CONCLUSION: THE POLITICS OF CARE

The basic mode of politics today is a depoliticised expert administration and coordination of interests […] the art of expert administration as politics without politics.

(Žižek 2014)

This study has delved into the politics of care; it took up Finnish elder care policy as a case study to examine why and how care is political in general, and an increasingly visible and weighty matter in national politics in Finland in particular. Starting off from puzzlement over what is at stake in the creation of legislation which aimed to tackle the ‘biggest challenge facing Finnish society’, this research executed an analysis of a policy process for the elder care act where the discursive framing of the matter at hand proved highly significant. What was first acknowledged as being largely a problem of insufficient resource allocation became one of regulation; an issue of recognition and redistribution was reframed as one of regulation, which in turn limited the scope of the legislation passed.

I argue that the politics of care consists not only of a struggle over recognition, redistribution and representation, but also, and in particular, over the way (elder) care is conceptualized and delineated as a problem field in the first place and pursued as an object of governance. The dominant, if not hegemonic, framework through which care is today articulated is chiefly characterized by neoliberal trends, whereby care is understood as service and where the value hierarchy is based on economic factors. Tied to the will to rationalize and make care service provision more efficient, reforms of elder care in Finland today coincide with increasing marketization and bureaucratization which in turn intensify the classification, categorization and systematization of care processes and procedures. Care understood as something beyond measurable services, namely as an embodied, ubiquitous relation with a logic that is adverse to such measurement systems, disappears from view when the regulation of care is presented as a solution to the problems of care.

In chapter 1, I explained how Nancy Fraser’s three dimensional framework functions as an analytical framework and starting point for my research. Fraser’s approach offered a fitting viewpoint for the subject matter, as there is no existing political theoretical framework, no ‘politics of care’

literature which would point a researcher to an established framework through which to study care as a political issue. Fraser’s multidimensional perspective supplies efficient tools to chart the landscape of elder care policy and politics, especially as previous care research suggests that elder care lacks adequate recognition, and challenges faced in elder care policy seem to emanate from this lack of recognition, and the corresponding lack of

Conclusion: the politics of care

redistribution. Further analytical tools drawn from discourse theory add depth to the analysis, as the political significance of the policy process turned out not to be chiefly about competing justice claims in terms of recognition, redistribution and representation. Instead the process was dominated by a consensual outlook of the issue as one in need of better administration and regulation. A discourse theoretical perspective of hegemony and governmentality was utilized to focus on the discursive struggles which accompanied the emergence of such a consensus and helped to sustain it.

The initiation, drafting and passing of the elder care act presented a case for policy analysis to examine how and why care figures in the everyday politics of the parliament and government, how it emerges on the political agenda, and why the challenges it presents are dealt with through particular policies rather than others. The existing (care) regime requires a level of hegemony to maintain and perpetuate its practices, social relations and ideals, although this stabilization and consensus is always only partial. There are always competing discourses and alternative, challenging viewpoints and mobilizations with the potential to threaten and destabilize dominant practices. The state of affairs in elder care services was thus criticized and challenged in 2009, to the extent that the Finnish government had to act in a (seemingly) potentially transformative way, by promising new legislation.

Eventually however, very little changed in the way elder care relations are governed and services are organized. This study looked into how and why this issue and situation developed and turned out the way it did.

Chapter two reviewed the literature and previous research on care, noting how there is no established research tradition on the political aspects of care.

A rich body of literature does exist which examines social policy and elder care, mainly in terms of social reproduction and work, or as an ethical orientation and practice. A political understanding of care, however, remains weak. This chapter explains this deficit with reference to feminist political theory which elucidates how the traditionally private, domestic and feminized sphere of life where care traditionally belongs sits in an uneasy relation to political thought and political practices understood in a more narrow sense. Challenges around care persist even within today’s ‘welfare states’ which to some extent do recognize and aim to equally redistribute the demands of care. Joan Tronto (1993) is shown to supply the most potent perspective on care politics, as she ties the social and discursive subordination of care to the birth of the modern political project. However, her seminal research, too, fails to consider the present day political boundaries around care, which would be pivotal in understanding what care politics today is about. These boundaries are fortunately being investigated in more recent care research which has shown how for example the global care chains today define care relations, and how the embodied nature and material-economic dimensions of care play into the politics of care. I suggest that care research needs to turn its attention to precisely those developments

of (neoliberal) governance of care, which are a central site in which the politics of care unravels (see also Hoppania and Vaittinen 2015).

Studying the political processes through which care is governed, through which power is exercised over care relations, that is, for example policy and legislation that aims to regulate and manage elder care, what must be uncovered is what is at stake in this governance. How in these processes is care represented and defined, and how is this framing and delineation of care, its problems and the professed solutions to those problems, a site of discursive struggle? In such an examination the corporeal relations and the logic of care which care research has articulated seem to emerge as counter discourses and competing logics to the now quite ubiquitous neoliberal governance. To be sure, this is not to say that governance as such is somehow detrimental to care. On the contrary, governance designates a form of power, and power shapes the conditions of possibility both by delimiting action and making it possible. Thus what is relevant is what kind of governance characterizes care policy. The structures of governance are significant also from the point of view of democracy; they organize representation and may allow for demands for recognition and redistribution to be raised.

To contextualize the present study, chapter 3 introduced Finland in terms of its social policy, the history of elder care governance and present day care policies. This background is pivotal to developing the central argument of the dissertation with respect to governance. A survey of the history of social policy reveals how already over hundred years ago, when institutional elder care policies were created, the state elites producing care discourse exhibited a will to avoid the politicisation of the ‘poor relief’ discussion, as it was then termed. To frame elder care as an expert concern of administration and governance precludes an understanding of it as an explicitly political issue of conflicting interests regarding redistribution. The tendency to thus

‘depoliticize’ care has a long history, and tied within it are gendered ideals of citizenship and class relations. The chapter then explained how the birth of the welfare state was connected to a change in production structures, to industrialization and urbanization which also reshaped care relations. In such turbulent times, the way elder care came to be rearranged was part of political struggles and movements for shared, socialised responsibility for dependants. An ethos of universalism, of strong social rights and expanding social and health care services characterized the post-war decades. Still, no subjective rights for the elderly for services were attained, unlike what was the case for example in child care. Since the 1990s, the tide has been turning against an extensive welfare state, and gradually towards market-oriented governance. This ideological turn is explained in terms of neoliberalization, which characterizes the reforms of the past two decades. By the 2010s elder care has become a central cause for national worry in an ageing society, and an object of tightening provisions. Concurrently the responsibility for caring is being shifted back to families and individuals, but also produced as a field of competitive markets.

Conclusion: the politics of care

This steering of elder care relations to suit the emerging neoliberal regime has happened in and through dispersed sites of governance, from legislation, structural reforms and incentives for marketization to softer forms of regulation such as quality recommendations and a gradual tightening of the procedures in granting services. I consider the fact that the discourse which characterizes these reforms is international. It emanates from, among things, the European Union and bodies such as the OECD. The discord of the relationship between the municipalities and the state (that is, mainly the ministries, and the treasury in particular), and the way government subsidies are allocated, is shown to be a significant factor in the governance of care service provision, which today is a mix of old and new forms. The hegemonic discourse of the governing bodies such as the ministries is characterised by a rhetoric of necessity, and of an impending care deficit caused by the worsening dependency ratio and economic crisis, and by ideals of free choice, individual responsibility and detailed regulation. While popular support for the welfare state remains strong, many neoliberal reforms have been made in the name of sustainability of the welfare state.

Such tendencies and trends were the context in which the media scandals of deficient elder care arose in 2009. Chapter 4 described the policy process of drafting and passing the elder care act, and showed how the impetus for it came from the eruption of a wide-scale public debate concerning reports about deficiencies and low quality in long-term institutional care. This debate forced the topic onto the political agenda. It was largely recognized that the issues which had been raised were a genuine problem which needed to be attended to. The idea and demand for better regulation in the form of a new law was presented as a solution, and the elder care act emerged as a floating signifier at the beginning of the process, as different actors attached varying objectives and hopes to the coming law. But as it turned out, the hegemonic view of there being no money prevailed, and thus it was necessary to find a solution to the problems by other means than for instance by simply putting more resources into the grassroots level of care services. I argue that the scandals and debates in fact amounted to a political opening, a momentum for rearticulating the concerns of care in terms of redistribution. Finally, however, no significant reframing or transformation of elder care took place, because the ministerial and administrative discourse, which managed to maintain its hegemony in elder care governance, contained any substantial criticisms of the existing regime and practices. Whilst the process witnessed calls for recognition for care-givers (both professional and lay) and for the right to care services and commitment to the welfare state, these articulations remained quite symbolic and did not lead to improved recognition or redistribution for care-givers. Better administration, leaner and clearer procedures, improved organization and prevention were the solutions presented in what was and remained the hegemonic understanding of the problems at hand. Whereas calls for human dignity and basic rights supported by adequate resources first characterised the process, finally an

improved machine of regulative control over care service procedures was the outcome of the policy process.

The most pronounced critique of the hegemonic discourse concerned the lack of binding force of the new law. This challenge was typically articulated as a problem of resources, particularly as regards staffing levels, and demands to bring back earmarked subsidies were raised. Likewise, subjective right for the elderly to care services was demanded to enforce improvements in the attainability and quality of services. This resource discourse, however, was not successful in winning over enough agents in the struggle over the understanding of what was at stake in the reform of elder care.

Chapter 5 showed in detail how what I term dwindling resources, bureaucratic division of labour, and prevention functioned as important nodal points which organised and fixed the elements of the hegemonic discourse, and justified the approach undertaken in the preparation, drafting and passing of the elder care act. Regulation and supervision, living at home, and quality, on the other hand, were concepts which most of the time acquired a floating status, as different parties attached different meanings and hopes to these ideas. The elder care law itself was such a contentious object, one which was meant to rectify the flaws discovered in elder care; how it was to succeed in this objective was not fixed in the beginning of the process. Whilst competing views of what was at the root of these flaws and deficiencies were articulated, the hegemonic discourse framed the problems largely in terms of lacking regulation. This perspective, which emphasized governance rather than recognition or redistribution, a discourse largely produced by the Ministry of Social Affairs and Health and various other experts and national governing bodies, dominated the process, with the logic of difference functioning to weaken, displace and subsume the alternative, competing viewpoints and demands for redistribution.

This chapter also reflected on the recognition, redistribution and representation aspects of the policy process and the final law. It argues that the improved recognition for the care needs of the elderly which was granted during the process remained dubious and on a symbolic level as practically no redistribution for elder care was made. In fact it was demonstrated that the ongoing structural reforms entail redistribution away from public care service resources. The elder care act itself does not take any stand on the issues of redistribution and production of services whilst these actually significantly shape the reality of elder care services and elder care relations.

The counterhegemonic resource discourse, through which the concerns for redistribution were raised, was not successful in gaining any results, and my analysis of the representation structures involved offers further reasons as to why this was so. The acceptance of the structures of social policy governance as a given, in particular the relationship between the state and the municipalities and how it affects the way state subsidies and budget appropriations are defined, served to delimit the scope of possibility of the process. The manner in which the ministry dealt with the numerous

Conclusion: the politics of care

comments on the draft laws was moreover a crucial mechanism to prevent the question of redistribution from surfacing on the political agenda.

Recognising, redistributing and representing