United Nations Development for Social Policy and Development, Programme on ageing United Nations Division for the Advancement of Women International Institute on Ageing Caregiving and Older Persons - Gender Dimensions Expert Group Meeting Malta, 30 Novemver - 2 December 1997 Report Preface With the ageing of populations, the issue of caregiving for dependent older persons has become increasingly important. Most older persons and most of their caregivers are women. However, many policies and programmes addressing the issue ignore the gender specific needs and interests of women and men. In March 1997, the United Nations Commission on the Status of Women recognized the importance of analysing the situation of older persons from a gender perspective. The Commission decided to consider the status of older women as an emerging issue at its 42nd session in 1998 (resolution 41/2). The United Nations Programme on ageing of the Division for Social Policy and Development and the Division for the Advancement of Women organized this meeting in order to provide the Commission on the Status of Women with a thorough analysis and suggestions for gender-sensitive policies. Furthermore, the results of the meeting will be used to highlight the importance of gender in the International Year of Older Persons in 1999. The Expert Group Meeting focussed on informal caregiving for dependent older persons, which is almost always provided by women. Informal caregiving has become an important issue as many governments make cut-backs in the formal support systems. Policies that are not based on a gender analysis of the situation tend to discriminate against women. This Expert Group Meeting is a first step in the international arena to explore the issue of caregiving from a gender perspective. The Meeting took place from 30 November - 2 December 1997 and was hosted by the International Institute on Ageing in Malta. CONTENTS Paras Page PREFACE......................................... i I. ORGANIZATION OF WORK ...................... 1- 6 1 A. Attendance............................ 1 1 B. Documentation......................... 2 1 C. Adoption of the agenda ............... 3 1 D. Election of officers.................. 4 1 E. Opening and closing of ceremony....... 5 2 F. Working groups ....................... 6 2 II. SUMMARY OF THE GENERAL DEBATE ............. 7 - 24 2 - 4 III. CONCLUSIONS AND RECOMMENDATIONS ........... 25 - 33 5 - 9 A. Support policies in the workplace for caregivers and care recipients .................. 26 5 B. Social security....................... 27 5 - 6 C. Care support policies through fiscal measures ............................. 28 6 D. Community-based services ............. 29 6 - 7 E. Research ............................. 30 7 F. Education and training ............... 31 7 - 8 G. Empowerment .......................... 32 8 - 9 H. Disease prevention and health of care givers and receivers.................. 33 9 ANNEXES I. Papers ......................................... 10 -11 II. List of participants ........................... 12 - 14 I. ORGANIZATION OF WORK A. Attendance 1. The Meeting was attended by 11 experts, representing all geo-political regions, and 7 observers (see annex 2 for a full list of participants and observers) B. Documentation 2. The Documentation of the Meeting comprised two background papers prepared by the United Nations Division for Social Policy and Development and by the Division for the Advancement of Women, 9 expert's papers, one paper prepared by the International Institute on Ageing, and two papers from observers (see annex 1). C. Adoption of the agenda 3. At its opening session on 30 November 1997, the Meeting adopted the agenda as follows: Opening ceremony Election of officers Adoption of agenda Plenary session: The Situation of Caregivers and Carerecipients Plenary session: Policy Approaches to Caregiving - Analysis from a Gender Perspective Working groups on policy recommendations Plenary session: discussion of recommendations Adoption of the report Closing ceremony D. Election of officers 4. At its opening session, participants elected the following officers: Chairperson: Dr. Hana Hermanova (Czech Republic) Vice-Chairperson: Dr. Tan Poo Chang (Malaysia) Rapporteur: Ms. Irene Hoskins (USA) E. Opening and closing ceremony 5. The following persons made statements at the opening ceremony: Ms. Dorota Gierycz, Officer-in-Charge, Gender Analysis Section, United Nations Division for the Advancement of Women Ms. Rosemary Lane, Social Affairs Officer, Programme on Ageing, United Nations Division for Social Policy and Development Dr. George Hyzler, Director, the International Institute on Ageing The Hon. Dr. Michael Farrugia, Minister of Health, Care for the Elderly and Family Affairs, Malta Dr. Nina Hill, Director, Civic Affairs, Corporate Affairs Division, Pfizer Inc. The Meeting was closed by the Hon. Dr. Louis Buhagiar, Parliamentary Secretary for the Elderly, Malta. F. Working groups 6. At the second day of the meeting, participants split into two informal working groups to deliberate action oriented recommendations. II. SUMMARY OF THE GENERAL DEBATE 7. The debate focused on how to change the traditional roles and expectations of men and women in the workplace and home with regard to care giving. It recognized that womens' participation in the labour market, occurring increasingly in all world regions, has outpaced adjustments in perceptions, attitudes and expectations, and in the organization and infrastructure of societies, especially with regard to caring for older persons. 8. This discrepancy is out of step with the fast-changing demographic reality whereby the numbers and proportions of older persons are increasing in both industrialized and developing countries, with this increase occurring at an even faster rate in developing countries. It is estimated that by the year 2025, over 70 percent of the world's older population will be living in developing countries. Moreover, since women live longer than men, women make up the majority of older persons all over the world. 9. While the vast majority of older persons continue to be a vital resource for their families and communities and lead healthy and productive lives, the risk of dependency grows with increasing age. 10. Within the older population age 60 and above, older persons aged 80 and over are the fastest growing group in the world, with women generally surviving to older ages than men. Indeed, among people over age 75, almost two-thirds are women. Considering that persons in the age 80 and older group may be most often in need of support and care, the rapid increase in the world's very old obviously has implications for policies intended to assist family caregivers, the majority of whom are also women. 11. Further, traditional support systems of older persons are severely challenged today. Due to demographic development, including falling birth rates, the ratio between older persons and available younger family caregivers is declining. In addition, many developing countries are experiencing rural/urban migration, urbanization and industrialization, which often result in an erosion of traditional family support patterns. 12. At the same time, faced with increased spending for public pensions and health care due to population ageing, many industrialized countries are searching for cost-saving measures and have already made or contemplate cut-backs in their public welfare systems. One of the prevailing trends is to shift responsibilities from public support policies back to the families, which means mostly to women. 13. The Expert Group Meeting affirmed that it remains the responsibility of governments to design policies and programmes to provide care for dependent older persons and to support those who provide such care. Such public policy should build supportive environments, reduce inequities, and enhance coping and control through a care giving mix which involves government programmes, and civil society such as NGOs, religious organizations and community. Most importantly, cost savings should not be undertaken to the detriment of dependent older persons or the caregivers on whom they depend. 14. The Meeting also noted that, according to the latest Review and Appraisal of the International Plan of Action on Ageing of January 1997 carried out by the United Nations every four years, a continuing trend has been noted that governments and many (but not all) older persons themselves often tend to prefer care by the family, whether in their own homes, with assistance from family members, or in the home of kin. 15. Participants recognized the very different care giving systems in industrialized and developing countries. It was noted that in developing countries, the older population growth had not yet reached its peak, and therefore, now was an opportune time to develop innovative care giving policies which are more gender-sensitive and which provide a range of benefits and good quality services. In developing countries, informal familial and community systems prevailed, and were, in some places, exclusively the concern of women. In fact, in some countries, men could lose prestige by caring for dependent relatives. 16. Therefore, caregiving needs to be restructured by removing gender biases and adding value and recognition to caring. Caregiving also needs to be structured as a multi-generational enterprise, with life-span stages which recognizes the assistance that children, youth, adults and older persons can give each other in the creation and maintenance of a caring society, which takes into account that everyone can become a caregiver and care recipient. This would ensure the preservation of the social capital which is so important to the well being and functioning of society. 17. Parallel with the ageing of populations, women are entering the labour force in growing numbers worldwide - both by choice and by necessity. The interaction of the ageing of populations, differential longevity for women and men, and women's increased labour force participation will inevitably lead to conflicting demands and increased stress placed on women. 18. Expectations of the tasks of women at mid-life, in particular, are often unsustainable - with double and triple burdens of child care, elder care and personal career occurring simultaneously. These expectations combined with historical and cultural factors, as well as the process of the differential socialization of boys and girls, promote women's low status and low self-esteem. Women therefore, themselves often add to already difficult situations because they may be reluctant to ask for support or redistribute household responsibilities more equally among other members of the family. 19. The concept of active ageing to promote positive self-perception among older persons and a positive attitude to older persons by the general population is a popular philosophy. An emphasis on active and healthy ageing perpetuates a sense of well-being that promotes physical and mental health. Thus, active ageing was seen as an important concept in the prevention and delay of the onset of disability. At the same time, Working Group participants expressed some concern that this attitude, while beneficial, should be counterbalanced with the recognition that dependence may increase eventually, particularly for the very old. 20. The Expert Group considered it essential to analyse the situation and formulate policy recommendations from a gender perspective taking into account differences in the socially constructed roles of women and men, their different needs and interests, both as caregivers and as recipients of care. 21. When analysing the situation of older persons from a gender-perspective, it becomes obvious that women are at a disadvantage in many ways: Older women are more likely to lack family support than men, they are more vulnerable to poverty than men, and they face a higher risk of being ill or disabled. However, based on their experience and wisdom older women are also a resource for the well being of their families and communities as leaders and decision-makers as well as for providing care to both younger and older family members. 22. The Expert Group further considered that while older persons enjoy both rights and responsibilities, the rights of the (mostly female) carers of dependent older persons are often unrecognized and neglected. It therefore considered it essential to balance the rights of the dependent older person and his/her caregivers in a fair and equitable manner. Independent older persons should not be excluded from care giving. 23. The Expert Group Meeting considered a variety of policies which provide choices between a range of benefits and services, such as day care, domiciliary care and, where feasible and desirable, direct cash payments to dependent elders to pay for care. The question of whether cash benefits devalue family care provoked differing views among the participants. Many developing countries and countries in transition lack the resources to implement such policies, but have, nevertheless, to rethink current systems of health and social service delivery. 24. Participants recognized that the Meeting was a first exploration of the issue that needed to lead to a more focused and comprehensive examination in which gender, geographic and sectoral aspects of care giving for dependent older persons are analysed from an intergenerational, inter-cultural and interdependent perspective. Such an examination should lead policy makers towards a plan of action in which all sectors of society will be sensitized toward a new philosophy of care, in which men and women are partners in designing and actively implementing policies for care giving within the family, as well as other institutions. III. CONCLUSIONS AND RECOMMENDATIONS 25. The Expert Group Meeting formulated policy recommendations in the following general areas: Support policies in the workplace for care givers and care recipients; Social security; Carer support policies through fiscal measures; Community-based services; Research; Education and training; Empowerment; Disease prevention and health care of care givers and receivers. A. Support policies in the workplace for care givers and care recipients 26. The workplace was recognized a critical site in providing assistance to employees who are also care givers. It was, therefore, recommended that through employment and personnel policies, governments, NGOs, and in particular the private sector (employers), should assist care givers in their efforts to care for family members. Family friendly and gender-sensitive workplace policies aimed at reconciling work and care giving for both men and women carers should include: - improving pay scales in the caring professions (nurses, etc.) as a clear signal regarding the true value of care giving to society; - expanding parental leave to family leave in order to include care for other dependent family members; - enacting policies for equal pay for work of equal value between men and women; - establishing flexible work arrangements; - providing workplace care services for older persons; - providing workplace stress management training for care givers; - enacting policies to reintegrate the carers of older persons into the workforce after a career break; - establishing personal leave policies, (preferably with benefits, such as medical and pension coverage). - urging governments to ratify and implement ILO Convention 156, and Recommendation 165, on Workers with Family Responsibilities. B. Social security 27. The Expert Group Meeting highlighted the importance of social security as a basic form of income security for both care givers and care recipients. It is recommended that governments adopt the following policies: - awarding social security credits to carers for periods devoted to care giving ; - providing equal access to social security and pension systems for women and men; - redressing past pay inequalities to enable women to have access to social security and pension benefits irrespective of their former labour market position; - where appropriate, providing alternatives to formal social security systems, including, the promotion of income generating projects to assist older persons to remain self-sufficient; - providing care givers with options with respect to work and retirement such as flexible, phased and partial retirement programmes. C. Carer support policies through fiscal measures 28. The Expert Group Meeting noted that many governments provide assistance to care givers through fiscal policies - and in particular through tax credits. However, in many cases, "dependents" are only recognized to be children. Therefore, the Meeting recommended that governments should: - expand tax deductions for carers by expanding the dependent category from child care to "dependent care", which would include care for the dependent elderly. D. Community-based services 29. The Meeting noted that the level and quality of community-based services are particularly important in supporting care givers and recipients, and thus allowing older persons to remain in their own homes. The Expert Group Meeting recommended that governments, local authorities and NGOs should: - examine all services to eliminate gender-biases and gender stereotyping (for example, setting different standards of qualification for services between male and female care givers); - include in all programmes and policies the vital aspects of care: physical, psychological, cultural and economical; - provide good quality and gender-sensitive services for dependent older persons as a continuum, from in-home household help to visiting nurses and day care to institutional care; - provide adequate and gender-sensitive services for the care giver, including housekeeping help, respite care, self-help groups, care giving instruction, and specialised counselling.; - ensure that gender-sensitive services reach ethnic minorities, particularly ethnic women; - offer a choice to older persons for care, either in their own home, in the home of a relative or friend, or if necessary and desirable, in an institution. - provide support systems which enable families to continue being care providers for dependent older persons. This may take the form of local, intergenerational community support centres which cater to the needs of both young and old (educational, social, recreational, economic, health etc.); - target and publicize available care services more specifically to reach care givers who are also in paid employment. - provide payments and benefits in cash and/or in-kind to either care givers or receivers in order to ensure choice of services by either party. E. Research 30. As in any policy area, data is vital to successful policy applications. In the case of women and care givers, it was noted that there is often a lack of useful and detailed data. Therefore, in order to better identify and assist care givers, the Meeting recommended that national and international statistical and research institutions, as appropriate, should: - collect gender-specific data regarding employment in both the formal and informal sector, income distribution, participation in decision-making, life expectancy and morbidity, as well as psycho-social well-being; - carry out research to identify the gender differences in care giving and care receiving, and its differential impact on women and men; - conduct research on the value of unpaid care giving work in accordance with the goals and principles stated in the Platform for Action adopted at the Beijing Conference on Women, and reviewing concepts such as productivity and economic activity; - conduct cross-cultural and inter-disciplinary research about holistic care (physical, psychological, cultural and economic) and holistic prevention strategies taking into account the life-span perspective; F. Education and training 31. The Experts recognized that healthy intergenerational and gender relations are a prerequisite for sustainable human development. Therefore, they recommended that governments, intergovernmental and non-governmental organizations, including educational institutions and mass media, should: - sensitize young people to intergenerational values; - build-up and/or support local, regional, national and international networks of older persons in pursuit of the goals of education, training, work and companionship; - facilitate opportunities for gender-sensitive education, work and leisure throughout the entire life span with special attention to mid-life so as to enable individuals to realise their full potential in later years; - organize and/or support training and retraining to involve older persons in the mainstream of society through education, skill development and the introduction to modern and traditional technologies, with special emphasis on enabling women to undertake non traditional work, and men to undertake care giving; - provide public education aimed at awareness raising regarding care giving, its importance to society, and the contribution of women in this area; - support organizations that function at the grassroots community levels and their activities related to education, awareness raising and organization of self-help, focussed on older citizens, their gender-specific needs and contributions to society. The infrastructure of existing groups could be the vehicle for educational programmes; - offer gender sensitive carer training to formal and informal care givers. G. Empowerment 32. The Meeting stressed that the achievement of equality between women and men in all spheres of life, including sharing responsibilities in caring for dependent individuals, is critical not only for their enjoyment of human rights, but also for their well-being and sustainable development of society. Therefore, jointly with civil society, governments should: - enact legislation which ensures that women and men enjoy equal rights and opportunities throughout the life course, including periods of dependency and care giving; - ensure the participation of older persons and their carers in society by promoting autonomy and productivity; - ensure that the rights and needs of care givers are more explicitly recognized and addressed, including those to pursue a career, as well as to receive adequate rest and leisure; - sustain gender equality by sharing responsibilities and opportunities in the various social, political and economic structures of society. Empowerment of women should start as early as possible, including through education; - ensure that governmental and non-governmental organizations, as well as the private sector continue to enable older citizens to participate creatively in the home, society and the economy; - empower older persons who need care, in cooperation with civil society, by ensuring that older dependent persons have access to gender and culture sensitive services that respect their own choices; - ensure that policy makers, service providers and researchers take into consideration the voice of both older persons and their family care givers in designing care-related policies and projects. H. Disease prevention and health of care givers and receivers 33. The Meeting noted that ageing is a life-long process. The disadvantages older women face are rooted in the discrimination they suffered earlier. The health of older women requires specific attention to factors such as prevention and alleviation of chronic disabling diseases. Care giving can have a negative impact upon the emotional and physical well-being of care givers since care giving can be of several years duration, demand many hours per day, and involve considerable physical and emotional strain. It also noted the importance of responsive and adequate policies, legislation and services to protect the health of care givers and receivers. Ultimately, this would be a more cost-effective approach for governments. Therefore, the Meeting recommended that: - to prevent poverty and illness in old age, girls, young and middle-aged women need equal access to education, income, health care and nutrition. The Beijing Platform for Action provides concrete goals and strategies to achieve women's equality in these areas, which should be implemented by governments, international organizations and NGOs; - gender-specific health promotion strategies should be developed by governments and civil society to ensure that the years added to life are disability-free years. Health promotion strategies should include: better nutrition, health checks, exercise programmes and information on healthier lifestyles. - the health of older women, as (both care givers and care receivers, should receive more attention in preventing, postponing, and alleviating both acute and chronic health problems; - care giving households should receive more community-based health care, including rehabilitation treatment, especially since older women and men are being discharged from hospital quicker and sicker; - the living environment of dependent older women and men should be improved in order to support activities of daily living and care in the home. ANNEX 1 Papers Experts EGM/COP/1977/EP.1 Ms. Marie-Jo Guisset - Caregiving and Older Persons: Gender Dimensions EGM/COP/1997/EP.2 Dr. Kathleen Hall - Caring for the Elderly. The Family and Policy Perspectives in Study Sites of the Indiana University Comparative Epidemiological Studies Group EGM/COP/1997/EP.3 Ms. Lilian Mapati - Caregiving for Older Persons: Gender Dimensions EGM/COP/1997/EP.4 Dr. Tan Poo Chang - Caregiving in Asia: The Need for Community Support EGM/COP/1997/EP.5 Dr. Elisa Dulcey-Ruiz - Caregiving for Older Persons: Gender Dimensions EGM/COP/1997/EP.6 Dr. Judith Healy - Is Community Care in the UK "Family Friendly"? EGM/COP/1997/EP.7 Dr. Hana Hermanova - Caregiving and Older Persons; Gender Perspectives with Main Focus on Older Women's Health EGM/COP/1997/EP.8 Dr. Ella Libanova - The Demographic Crisis and Social and Economic Problems of Ukrainian Pensioners EGM/COP/1997/EP.9 Ms. Irene Hoskins - Gender Equality and Elder Care: International Instruments and Perspectives for NGO Advocacy United Nations Secretariat EGM/COP/1997/BP.1 United Nations Division for the Advancement of Women - Older Women and Support Systems: New Challenges EGM/COP/1997/BP.2 United Nations Programme on Ageing - Background Paper International Institute on Ageing, Malta EGM/COP/1997/EP.10 Dr. James Calleja and Dr. Maja Miljanic Brinkworth - A Gender Perspective on Ageing. Eight Propositions for the 21st Century ANNEX 2 List of Participants Experts Ms. Marie-Jo Guisset (France) Fondation de France 40, avenue Hoche 75008 Paris, France Dr. Kathleen S. Hall (USA) Assistant Professor of Psychiatry Department of Psychiatry Indiana University 541 Clinical Drive, Suite 395 Indianapolis, IN 46202-5111 Dr. Judith M. Healy (Australia) Programme Director Policy Studies Institute 100 Park Village East London, NW1 3SR, United Kingdom Dr. Hana Hermanova (Czech Republic) Director Center on Aging West Virginia University Robert C. Byrd Health Sciences Center 3408 Health Sciences South PO Box 9123 Morgantown, WV 26506-9123 Ms. Irene Hoskins (USA) American Association of Retired Persons Representative to the United Nations at Geneva 20, Chemin de Valerie 1292 Chambesy, Switzerland Dr. Ella Libanova (Ukraine) Council of Productive Forces Study National Academy of Sciences blvd. Strevichenko 60 Kiev, Ukraine 252032 Ms. Lilian Mapati (Zimbabwe) Training Officer HelpAge Zimbabwe PO Box CY 2032 Causeway Harare, Zimbabwe Professor Tan Poo Chang (Malaysia) Associate Professor Faculty of Economics and Administration University of Malaya 50603 Kuala Lumpur, Malaysia Dr. Elisa Dulcey-Ruiz (Colombia) Directora del Centro de Psicologi'a Calle 62 No 3-58 Apartado 52366 Santafe' de Bogota', D.C. Colombia Observers from Governments Ms. Jane Spiteri Holy See Aposlic Nunzjatore Cor Gesu' Tal-Virtu Rabat, Malta Observers from Non-governmental Organizations Ms. Helen Borg Bonnici Vice Chairman/Co-Coordinator University of the Third Age 31, St. Christopher Street Valletta, Malta Ms. Lina Bugeja National Council for the Elderly 76 Capuchins Street Floriana, Malta Dr. Francis Cachia Flat 4, Block B Perry Courts Birkirkara Road St Julians, SLM 13, Malta Ms. Gilda Estipona Student of Gerontology and Geriatrics Chantilly Court University Street Msida, Malta Mr. Marvin Formosa Senior Technical Officer International Institute on Ageing 117, St. Paul Street Valletta, Malta Ms. Lily Gauci International Confederation of Christian Family Movements Antemma Parish Street Melieha, Malta SPB14 Ms. Amanda Heslop Training and Research Officer HelpAge International 67-74 Saffron Hill London EC1N 8QX, United Kingdom Ms. Marie Lautier Action Committee on Elder Abuse Malta Ms. Josephine Mahoney PRO, National Council for the Elderly 76 Capuchins Street Floriana, Malta Mr. German Montevilla Student in Gerontology and Geriatrics Chantilly Court University Street Msidad, Malta Dr. Leyla Pappalettera Soroptimist International 80 Triq Matty Grima Bormla CSP 09, Malta Ms. Joyce Pullicino President General Catholic Action Catholic Institute Floriana, Malta Ms. Maria Ruggier A/Secretary/PRO University of the Third Age Malta Mr. Ricardo Sandoval Student in Gerontology and Geriatrics Chantilly Court University Street Msida, Malta Dr. Mercedes Schembri Wismayer National Council of Women 25 St. Andrew's Street Valletta, Malta United Nations Secretariat Ms. Brigid Donelan Social Affairs Officer Programme on ageing Division for Social Policy and Development Department for Economic and Social Affairs Room DC2-1330 New York, NY 10017 USA Ms. Dorota Gierycz Officer-in-Charge Gender Analysis Section Division for the Advancement of Women Department of Economic and Social Affairs Room DC2-1230 New York, NY 10017 USA Ms. Christina Janssen Associate Expert Division for the Advancement of Women Gender Analysis Section Department for Economic and Social Affairs Room DC2-1208 New York, NY 10017 USA Ms. Rosemary Lane Associate Social Affairs Officer Programme on ageing Division for Social Policy and Development Department for Economic and Social Affairs Room DC2-1340 New York, NY 10017 USA International Institute on Ageing, Malta Dr. James Calleja Principal Technical Officer International Institute on Ageing 117, St. Paul Street Valletta VLT 07, Malta Ms. Maja Brinkworth Miljanic Advisor Central Office of Statistics Auberge D'Italie Merchants Street Valletta, Malta Representative of Corporate Sponsors Dr. Nina M. Hill Director, Civic Affairs Corporate Affairs Division Pfizer Inc. 235 East 42nd Street New York, NY 10017-5755 USA
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