Straddling the care gap: Why Christians must think beyond self-sacrifice to support caregivers

Elizabeth Hinson-Hasty explores the contemporary context of caregiving and how the church can support caregivers.

Carmen Romero is in her late 40s. Her day begins before the sun rises as she makes lunches for her three children to take to school. They range in age from 9 to 15 years old. After everyone quickly changes from pajamas into school and work clothes and then scarfs down some breakfast, Carmen walks the two youngest to the bus stop. Her oldest son waits at home alone for the carpool ride.

Carmen’s paid workday begins once the kids are all safely on their way to school. She heads early to the local community college office where she serves as an executive assistant. Fortunately, her employer allows her hours to be flexible enough to leave before 5 p.m. on some days or to work from her computer at home.

The caregiving responsibilities of this single parent extend beyond the needs of her kids. She also assists her mother, who is now in her 70s and trying to live independently as long as she can. Flextime, finding time, multitasking and stretching household income all help to ensure this family’s survival. Squeezing extra minutes into Carmen’s daily schedule provides her time to take turns as the carpool driver, help her mother go to appointments and make calls to address her health needs, and sometimes deal with family emergencies. The family responsibilities that Carmen shoulders leave her little time to care for herself or to be involved in church or
other organizations.

You may identify with Carmen’s story. She is among the millions of people today in the United States – most of them women – who are straddling the care gap. According to a 2015 joint report of the National Alliance for Caregiving and the AARP Public Policy Institute, about 43.5 million U.S. adults are providing unpaid care for another adult or child. That number, documented before the pandemic, represents about 13% of the U.S. population.

To remain efficient and maximize productivity and profits, our society, institutions, healthcare system and places of employment rely heavily on the unpaid labor of many caregivers for children, for people with mental and physical impairments, for elderly family members and for others. The unpaid work of caring for family members and other dependents often requires these caregivers to have one foot firmly in the paid working world while keeping another grounded in the undervalued economy of care.

The stories of these caregivers bear similarities with the biblical story of Ruth, as they step into their own place of vulnerability, embodying lovingkindness. At the same time, the larger contemporary context of social, economic and political power relations in which caregivers act is quite distinct from the realities of the ancient world. Carmen’s story and my own experiences of straddling the care gap – working fulltime as a professor, raising children, helping a family member with disabilities and taking care of aging parents and other family members – led me to reflect upon Christian teachings about dutiful love or self-sacrificial love and how we live them out in the current context.

In 2020, the National Alliance for Caregiving and AARP Public Policy Institute asked a group of caregivers what made them take on the responsibility of caregiving. Over half of the respondents said they felt they had no other choice. These feelings emerge from the fear that our social safety nets are far too worn or loosely woven to support our family members, from the worry that our loved ones will be left vulnerable and at risk, and from our sense of dutiful or self-sacrificial love. Many Christians, particularly women, have been shaped and formed to understand that the extent of our giving, even at a cost to ourselves, measures the depth of our love for others. But do the ways we speak, preach and model dutiful or self-sacrificial love in churches today capture the lived reality of people’s lives, particularly of those who are straddling the care gap?

Care’s contemporary context 

Maybe you noticed the point I made earlier that most U.S. caregivers – two-thirds, or 66% – are women, according to the CDC. Studies show that women across the world spend an average of four and a half hours a day doing unpaid work, compared to slightly more than two hours a day spent by men. Caregiving is stressful, demands multitasking and makes a life-sustaining contribution both socially and financially to people whom we love. It can also come at a cost to the caregiver. Unpaid adult caregivers tend to complete fewer years of education, are twice as likely to be unemployed and experience greater psychological distress.

Women also make up the majority of the healthcare and social workforce. According to a 2019 report from the Organisation for Economic Co-operation and Development (OECD), two out of three paid healthcare and social workers are also women. Even well-educated women in the care industry report higher rates of poverty than do their male peers, and these jobs can have their own significant financial and health risks.

Elder care is one aspect of the economy that is growing rapidly. By 2024, the U.S. Department of Labor estimates that 1.6 million jobs will be added in this field. Although more men are entering the long-term care industry in the United States, women still hold almost 90% of those jobs according to the 2019 OECD report. These jobs often pay an hourly wage that is not high enough to sustain a family. Kaiser Health told The New York Times in November 2021 that “about 70 percent of long-term care workers earn less than $30,000 a year … and they are more likely to live in poverty.” And although most care workers identify as female and White, according to a 2018 report from the Institute for Women’s Policy Research, the greatest growth in the caregiving workforce between 2005 and 2015 occurred among workers identifying as Latinx or Hispanic (growing more than five times as much as White workers) and multiracial (growing six times as much).

Experiences of people straddling the care gap reflect the growing wealth divide in our nation. Those with significant wealth and access to health insurance can hire, pay or use benefits to employ caregivers outside their family to assist them. Many relying upon subsidies are caught in the care gap. And many others lack access to health insurance and simply don’t have the financial means to hire caregivers who are not family members. Family caregivers then are forced to become master multitaskers and work harder and harder to provide for all the people who depend upon them.

Let me be clear. It isn’t that family caregivers don’t want to help or express their love for family members in this way. The issue is balancing capacity in relation to the need.

The story Nitzia Chama told NPR in March 2019 also captured my attention. Chama immigrated to the United States from Mexico. She came pursuing her dream of becoming an actress. Soon after arriving she was called upon to care for her grandparents, both of whom had significant health issues. Despite the amount of work she has to do and all that she sacrifices, NPR says, Chama doesn’t consider caregiving a burden: she “considers it to be the right thing to do.”

The NPR story adds that on average, “AARP reports Latinx millennials clock in an average of 42 hours a week compared to 36 hours by other millennial caregivers. This is in addition to the full time jobs many already have.” These family caregivers and many others across the United States are stretched too thin. They need greater support and much more tightly woven social safety nets to ensure that no one is placed
at risk.

Proclaiming self-giving and life-restoring love

Churches embody Christ’s love in the world. Christian theologians, religious leaders and people in the pews can lift up models of self-giving love that are empowering and life-restoring for caregivers who are straddling the care gap. Doing so requires us to consider seriously the context in which caregivers act today.

Jesus proclaims that the greatest commandment in the Torah is “‘You must love the Lord your God with all your heart, with all your being, and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘You must love your neighbor as you love yourself.’ All the Law and the Prophets depend on these two commands” (Matthew 22:37-40). Jesus’ teaching balances love of neighbor and love of self; he emphasizes self-giving and mutuality.

The reality is that our humanity and provisioning for life depend upon self-giving love and reciprocity — other people and the planet giving to us and us giving to others and taking care of the earth itself. If people in need of support and their caregivers are put at risk in our society, then we must realize that our community as a whole is diminished by their vulnerabilities. Ethicist Barbara Hilkert Andolsen, in a 1981 publication of the Journal of Religious Ethics, suggests that when self-giving love, reciprocity and mutuality are used as norms “for judging public life, it becomes apparent that the structures of society will have to undergo profound change.” The challenge before us now is to envision new ways to support caregivers and their families and to advocate for systems and structures in which all bodies are cared for, loved and sustained.

Self-giving love and reciprocity in action

My most recent book project, Dutiful Love: Empowering Individuals and Families Affected by Serious Mental Illness, explores Christian ideas of self-sacrificial love and caregiving as they relate specifically to the lives of families affected by serious mental illness. People with serious mental illness are among the most marginalized and vulnerable populations in the United States and around the world. To understand the circumstances of these families, I conducted interviews with individuals affected by serious mental illness and their sibling caregivers. Their stories represent the experience of more than 20 families and reveal places where the U.S. social fabric of support for individuals and their family caregivers is worn threadbare or simply nonexistent. Sibling caregivers also shared reflections about times when they felt significant support from churches or other organizations in their local community.

One sibling whom I interviewed chose the name Dorothy to identify herself. After her parents died, Dorothy’s brother moved into her home. Peter had been diagnosed with schizophrenia in his 20s. She couldn’t imagine crafting any other plan to help, but she admitted there was a time in her life when it felt “deeply sacrificial.” Professionally, Dorothy is also a theologian, and she makes theological sense of things by balancing dutiful love or self-sacrificial love with the common good. Dorothy and Peter now choose to live in a small community, where neighbors invite each other into their lives. The whole community recognizes that “it takes a village” for everyone to flourish. Dorothy told me, “Community helps make my care of Peter possible and my ability not to be stopped by other things because of that responsibility.” The “common good” refers to some of the most basic things that we also need to provide to support each other in community: food, shelter, education, roads, electricity and basic conditions needed to exercise our own sense of agency as freely as possible.

We are in a critical time for religious leaders and congregations to support caregivers. The pandemic lays bare far more than our personal human frailties and vulnerabilities; it underscores structural inequalities and systemic injustices between and among close neighbors and nations. In the United States alone, about 800,000 people are currently on waiting lists for subsidized in-home care, according to The New York Times. If family caregivers cannot step in, then they simply struggle alone to find support. So many of the support systems that we all relied upon to function efficiently and effectively in our daily lives are strained or have all but disappeared. The only way we can close the care gap is by vowing to work together and advocate for better public policies to tighten our social safety nets.