What’s Causing the Caregiving Crisis? Part 2: Careers

If you missed part 1, find it here.

Joseph B. Fuller and Manjari Raman of Harvard Business School recently dissected the role of employers in caregiving. The first line of their report, The Caring Company, seems to sum it up:

“American companies are facing a caregiving crisis—they just refuse to acknowledge it.”

The report is a fascinating read, rich with data and insights. Frankly, I don’t think a better compendium exists on the stress points between worker and employer. The report positions caregiving as an unexpected crisis that has snuck up on employers, which helps set up the strategies they lay out for companies to consider. While this is a perfectly suitable lens to look through for the purpose of understanding and addressing the problem, I believe that it’s equally important to look even earlier, and consider the ways in which observable changes in patterns of work have contributed to the caregiving crisis.

My Connection

I come from a medical family: My dad is a surgeon, his father was a doctor, and my mom is a nurse. I always thought I would follow in their footsteps. One major benefit of a career in medicine is how structured and well-defined it is: You complete years of schooling, pursue the fellowships and residencies that interest you, then likely settle into a pattern of practice for the rest of your career. If you're from a city with a medical school, like I am, you may not even need to move away from home. This was exactly my plan.

After graduating from the University of British Columbia with a degree in genetics, I took a year off to travel and gain relevant work experience to bolster my school application. This is when my plan started to change. I was fortunate to land at Ondine Biomedical, where I was exposed to a breadth of choices I never knew I had. Carolyn Cross, Ondine’s CEO, became my friend and mentor. Her advice and vision set me on a career path far less predictable than anything I could have expected, and I’ve loved nearly every second of it. I will be eternally grateful to her for daring me to dream big and inspiring me to put in the long hours. Fortunately, my parents were supportive as I embarked on this journey—though they still haven’t stopped telling me that I would’ve been a great doctor. 

On Carolyn’s recommendation, I left Ondine to pursue my MBA at Harvard Business School.  After spending two years between Boston and San Francisco, I moved back to Vancouver, where I found my mom and aunt deep in the responsibilities of caregiving for my grandfather. To me, his need for care felt sudden, but my family had been steadily moulding this new reality for themselves during my time away. Not only was I embarrassed that I hadn’t been fully aware of what was going on, but I also felt unsure of how I could help.

Our Shared Story

Consider your own career, and the careers of people you know. Let’s think about the levers created and used by modern workplaces, and about what it means to pull those levers in a caregiving context. 

Location 

Have you ever moved away for the sake of your career? You already know I have. While moving to a big city to work at a dream job or attend a prestigious school can feel a lot like freedom of movement, in reality, employers have made it something of a requirement. Today, we may be at the peak of relocation for career’s sake. Let’s take America’s largest city, New York, as an example, which boasts some impressive proof of attracting people, often for work or school. According to the NYU Furman Center, in 2015, 38% of NYC residents (~3.2 million people) were those born outside of the United States, and 14% of the population (~1.2 million people) were natural-born Americans from other states. Many of the remaining residents would have come from elsewhere in New York state. Until remote work and online study become the rule rather than the exception, people will continue to move away from their families, and toward locations they deem important—including not only NYC, but many other city centres as well—to further their careers.

This movement has a huge impact on families. I was able to adjust quickly to my grandfather’s condition upon returning home, but I still but had no idea how to plug back in. In more acute situations, the transition can be much more jarring for an individual’s loved ones and caregivers as they try to quickly adjust. 

Consider, for example, the aftermath of a severe injury caused by a car accident. Unlike dementia, this type of medical crisis occurs in an instant. In scenarios like this, homes must be retrofitted, surgeries must be scheduled, and at least one career must be put on hold. For loved ones who live far away, however, this news still just comes as an email or a phone call, both of which lack context and permanence. Even in a globalized world, physical distance can still leave us blind to the realities of care.

Time

The expectations around working evenings, weekends, and other long hours made sense in an agrarian society where farmers were responsible for their own land. Because they worked together, entire families could even pause for a crisis and try to catch up later. Now, similar expectations are placed upon workers for companies they don’t own. Their compensation, though sometimes gaudy, comes with a daunting caveat: If you don’t work hard enough, you could lose your job, or at least your ability to advance. Fuller and Raman discuss this unforgiving phenomenon in great detail in their article.

Caregivers simply can’t do the extra hours. In fact, sometimes they can’t do the regular hours. Employers often say the right things, but when it comes down to it, the colleague who was able to put in more hours is probably going to get the promotion—tough luck to the guy who had to bring his son to chemo every Tuesday, or the woman who had to cancel client meetings to deal with her mother’s unexpected crises.

Security 

What’s your safety net for your health and well-being? In Canada, the public healthcare system provides a certain level of protection and security; most Canadians who experience chronic illness are not made destitute by the cost of their care. However, the demands of both chronic illness and caregiving can still rob people of their ability to earn a living. In such an event, many must resort to public employment insurance and even charity. In the United States, a complex system of insurance, most often provided through employers, is buttressed by charities, government programs, and, of all things, GoFundMe campaigns. As a patient, the peril of illness or injury has largely shifted from a risk of death to a risk of financial ruin.

Not having a solid safety net as a caregiver is a terrifying reality. Caregivers are responsible not only for themselves, but also for the well-being of a loved one. As a result, healthy workers, even those full of ambition and energy, can feel that they are trapped in their current jobs. Because they must prioritize security, these individuals often fail to look out for their own interests.

Identity

Identity is a massive, multifaceted topic—one that I can’t possibly cover in this article, or even in an entire series of articles. What I will say is that a person’s identity can have significant implications for their workplace experience. Members of the LGBTQ community, people of colour, and others who have proudly embraced the complexity and beauty of their identities often feel that the workplace has not been built for their success. Sadly, that’s often because it isn’t.

One group for whom the playing field isn’t level is women, and they are key to the caregiving story. The injustices are well documented: pay gaps, imbalanced power dynamics, and discrepancies in opportunity are just a few. Women are finally getting their chance to punch through the glass ceiling, but one thing holding them back is that we, as a society, expect them to provide care. 

There's no research to support the notion that women are genetically predisposed to caregiving. A person of any gender can care for a cancer patient, trauma victim, or family member with dementia, yet women make up three quarters of family caregivers. If we can accept that caregiving is hard on careers, it is also clear that the careers of women are disproportionately affected. This is not to say that a woman will necessarily feel the effect more than a man in the same situation—rather, it is simply to acknowledge that for each man experiencing these effects, there are three women in a similar situation. This imbalance effectively penalizes women in the workplace.

Thankfully, it seems like employers are starting to become more aware of how their norms and policies relating to location, time, security, and identity affect the careers of caregivers. Institutions like Harvard Business School are performing research, while these trends are getting coverage from publications like The Wall Street Journal; these are good indicators that individuals and institutions with deep pockets are starting to take this situation seriously. 

In part 3 of this series, I’ll dive even deeper as I look at how new cultural trends are making caregiving more common—and more difficult—than ever before.