What’s Causing the Caregiving Crisis? Part 3: Culture
The final piece of this series is an attempt to dig into cultural changes driving the caregiving crisis. This is a huge, huge topic — one that I can’t possibly unpack in its entirety. With this in mind, I’d like to turn my attention to Western culture, and more specifically to the trends that are observable across Canada and the United States, which have informed almost all of my thinking for Caregiver Support Technologies. Specifically, I’d like to focus on the effects of shifting family structures and new communication norms, both of which have drastic implications for modern caregivers.
My Connection
After my grandfather passed away, most of the caregiving needs went with him — the physical ones, anyway. While caregiving in the literal sense encompasses a set of responsibilities for supporting a living person, I believe that the term actually warrants a much broader definition. The care one provides to a child begins well before life, and neither death nor recovery, in my mind, grant finality to caregiving and its effects. Though it has been years since we visited my grandfather at his assisted living facility, adjusted finances to ensure his needs were met, or worked with his healthcare practitioners to make decisions around his care — to name just a few examples — our family continues to care for grandpa and to feel the effects of his caregiving needs. About a year after we lost him, I was feeling the need for a fresh start, so I packed up and moved from Vancouver to Toronto for a job at an experience design consultancy.
Grandpa was still on my mind, though, and it wasn’t long before I started contemplating what caring for my parents would look like if their health were to deteriorate. The effect of distance, which I discussed in my last article, was immediately apparent to me, and I soon found myself considering the more specific implications this challenge might have for my family. I have one sibling, a sister, who is not only twice as brilliant but also twice as caring as I am. While I was in Toronto, she continued to reside in Vancouver — meaning that if anything had happened to either (or both) of our parents, she would have been left carrying the load. Supportive phone calls and financial contributions aside, there’s not much I could have done from across the country had the need arisen. This hypothetical situation made clear to me the effects of not only distance, but also isolation, further showing how dated the solutions are for caregivers and those supporting them.
Our Shared Story
I lived in Toronto for just two years, but that brief sojourn was pivotal for both my own development and my understanding of the bigger picture. My consulting job provided me with new skills and a deeper understanding of caregiving, and care itself. Perhaps even more important, however, was seeing the cultural contrast between Vancouver and Toronto. I love Vancouver, but I would argue that Toronto is well ahead of it culturally — outside of initiatives related to wellness and the environment, which Vancouver is famous for. When it comes to diversity (particularly ethnic diversity), economic activity, and embracing new trends (from fashion to technology), there simply isn’t a comparison. This contrast provided a lens for me to use when considering the future Vancouver may have — as well as how that might shape my own family’s lives — if the city evolves to become more like Toronto.
This transition of norms, which can be attributed to urbanization and the proliferation of technology, has been happening globally, with the United States serving as the bell cow for generations. Decades of America dominating North American — and by a crude proxy, Western — culture have led to two phenomena I’d like to address: Smaller families, and communication focused on connectivity rather than intimacy.
Smaller Families
The average family size in the US and Canada has been shrinking over the past 50 years. Check out this data from the US Census Bureau:
Since 1970, the number of children per household has fallen off by about 20% or so. Most of that decline happened in a span of less than 15 years, meaning that there is an interesting generational divide at play: Namely, baby boomers are more likely to have more siblings and fewer children than people of any generation before or since. This matters from a caregiving perspective, because it has resulted in something an operations professor would call a bullwhip effect. When the boomers were in their prime working years (from the 1980s to the 2000s, roughly), they were the “supply.” The sheer size of their generation, driven by bigger families, meant they had more labour to do the job when it came to caregiving. In other words, they had more siblings who could contribute to the care of aging parents — not to mention having fewer children to care for themselves. Even still, many boomers have struggled to provide care.
Today, the boomers represent a significant portion of the demand for caregiving. Because they comprise such a large cohort, this group is creating a larger demand than usual — especially relative to the supply of younger people. Many children of boomers have no siblings, making these individuals the sole caregivers for their aging parents. These children may even have aunts and uncles to care for, in addition to aging in-laws. Compounding this, if you recall from the first article in this series, which looked at the topic of survival, today’s aging adults are also likely to live longer, thereby extending the caregiving experience. And of course, many children of boomers have spouses and children who also require some level of care. For those who have siblings, caring for aging parents is a strikingly different experience.
More Connected, Less Intimate
There’s a saying that people love to throw around in caregiving: “It takes a village.” The sentiment of this message is great, but it’s not really true anymore — rather, it’s reflective of a time when a village model of care could flourish organically. Generations ago, people actually helped their neighbours through challenges and even crises in personal, consistent ways. Now, people rarely even know their neighbours. This isolation can be amplified for caregivers; more often than not, a caregiver will shoulder their load in isolation until they simply can’t do it anymore, even going so far as to actively avoid the conversations that would get them support from their “village.” So, what happened?
It feels silly to even need to say this, but social interaction was, at one time, conducted entirely in person. Most individuals would regularly see members of their community at places of worship, in the store, and even from their front porches. A person’s words, body language, and even their shopping cart were all visible to others in real time, without filter or delay. Now, people keep up with friends and family across massive distances — but the content they share is curated and filtered, the messages they send are never entirely spontaneous, and they are rarely compelled to break out of this comfort zone of communication.
This connected world was never going to be as intimate as face-to-face conversation, but I don’t think anyone predicted the extent to which people would become isolated. I’ve been reflecting a lot lately on the fact that I sometimes know more about what’s going on with my friends in Europe than I do with my friends who live within walking distance. Thanks to services like Instagram, I get enough snapshots to know how a friend’s life is going, even if I haven’t seen them in years . . .
Or at least I think I do. And that’s the core of the problem when it comes to why caregivers often feel so tremendously isolated. I wrote before about information asymmetry, and that’s certainly a big part of the issue — very few caregivers want to post all of their difficulties on Instagram. A broader problem, however, lies in the lack of intimacy that comes with each interaction. Clicking like on a photo is probably one of the most common exchanges people have with their friends — and this is something that has worried Instagram enough for them to test disabling like counts here in Canada and in many other countries outside the US.
Even text messages, which are personal in that they are one-to-one, are problematic. Think about meeting someone for the first time at a cocktail party. How do you end that conversation? How do you end a phone call with a friend? Usually, the conclusions of these conversations require some back and forth, some pleasantries, and even some accidental extensions as new information comes up. What about a friendly text conversation? That can end with literally anything. You might say “bye,” or just “k”; depending on context, it may even be appropriate to not answer at all!
When it comes to caregiving, the ramifications of this lack of intimacy are huge. Consider the difference between these two scenarios. In the first, you’re out for coffee with a caregiver. You ask how they’re holding up, and they don’t respond at all. How concerned would this response make you feel? What might you do to follow up? Now think about this alternative scenario: You send a text to a caregiver and receive no response. Do you feel concerned, or do you just think they’re too busy to answer? Do you follow up at all, or do you assume they don’t want your help? Honestly, anything could be true, and most people have become accustomed to that ambiguity. The mode of communication we now default to has robbed us of our intimacy with each other.
Conclusion
In true Canadian fashion, I want to apologize for taking you down the rabbit hole of despair by diving deep into the challenges inherent to modern caregiving. I think that understanding these barriers is a necessary step, however, as this holistic view is key to seeing caregiving as the contextually dependent, intricate, and chaotic puzzle that it is.
I come from a distinctly healthcare background, and it took me a long time to appreciate a simple truth in caregiving: This is not a medical problem, but a social one. While primary family caregivers and the people requiring their care might be the central actors, they are far from the only players affecting the landscape of caregiving.
It’s this truth, however, that allows me to see a brighter future. If caregiving were a medical problem, major organizations and institutions would be searching for a drug, a device, or some other intervention that could save lives — in other words, they’d be making a billion-dollar effort to solve the problems discussed in this series. Instead, individuals and companies of every description must recognize the need to repair the fabric of Western society and embrace the most effective behaviours. If we’ve learned nothing else in the past few decades, one thing has become abundantly clear: It’s entirely possible to rapidly modify behaviour with technology. The good news? That doesn’t always have to be a bad thing — especially when technology is designed and used with real intention. Take, for example, my favourite piece of social impact tech: Be My Eyes. This app allows volunteers around the world to lend their sight to the blind, on demand. This can mean directing them through foreign airports or even just confirming that, yes, that milk has expired. The service is all based on a simple, surprising insight; namely, that thanks to iPhones with settings for the visually impaired, there’s a large population of blind people carrying cameras in their pockets. The biggest complaint about the service? Volunteers want to help more often.
As destructive as the trend toward connectivity has been, innovations like Be My Eyes show that it has also laid the foundation for tremendous innovation. There’s a village out there, but the roads and gathering places are digital, not physical — we just need to learn how to use them.
If you missed the rest of the series, here are part 1 and part 2.
