Not a Nurse, Not Househelp: The New Occupation of Elder Carer in Urban Ghana

As Ghana goes through a demographic transition, in which people are living longer and with long-term, chronic diseases (de-Graft Aikins et al., 2012), families are experiencing a growing strain in caring for their elderly and frail members. Reciprocities across the generations are changing (Aboderin, 2006, Apt, 1996, Dsane, 2013). There is a growing demand for dedicated elder care providers to supplement the direct care provided by kin busy with work and school in Ghana and abroad. Middle-class households in urban and peri-urban areas tend to use the labor of househelp and fostered adolescents for this purpose, while wealthier households and middle-class urban households with access to migrant remittances increasingly turn to carers hired through commercial nursing agencies, who supplement the work of househelp and fostered adolescents and work alongside them in households. Thus, changes in aging in Ghana have generated a new, emergent occupation: the elder carer. Although the occupation is modeled after its counterpart in the United Kingdom and other Western countries, I argue that it is understood in relation and opposition to recognized social roles in Ghana, in particular those of daughter, househelp, and nurse.

Changes in household work often reflect wider social changes. In particular, because household work instantiates the inequality that exists in particular societies (Rollins, 1990), changes in social inequality are reflected in changes in domestic labor. An expansion of wealth or the growth of a wealthy class brings new kinds of servants and new varieties of domestic services (Colen and Sanjek, 1990, Sassen, 1998). In the United States, with increasing income inequality, the growth of commercial elder care services in the past two decades has enabled a re-flourishing of gendered, racial, colonial, and class hierarchies (Glenn, 2010, 1992). In urban Ghana, with a more prosperous middle class after years of strong economic growth (Lopes, 2015), and with remittances flowing from established migrants abroad (Orozco et al., 2005), the new role of carer is a sign of emergent forms of social inequality. Social changes in aging are thus not only resulting in changing intergenerational reciprocities between parents and their children but also creating new hierarchical relations within households. These new hierarchies build on and reconfigure previous hierarchical domestic relations between kin, fictive kin, and non-kin.

Based on ethnographic research and interviews with carers, clients, and nursing agency owners and staff, this paper examines how the young women and men who work in this new occupation are often confused with their adjacent roles—namely, nurses and househelp. These confusions with adjacent roles have repercussions on carers’ status, pay, and treatment in households. As a result, I argue, carers attempt to navigate their status in relation to the adjacent roles: they position themselves as professionals like nurses against the category of househelp through wearing uniforms, sharing biomedical and scientific knowledge, and showcasing their educated status. However, these forms of cultural capital are not always recognized or valued by elderly clients and other household members, including househelp themselves and kin of the client. This paper, by examining a new kind of care worker, explores how new configurations of inequality emerge for young people, within the context of an aging population and changing intergenerational reciprocities.

The Significance of Adjacent Relationships and Cultural Capital in a New Occupation

In earlier work (Coe 2013a, 2012), I discussed the significance of adjacent or contiguous relationships in a social field, in allowing people to change the obligations of relationships in contested situations. In that work, I was particularly interested in how child slavery, child pawning, and fosterage were adjacent relationships in the southeastern Gold Coast in the late nineteenth and early twentieth centuries. Each role was associated with a different status and set of rights in the household economy, but they were similar enough in some of their tasks and norms that participants could define a particular situation differently; they could elide the differences in these relationships. My thinking about adjacent relationships owes much to the work on adoption by Melissa Demian (2004) who insists that “it is frequently difficult to single out an ‘institution’ because...