility that encompasses both challenges and great rewards. However, caregiving for older family members became regarded as a constraint and associated with a burden as time went on. The social construction of childhood that became widely adopted in the early twentieth century exacerbated the split between how we think about caregiving for children and for older people. Previously, children typically had been tasked with substantive work responsibilities and treated as economic contributors to the family. When the economic landscape no longer necessitated this practice, society’s idea of childhood evolved.

Bad Company

It became identified as a stage in which to grow, play, learn, and develop in supported and protected environments. This new social construction of childhood also advanced the understanding of aging itself as a rise in ability and vitality from childhood into adulthood followed by a slow and steady decline into old age. With an increased emphasis on childcare as a familial obligation came an increased reliance on paid caregivers for elders. The concept of the caregiver’s burden emerged in the 1960s and effectively pathologized the caring relationship. This in turn added to the stigma of dependence and promoted the illusion of autonomy as the goal of successful aging. Who wants to be a burden? I have heard numerous conversations in which an elder expressed fear of encumbering a loved one through dependency. Emanuel’s writing had its share of satire and hyperbole to be sure, but his disdain for support and fear of dependency was crystalline. Of course, relying directly on others every day can elicit feelings of vulnerability, frustration, and weakness for both the care provider and the care recipient. However, the care process can also evoke warmth, connection, trust, purpose, and love. Providing care to others can be a rich and gratifying experience that encourages meaningful relationships built upon interdependence. It wasn’t until the 1990s that research began to focus on caregiving’s positive aspects with concepts such as caregiver satisfaction and caregiver rewards. Ending this pattern and healing damage already done starts by recognizing the stigma currently associated with dependence and the concurrent misconception of independence as an attainable goal.

A Better Day

This false dichotomy then must be replaced with an appreciation of the reciprocity involved in giving and receiving care as a healthy relational process. The transition to segregated facilities for housing and caring for the old and disabled further solidified nursing as a paid profession and accelerated movement away from traditional intergenerational family care to the relegation of responsibility for looking after older people to paid caregivers. Systematically the almshouses that accompanied industrialization and urbanization transformed into homes for the elderly, creating the perfect storm of social and economic changes to cement discriminatory ageist practices and policies. Older people, especially those with physical, cognitive, or psychological vulnerabilities, started to become warehoused away from those of us regarded by society as productive and independent. Is this what older people wanted? Given that we have no survey data from the time of the Industrial Revolution, we can only speculate that older people were no more in favor of being segregated back then than they are today. Recent findings from the United States of Aging National Survey show that nine of ten older adults strive to remain living in their homes and communities despite physical or economic difficulties.[8] The most prevalent reasons for wanting to stay in their homes is that they like where they live and have friends nearby. It should not be shocking to think that older people, like people of other ages, would prefer to have the autonomy, agency, and ability to live where and how they wish and to be among the people they know. Subtle shifts in the language used to discuss productivity and profits in the job market, however, pointed to changes that were becoming endemic, such as the new practice of retiring older workers from their positions, a practice sold to the American public as beneficial.[9] From 1880 forward, a substantive shift in language that advanced age stereotypes grew exponentially as the term elderly became equated with frailty. Handicapped became associated with social, economic, and physical disadvantages, and terms like cripple or lame were used as pejoratives. The concept gained traction in the early twentieth century, resulting in forced sterilizations of those with mental illness, physical and mental disabilities, and racial and ethnic minority status.

Heart Of Stone

Today we use the term ableism to describe a set of beliefs and practices that places value and judgment on physical, cognitive, and intellectual ability. As with ageism, we are aware that the preference for particular abilities over others leads to oppression and marginalization and ultimately othering of people deemed less capable. It wasn’t until the latter twentieth century that concerted efforts were made to clarify the weighty stigma intrinsic to these terms and to provide alternatives to the term handicapped, such as disabled or differently abled. The rise of the eugenics movement and the biomedicalization of aging equated disabled and old with inferiority and social problems. Negative attitudes and behaviors toward disability and advanced age became more mainstream, driven by concerns that older people were a drain on economic resources.