Theorizing and Conceptualizing Care and Caregiving

Within geography, a central concern has been to elucidate the spatial manifestations and characteristics of care and caregiving in people's everyday lives with the explicit purpose of challenging taken for granted assumptions within prevailing health policies and practices. There are, however, many different and often contested ways to think about care and caregiving, and main contributions have come from, among others, the political economy, cultural, and feminist perspectives.

Political/Institutional Change

Since the 1990s, the restructuring of health and social care services has had a tremendous impact on care relationships and roles. Key studies have revealed that the shift in where care is provided and how care is delivered affects the experiences and meanings of home and community. Drawing on political economy, much of this work seeks to understand how institutional, political, and economic structures shape experiences and realities of receiving and providing care. These studies help to explain the unequal distribution of care resources between groups of care providers and receivers, between different regions, and between various care settings. In other words, healthcare policies affecting the provision and receipt of care are entrenched in specific political, economic, cultural, and social contexts. From this perspective, care is viewed as a political concept that involves the allocation of public resources, and issues of justice, rights, and citizenship, and researchers have used this approach to examine care and caregiving relations and practices in the home, community, and hospital. Ultimately, this work reveals the consequences that healthcare restructuring has on various groups such as care recipients, informal caregivers, health professionals working in the home and community, and individuals affected by the closure of their community hospital.

Landscapes of Care and Caregiving

The long standing geographical concern for understanding the human experience of place has inspired work on the social and cultural dimensions of care and caregiving. Of particular note is the concept of therapeutic landscape, which draws on the humanistic interest in sense of place, and the attachment and deep meaning that places hold for people. Using this concept, researchers have theorized how particular attributes of the physical and social environment, and the meanings associated with place identity can have a profound impact on health and well being, and on care and caregiving. This concept informs understanding of care providers' and receivers' attachment to particular locations. It is particularly useful for understanding care and caregiving in the home, which is a space of care that is deeply symbolic, familiar, and where individuals may experience profound attachment and place identity.

Gender, Care, and Caregiving

Approaching care and caregiving from a gendered perspective raises questions about how the caring work performed by women is undervalued and often invisible in society. The majority of caregiving, both paid and unpaid, is the responsibility of women (see Table 1 for international data on unpaid caregiving). The profound changes in healthcare policy and delivery affect women the most. Care and caregiving activities that were once the responsibility of skilled professionals now are the responsibility of volunteers and family members in the home and community, the majority of whom are female. Research in this area has contributed to critiques about the often invisible and neglected work done by women in the home, and their critical role in maintaining the health of their family members, neighbors, and friends. An important area of care and caregiving research centers on the connections between gender, paid work, and caregiving. Drawing on feminist perspectives, work on gender, care, and caregiving examines the travel and activity patterns of women between their home, paid work place, and caregiving location. These explorations of space–time mobility patterns and travel requirements illustrate the difficulties that women experience in balancing the competing demands and responsibilities of their households, children, work, and caregiving.

Ethics of Care and Caregiving

Underlying the diverse perspectives described above is a growing concern to develop an ethical and progressive politics of care and caregiving. Recent commentaries highlight the need for a more careful consideration of the ideologically driven settings in which, and from which, care and caregiving occur. For example, studies question whether 'community' is an appropriate resource for caregiving as opposed to institutions, the state, or the market. The changes in where care is delivered and the practice of providing care have led to a blurring of the boundaries between healthcare settings and nontraditional healthcare settings; researchers are questioning the dualism and polarity of concepts such as formal and informal care, and private and public. For some in dividuals and their families, the home's physical and social space can go through some drastic changes. Medical equipment, strict medication and care schedules, and paid care workers coming into and moving about the home can change the way a home looks and feels. This has led to some researchers discussing the institutionalization of the home space, which in some cases, begins to look and feel like a hospital. There is a blurring in the type of care as family members caring for individuals with very complex and intense needs may be providing the same level of care that trained health professionals provide in the hospital setting. The only difference between the care provided by family and friends (informal) and that provided by trained health professionals (formal) is that the latter group is paid.

An ethics of care and caregiving is informed by concepts of social and/or compassionate justice, which advocate an inclusive approach in which all groups involved in care are included in debates about healthcare restructuring and caregiving. Work in this area is charged with setting the agenda for how the politics of care and caregiving might be played out, and critiquing the assumptions and ideas that are framing the healthcare policy that impacts care and caregiving. In other words, the ethics of care and caregiving moves beyond analytical exercises in description.