“When you are a carer, your personal life takes a back seat. Although you have moments to yourself, the fact is that you spend 90 per cent of the week caring and only 10 per cent of the week is spent on yourself [...]. Our care ends when our loved ones pass away,” explains 58-year-old María Isabel, a civil servant who, together with her sister, has spent the last few years caring for her parents.

First they cared for their father and now they are facing the challenge of caring for their mother, diagnosed with Alzheimer’s disease. María Isabel and her sister battle on a daily basis to do a job that is rarely recognised or receives the support it deserves.

Every day, María Isabel makes an early start, alternating between working from home and at the office. On the days she works from home, she takes care of her mother, who requires constant assistance with tasks such as dressing, toileting and other everyday activities. María Isabel is helped by a cousin, but the routine is still very demanding. Her mother wears thick pyjamas during the winter and nappies to avoid accidents, and her mornings are marked by complaints of pain from a hip fracture she suffered a year ago.

During the day, María Isabel entertains her mother with television and makes sure she has lunch. In the evening, she accompanies and cares for her until bedtime, sleeping alongside her to give her the medication she needs and to take care of her if she wakes up. At weekends, she does the shopping, sharing the chores with her sister. Despite the repetitive routine and the challenge of balancing work and care, María Isabel does her best to ensure her mother’s well-being and comfort, trying to make life as easy as possible for her in her old age.

This day-to-day reality reflects the challenges and lack of support faced by many Chilean families – particularly the women, who make up the bulk of unpaid carers – and these are the needs that the ‘Chile Cuida’ bill seeks to address, with the establishment of a National Care and Support System.

A new proposal underway

The bill presented to Congress in June, which is in its first stage of review and discussion, aims to make care a fundamental right. To achieve this, it proposes the establishment of an integrated system combining public, community and private initiatives, coordinated and regulated by the state. The aim of this system is to provide better quality, more accessible care services and to support the work of carers, especially unpaid carers, the majority of whom are women.

“The initiative sets out to be the fourth pillar of social protection, alongside health, education and pensions. Its scope extends from childhood to old age, promoting autonomy and preventing dependency. It also seeks to expand the provision of public care services, with greater emphasis on community care, shared social and gender responsibility, lightening the disproportionate care burden that falls on women,” Nayareth Quevedo, sub-regional secretary for the Southern Cone at Public Services International (PSI) in Chile, one of the organisations that has closely followed the legislative process and has made recommendations from a trade union perspective, tells Equal Times.

The Covid-19 pandemic uncovered a care crisis in Chile, with almost 1.5 million women absent from the labour market due to care responsibilities in the home, according to the National Statistics Institute (INE). In Chile, as in other countries in the region, care work has historically been hidden and unpaid, falling mainly on women.

A key aspect of the initiative is to recognise and value the work of unpaid carers, such as María Isabel, who dedicate their time to caregiving, without any financial reward.

To support such people, the bill proposes providing access to caregiver support programmes and services primarily designed to help reduce their workload and improve their personal development. It also aims to guarantee the right to decent work opportunities in the labour market, equality and non-discrimination, as well as facilitating free time and access to care training and certification, to enable them to improve their skills and working conditions.

‘Chile Cuida’ is presented as an initiative aimed at establishing a National Care and Support System. This system will not only provide care services but will also protect all carers, be they paid or unpaid, fostering greater equity and respect within society.

As Quevedo points out: “We value the concept of the care economy and how feminists introduced it as a way of giving value to care work, but we also need to progress towards a much broader approach. Care is no longer just a private matter for households, but a much deeper [structural] issue.”

This viewpoint focuses on the need to move towards shared social responsibility for care.

Professionalising and dignifying the sector

Care work, although often associated with domestic and family tasks, is much more present than we think, in hospitals, retirement homes, nurseries and schools, etc., according to the International Labour Organization. This is why ‘Chile Cuida’ focuses on the importance of care work for social wellbeing and promotes collective responsibility for its recognition and support.

According to Quevedo, it is essential to start by improving the working and economic conditions of all carers, paid and unpaid. The bill therefore focuses on professionalising the sector through training and certification. The aim is to raise the quality of care and to turn care work into a career that provides better economic opportunities for all carers.

But the high level of informal employment, which affects over 2.5 million people, according to the INE, and the 8.7 per cent unemployment rate among women, as reported by the Women in Work Index, together with the fact that 71.7 per cent of care work still falls on women, pose a significant challenge, underlining the need for policies that improve not only the quality of care services but also address the inequalities in the sector.

Karen Palma, vice president for Women and Gender Equality at the CUT trade union centre in Chile, is concerned about the gaps in the proposed legislation.

“This is not about replacing state protection, it being understood that we live in a neoliberal system, by training women [carers] and telling them that the problem is theirs now. This is a social responsibility and the state should be involved, training and qualifying, but not supplanting,” she insists.

Palma points out that although the bill proposes compensation for carers it lacks a labour policy. And while professionalisation could open up new job opportunities, it is still unclear how it will impact on the actual working conditions in the sector. For the CUT, the protection of carers’ rights therefore remains a concern.

Quevedo believes that the bill should be seen more as a policy shift than a technical one, as it highlights the need to address inequalities and recognise the diverse realities of workers. “This cannot be solved with a bill, it is much more deep-seated. But I think that we are moving towards putting these matters on the public agenda, getting people talking about them, and that’s important,” she argues.

“A good way to acknowledge the work of [unpaid] carers would be to give them a bonus or compensation that reflects their work,” says María Isabel, expressing her personal view. She argues that even if they care for a relative, like her mother, the state should also take responsibility for this work and, in so doing, dignify those who are providing care, often on their own. Organisations such as the International Trade Union Confederation insist on the need to avoid initiatives that perpetuate the gender division of labour. So, rather than paying out amounts for unpaid carers, it would be better to prioritise policies that invest in public care services that are accessible to all.

Perceptions of care: a cultural challenge

Social perceptions of care remain a challenge. Palma highlights the lack of recognition for care work in Chilean society. ‘‘We are very backward when it comes to care. People do not recognise care work as such. “Women are still responsible for caring for the elderly, for children, for people with disabilities. It’s almost a moral and cultural obligation,” she comments. Despite some progress in “more enlightened sectors”, Palma points out that there are still patterns of behaviour in poorer sections of society that reinforce inequalities and are deeply connected to poverty.

“The project, although focusing on the training of carers, does not address the need for education and awareness raising among the rest of society, which is also going to benefit from it. So, this is where we think trade unions are going to have to play a key role,” says Quevedo, stressing the need for unions and social organisations to play an active role in educating and raising awareness about care.

“Care sustains life and until it is understood that this life support currently falls mainly on women, but that sustaining it should be a responsibility shared by all, it will be impossible to move towards greater justice,” she says.

Palma adds that Chile urgently needs to review its public policies, taking an inclusive approach. There is an absence of “policies designed to address these [structural] inequalities. For example, if you put childcare facilities a considerable distance away, the assumption is that everyone has a car to take their children. This is not the case for people in precarious situations,” she explains. Overcoming this challenge, she cautions, is key to the success of ‘Chile Cuida’, as ignoring the inequalities would limit its impact and reach.

How to stop the commodification of care?

“We are so unused to having our rights guaranteed, because we’ve had to pay for everything, that we’ve ended up commodifying life and rights. So the government is going to struggle to promote these ideas, because people simply don’t understand them,” says Quevedo.

In a country where the free market has taken over public services, Quevedo explains that, for many, the idea of strengthening the sector may seem like a step backwards. The question is, how to stop the commodification of care and its impact on those who provide and receive it?

She explains that if the bill were to close the door on the private sector, it would be rejected. The text establishes that responsibility will be shared by the family, the state, the public sector and the private sector. Quevedo adds that the success of the programme will depend on the government’s ability to coordinate with these sectors and on active monitoring by trade unions and social organisations, to ensure both the quality of the care services and the protection of carers’ rights.

“We have to shake off the myth that we want to eliminate the private sector. We believe in coexistence with the private sector, but with appropriate regulation,” says Palma, who stresses the need for regulation that puts welfare and care before profit-making interests.

Future prospects and challenges

The main question is whether the ‘Chile Cuida’ bill will be signed into law and give rise to a project that will bring about a shift in perspective on care. The Chilean model of a non-interventionist state has, according to the interviewees, led to a considerable lack of protection in the care sector, disproportionately overburdening women and limiting its development.

The government has shown a commitment to decent work and presents itself as the “government of care”, says Palma. But to make real progress, she insists, it must set out clear strategies to improve working conditions in the sector. The policies must reflect the reality of all carers, including their needs and their specific circumstances, she insists.

For her part, María Isabel raises a key concern. “Carers like me are not valued. Policies and laws tend to focus on [health sector and/or paid] care workers, and not those of us who care for our family members at home,” she says. She points out that this lack of recognition reflects a persistent gap in public policy, which often ignores the real needs and challenges faced by those who do this essential work in the domestic realm.

But, more than a conventional proposal, ‘Chile Cuida’ presents itself as a transformative initiative, inspired by the pioneering approach taken in Uruguay, a benchmark for integrated care policies. Although it is still in the legislative phase and faced with the challenge of being passed in a “weakened and fragmented Congress”, its potential to set a significant precedent is remarkable.

If it succeeds, ‘Chile Cuida’ could redefine national policy priorities, placing the well-being and care of all people at the centre of the public agenda.

“It’s going to be difficult, yes, we have a 50/50 split in Parliament. We are going to have to convince not only the right wing about the importance of ensuring that the private sector does not profiteer, but also the extreme right wing, which is opposed to shared responsibility between the family and the state. The extreme right says that responsibility has to be shared within the home, between women: the daughter, the mother, the granddaughter, the niece. So we are going to have two discussions there,” explains Quevedo. She also stresses the need to guarantee appropriate and sufficient funding to ensure that the system is sustainable in the long term.

Nonetheless, “it is a political opportunity for the rest of the region for a country to promote a proposal like this. While it may have its pros and cons, it gives visibility to carers and recognises their role in society,” she concludes.