Involuntary dedication? Continuing home help work for older people in France at the start of the Covid-19 pandemic

1 Introduction

The Covid-19 pandemic and the policies adopted to respond to it had unequal effects on individuals depending on their class, position in the labour market (Bruckmeier et al. 2022), gender and migration status (Rubery/Tavora 2020). Sociological analyses of the impact of the 2020 Covid-19 crisis on work have highlighted the spread of teleworking, its role as a protection against the virus and as a ‘privilege’ reserved for managers and intermediate professions, but also its negative impact on the division of domestic and parenting tasks between men and women (Dunatchik et al. 2021; Cayouette-Remblière et al. 2021; Augustine/Prickett 2022). In contrast, working on site and in contact with the virus was mainly the situation for low-wage employees working in different sectors (Loustaunau et al. 2021, Gardes 2022). Female employees were more affected than male blue-collar workers (Cardon/Machu 2021): these women, the majority of whom were employed to care for and support vulnerable people in institutions and at home, ‘sacrificed’ themselves and showed ‘dedication’ during the lockdown in the sense that by continuing to work they took the risk of contracting the Covid-19 virus, putting the interests of the vulnerable people they cared for before their own health (Rubery/Tavora 2020; Van Hooren 2020; Daly et al. 2022; Guiraudon et al. 2024). The sociology of inequalities and relations of domination, which view the health crisis primarily as an accelerator of pre-existing inequalities, highlights the disadvantage suffered by lower-level employees during the pandemic. Following the example of Anglo-Saxon research affirming that in the United States most low-wage workers “had no choice other than to be essential and precarious and continue to work” (Loustaunau et al. 2021: 871), research on France suggests that for men and women who continued to work – in transport, warehouses, supermarkets, factories, in the homes of older people and in hospitals – leaving their homes was an “obligation” (Cayouette-Remblière et al. 2021: 84); “their sacrifice […] was probably not voluntary” (Gardes 2022: 18). Did these men and women not have the choice to continue working and did they do so against their will? Asking this question gives rise to four hypotheses. The first is that the effects of the health crisis on the work of low-paid workers depend on the national socio-political context, i. e. not only on the political responses to the crisis from March 2020 onwards but also on the existing structures of the social state (Béland et al. 2021). The second is that the sector of activity matters: the conditions for ensuring continuity of work in supermarkets, in hospitals or in the homes of older people may have been different. The nature of public intervention in the sector must also be taken into account. The third hypothesis is that subaltern workers’ relationship with work, “i. e. the perception they have of it and the meaning they give to it” (Avril et al. 2010, 18), is not given in advance. The fourth hypothesis is that the health crisis, with the disorganization and uncertainties it engendered, may have modified the forms of work management and the power relations that shape it (Didry 2023). Only an empirical investigation of both the prescriptions issued at the various levels of work management and the reactions of employees can settle the question of the nature of their consent to continue working during the pandemic. This article addresses this issue by focusing on a profession which, with its large and growing workforce, is a central component of the contemporary working classes in France and elsewhere in Europe (Masclet et al. 2023) and plays an important role in contemporary welfare states: home help workers for older people, known as “aides à domicile” in France, doing both home care and housework.

In a demographic context of an ageing population, there are currently 600 000 home helpers in France, which represents almost one in eight ‘low-skilled’ jobs (Devetter et al. 2023). These workers helping older people in their everyday life at home are almost exclusively women and their working conditions are highly precarious. They are only paid part-time wages for the hours they work despite being away from their own homes all day, and their schedule and income are irregular and unpredictable. Because of fiscal arrangement allowing older people to benefit from tax credits, these aides for older adults are less likely to be in the informal sector in France than elsewhere in Europe. Both trade unions and employers in the three main sub-sectors of home care and housework are fragmented, but the social partners have negotiated collective agreements which have been extended to include nearly all declared domestic and care workers who are not civil servants. These collective agreements have introduced minimum rights, regulations and protection for the aides for older people where previously there were none (Ledoux/Krupka 2021).^[1] Even if the question of the shortage of this female workforce and the acknowledgement of its value and work remains unanswered in France – especially for the aides directly employed by private domestic employers – it is the only country in Europe where a wide range of home care and housework employees are covered by binding collective agreements.

For the sociology of working-class women’s work, dedication is not just an act of self-sacrifice for others. Insofar as it tends to characterize the work of women engaged in the difficult activities of maintaining the lives of vulnerable people, it is a gendered social norm (Avril 2014), or, from the perspective of the structural sociology of gender, a disposition, i. e. an internalized constraint produced by family and school socialization (Skeggs 1997). The discussion in this article is not about the reality of the dedication of homecare workers to older people during the pandemic. The research cited above has already made this clear: by exposing themselves more than the middle and upper classes to infection by the virus, just like the other low-paid workers who continued to work on site, these women devoted themselves to their work. Nor is there any discussion of the origins or reasons for this dedication. The history and sociology of women’s work, whether they consider this dedication a norm or a gendered disposition, have already addressed the issue (Sarti et al. 2018). This article is therefore not concerned with the reality or the origins of this dedication, but only with the context and state of mind in which home help workers for older adults dedicated themselves to their work in France at the start of the pandemic.

We are studying home helps for older adults at the level of a French administrative Département located in the west of France, the Loire-Atlantique, in order to understand the continuation of their work in spring 2020 in its context as the product of the interaction of the various norms and categories that govern ‘social care’. These include ‘institutional categories’ (directives from the Ministry of Solidarity and Health, labour law, etc.), ‘categories of intermediation’ (produced in the implementation of public action by Départemental actors) and ‘categories of practice’: those directly produced by the employees themselves in their interactions with their managers and service users (Ledoux et al. 2023). This article aims so to demonstrate the benefit of a sociology of work that considers the historicity, context and materiality of state interventions in care work (Avril/Cartier 2019). In line with a theoretical perspective that considers work and workers to be both the product of interactions and power relations played out inside and outside the workplace (Avril et al. 2010), it warns against a mechanical and atemporal use of habitus theory, according to which in all circumstances low-level employees make a virtue out of necessity (Bourdieu 1984). It defends the idea that a large proportion of the women who continued to work as home helps for older adults at the beginning of the pandemic in France did not do so out of necessity, but out of virtue.

Our methodological approach combines in-depth interviews and the examination of professional documents. In order to meet homecare workers, we contacted the heads of several service providers, who also shared their experiences of the health crisis. The disorganization in the sector due in part to staff turnover and overworked managers made it drawn-out and difficult to be put in contact with home helpers. We also used personal contacts and trade union networks. We were careful to diversify the profile of the home helpers we met, regarding the status of their employer (non-profit, for-profit, private), the area where they worked (urban or suburban setting), their closeness or distance from trade unions. We finally conducted 29 face-to-face interviews lasting between one and two hours between October 2021 and July 2023.^[2] All of these interviews were transcribed. This corpus includes a group interview involving four colleagues working in the same association. Most of the interviewees were care assistants, and more rarely domestic helpers. They were mainly employed by non-profit organizations and private family employers, and more rarely by for-profit service providers. They worked mainly part-time. We also interviewed the employers or employer’s representatives of eight of the workers interviewed, and the head of the autonomy office of the Loire-Atlantique Département. To supplement these retrospective interviews on the health crisis, we tracked down written sources from within the organizations. In particular, the heads of the Département’s Autonomy office provided us with information bulletins (concerning health instructions and rules to be put in place) sent to homecare services during the health crisis. Exchanges of emails and national health protocols were also retrieved. These written sources enabled us to reconstruct the chronology of the national and local responses to the pandemic.

By examining the time frame in which the institutional prescriptions and their content were disseminated, we firstly show that the continuity of care for dependent older people was implemented autonomously by the Départmental actor in close consultation with the representatives of the home help services (section 2). Secondly, by focusing on the professional exchanges within care services between managers and home helps and between the latter and older people, we show that some of them devoted themselves to their work thoughtfully and voluntarily (section 3).

2 Continuity of home help for older people: a Départemental initiative rather than a State one

In France, between 17 March and 11 May 2020, the State suspended public freedoms by issuing a stay at home order, except for exceptional reasons controlled by the police. This nationally imposed lockdown, which set France apart from other European countries, attracted the attention of political science researchers, who highlighted a “state-centric” context (Bergeron et al. 2020) and an extension of state constraint and police control (Boulakia/Mariot 2023). Research in the sociology of work on the various economic sectors in which activity continued, focusing not just on the lockdown but on the health crisis as a whole, helps to qualify this thesis of vertical management of the health crisis by showing how, in a context of great uncertainty, health rules were negotiated with social partners within the framework of wage-earning institutions (Gardes 2022; Didry 2023). In the sector of help for older adults, which is usually the subject of a decentralized policy at the level of the Départements, it was these local players, and not the State, who, in cooperation with home help services, decided on continuing help. At the start of this first wave of the pandemic, there was no written document explicitly stating that home help activities could or should continue. “Assistance to vulnerable persons” appears as an acceptable justification to travel in the general travel authorization introduced by the decree of 16 March 2020. When lockdown was introduced on 16 March, homecare workers were initially overlooked in terms of their right of access to masks, which were in short supply at the time, but they were soon added to the list of priority professions (Guiraudon et al. 2024). It was not until 26 March 2020 that the Ministry of Solidarity and Health explicitly invited the Départements to step up home help services.^[3] It was noted that the masks were intended for homecare professionals working on “essential acts of daily living with the most vulnerable (older and disabled people)” to enable them to carry out “priority” visits that “homecare services must identify”.^[4] But by 26 March, many Départements and home help service providers had already identified these “priority” interventions and were ensuring their continuity without having any personal protective equipment. Therefore, the Ministry was merely securing continuity that had been organized ‘from below’, by the help services and families. The existence of regular exchanges of information between the General Direction for Social Cohesion and the organizations representing personal services was emphasized by a member of one of these organizations. This work of communication carried out by a central administration also helped to avoid the vertical imposition of maintaining continuity in home help. But the fact that it took around ten days for the government directives to be drawn up meant that both the Départements and the home helps for older adults were initially placed in a situation of uncertainty and relative autonomy, in other words that they were first required to draw up the rules themselves.

Even though the lack of masks for homecare workers was criticized in the local press and by institutions and the general public, the continuity of service was easily maintained in Loire-Atlantique. It should be remembered that at the time, the Loire-Atlantique region was characterized by a low incidence of the disease and low infection rates, only becoming a ‘high-risk area’ from 24 March onwards.^[5] There was no union or media mobilization in favour of the right of home helpers to withdraw from work in Loire-Atlantique.^[6] The person in charge of monitoring home help services recalls a situation in which the Département had “no instructions”.

So at the very beginning it was centred around the institutions, the protocols we received. But it wasn’t adapted to the home. The Agence Régionale de Santé knows little about the home, except for home nursing services. Home help and support services, all the professionals working in the home, well … We were waiting for instructions. In the Ministry’s first instructions, we were somewhat forgotten.

On 16 March 2020, the Département wrote to home help services to point out that the announcement of the closure of all nurseries and schools and all shops except pharmacies, food shops, tobacconists and banks could “increase the difficulties faced by home help and support services in ensuring the continuity of services for frail people in their own homes”. As a result, the ‘continuity’ of these services was already effective in this Département. The Département provided a detailed definition of “priority interventions for the most dependent and isolated people”, based on the assistance plans set up under the APA.^[7] These were activities “linked to human assistance”: getting up and going to bed, toileting, particularly in the case of incontinence, meals (stimulation, preparation, etc.). In practical terms, this meant that all housework tasks could be interrupted. The autonomous and proactive attitude of the Loire-Atlantique Département in favour of maintaining continuity of service stands out in comparison with the choice made by other Départements to initially suspend all activities, whether housework or personal assistance.

These words from a manager at a non-profit provider organization (ADPR^[8]) confirm the early involvement of this Département in establishing partial continuity of work centred on assistance for dependent people, ten days before the Ministry of Solidarity and Health issued directives to the Départements on this subject.

We’ve been requisitioned – well, requisitioned may not be the right legal term, but in any case that’s exactly what it was like. We were requisitioned by the Département, which told us: “The fear, if you like, is that we, homecare services, could be vectors of the virus. That’s fine. So you’re kicking out all the service users who don’t have priority”.

The director of another non-profit organization (ADOM) also recalls a logic of anticipation and autonomy and mentions with disapproval the decision taken by another non-profit organization to suspend all its activities. He states that he spoke with his employees after the announcement of the closure of the schools on Thursday 12 March 2020 in order to “ensure continuity of service”. He explains that he decided “on his own initiative”, on Monday 16 March, to suspend non-essential activities and maintain the others. On 16 March, the Département confirmed that work should continue on “priority” or “essential” interventions. Then, after a few days, the definition of ‘priority’ was revised and extended, in line with “feedback” from the home help provider organizations, with which the Département in turn organized very regular exchanges by videoconferencing.

Home help is a complex activity in which the boundary between what is ‘essential’ and what is ‘comfortable’ is far from objective and stable, and is subject to varying interpretations depending on care workers’ relationship to their work. While ‘housework’ was categorized as ‘non-essential’ by national actors and distant observers, its social dimension is known to home help workers and the managers who organize their work: for isolated people, often suffering from cognitive problems, housework can be an essential form of support and reference point. In response to this feedback from the field, on 20 March, four days after the lockdown came into force, the Département sent an email to all home help and support services: if “the person is isolated”, “shopping and household help” were added to the list of “priority interventions”. Then, in Information Letter No. 3 of 1 April 2020, once again at the request of certain assistance services that had noted the delicate situations in which some older or disabled people found themselves, services such as laundry and sanitary maintenance were authorized “on an exceptional basis”. The definition of ‘priority’ was therefore very quickly extended to household activities whose definition was left to the services and employees closest to the service users and their homes. Figures published in the local press on 23 March 2020 attest to the effectiveness of this partial continuity of work by home help services.^[9] On 27 March, ADPR made known the “anguish” but also the “motivation” of its employees: out of 1500, only 91 were off work, including 88 for childcare.^[10] According to national data, 83 % of homecare assistants directly employed by older people continued to work during the initial lockdown.^[11] However, the drop in activity was more marked in north-eastern France, an area hardest hit by the pandemic with more cases of Covid-19 and work interruptions among homecare workers.^[12] The context in which the continuity of home help for older adults was implemented in France in March 2020 is marked by the absence of prescriptions from the national level. In Loire-Atlantique, it was the Département that took the initiative, based on a relatively horizontal exchange with the home help services and their employees, marked by listening and taking “feedback from the field” into account. But how did the home helps themselves continue to work? Did they respond to their employers’ orders, and with what feelings and thoughts?

3 Home carers continuing to work during the pandemic: a more conscious dedication than usual

Although the homecare workers in Loire-Atlantique did not continue to work in March 2020 because government directives required them to do so, neither did they submit to the injunctions of their managers. Firstly, they could legally and factually stop working. Secondly, they had to cope with the fear of being infected.

4 Conclusion

Analysis of the Covid-19 health crisis as exacerbating socio-professional inequalities highlights the fact that low-paid workers were more exposed to the virus because they continued to work on site, while managers and intermediate professions were protected by teleworking. This inequality in the face of the crisis, brought to light by a statistical and structural approach, is an established fact. But to deduce from it that in March 2020 subaltern employees were obliged to continue working or that their sacrifice was ‘not voluntary’ seems questionable, at least when it comes to home helps for older people in France. By accurately reconstructing the context in which these women continued to work in a region of western France, we have highlighted the absence of government prescriptions and the relative autonomy in which the Département, the help and support services and their employees found themselves in March 2020. Information on the right to withdraw from work was also disseminated in the collective services, and the possibility of stopping work without loss of pay was a real possibility thanks to the protection afforded by salary status and the suspension of non-essential tasks. A study of the words and feelings that accompanied the continuity of help for vulnerable older people, both on the part of managers of collective structures and private employers, and on the part of the home helpers themselves, has revealed the existence among most home helpers of reflection, negotiations and moral dramatization. They continued to work, sometimes with an explicit sense of ‘choosing’ to do so, sometimes more with a sense of inner obligation, but always of their own free will and in a more thoughtful way than usual, putting their own health on the one hand, and the lives of the older people they cared for on the other, up for discussion and reflection. Their dedication during the pandemic is the result of a difficult decision taken in a situation where they could legally and in reality stop working, and where they were in fear of contracting Covid-19. Identifying this dynamic of voluntary dedication in the first few weeks of the pandemic helps us to better understand the dissatisfaction that later arose among some home carers who felt that the financial recognition they received through bonuses and pay rises in the non-profit organizations was not commensurate with the efforts they had made. To ignore this moral dedication, to make it disappear behind the idea that these women only responded to an external injunction, would be like depriving them of an autonomy which they are all the more keen to preserve in their field of work and personal values because they are partly deprived of it, legally and professionally, by the fact that they are subordinate employees.

Focusing on a specific service activity and on the Loire-Atlantique Département, this article does not settle the question of subaltern employees’ willingness to continue working during the pandemic in general. Further research would be needed to determine how employees in hospitals, warehouses and hypermarkets continued to work. However, two general observations can be made. Firstly, from the point of view of the sociology of the health crisis, this article shows that in March 2020 in France, the continuity of care for dependent older people living at home was ensured ‘from below’: it was not thought out, anticipated or prescribed by the State but rather by the employees in the sector themselves, in interaction with their managers and the Départements. Secondly, it reminds us of the need for the sociology of work to take seriously the relationship to work of the men and women who carry out objectively arduous and poorly recognized activities. This relationship to work cannot be mechanically deduced from their devalued professional position and considered in advance as disinvested, or devoid of meaning, values and valuations. On the contrary, in the lives of both men and women in which paid work plays a central role, depending on the context and the social and professional trajectories, this subaltern work can be invested with positive commitments and values through which these men and women express their will and their autonomy, and assert themselves as subjects.