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Economists have, traditionally, paid little attention to women such as Shireen Luchuk.

A health-care assistant in a Vancouver long-term care residence, she trades in diapers and puréed food for those members of society no longer contributing to the GDP. She produces care, a good that's hard to measure on a ledger. She thinks about cutting her patients' buttered toast the way she would for her own aging parents, and giving a bath tenderly so she doesn't break brittle bones. She often stays past her shift to change one more urine-soaked diaper because otherwise, she says, "I can't sleep at night."

Last week, a resident grabbed her arm so tightly that another care worker had to help free her. She's been bitten, kicked and punched. She continues to provide a stranger's love to people who can't say sorry. This past Monday, as happens sometimes, she did this for 16 straight hours because of a staff shortage.

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But let's not be too hard on those economists. The rest of us don't pay that much attention to workers like Shireen Luchuk either – not, at least, until our families need her. And not until someone like Elizabeth Tracey Mae Wettlaufer is charged with murdering eight residents in an Ontario nursing home. Then we have lots of questions: Who is overseeing the care of our seniors? Are our mothers and fathers safe? Will we be safe, when we end up there?

The question we might try asking is this: If the care that Shireen Luchuk offers is so valuable, why don't we treat it that way?

Dr. Janice Keefe, a professor of family and gerontology at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging, says "the emotion attached to these jobs removes the value."

Caregiving, says Keefe, is seen "as an extension of women's unpaid labour in the home." Those jobs are still overwhelmingly filled by women. And, while times are changing, the work they do is still mostly for women – whether it's the widows needing care who are more likely to outlive their husbands, the working moms who need child care or the adult daughters who are still most likely to carry the burden of aging parents.

Yet it's as if society wants to believe that professional caregivers should do their work out of love and obligation – as if care would be tainted by higher pay and better benefits. That's an argument you never hear for lawyers and accountants. It's certainly not one that Adam Smith, the founding father of political economy, made for the butcher or the baker.

In last year's book, Who Cooked Adam Smith's Dinner?, Swedish writer Katrine Marçal argued that the market, as Smith and his fellow economists conceived it, fails to accept an essential reality: "People are born small, and die fragile." Smith described an economy based on self-interest – the baker makes his bread as tasty as he can, not because he loves bread, but because he has an interest in people buying it. That way he can go to the butcher, and buy meat himself. But Smith missed something important. It wasn't the butcher who actually put the dinner on his table each night, as Marçal points out. It was his devoted mother, who ran Smith's household for him until the day she died.

Today, she'd likely be busy with her own job. But care – the invisible labour that made life possible for the butcher and the baker (and the lawyer and the accountant) – still has to be provided by someone. Society would like that someone to be increasingly qualified, regulated and dedicated, all for what's often exhausting, even dangerous, shift work, a few dollars above minimum wage. One side effect of low-paying, low-status work is that it tends to come with less oversight, and lower skills and standards. That's hardly a safe bar for seniors in residential long-term care, let alone those hoping to spend their last days being tended to in the privacy of their homes. We get the care we pay for.

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It's not much better on the other end of the life cycle, where staff at daycares also receive low wages for long days, leading to high turnover. "I am worth more than $12 an hour," says Regan Breadmore, a trained early-childhood educator with 20 years experience. But when her daycare closed, and she went looking for work, that's the pay she was offered. She has now, at 43, returned to school to start a new career. "I loved looking after the kids. It's a really important job – you are leaving your infants with us, we are getting your children ready to go to school," she says. But if her daughter wanted to follow in her footsteps, "I would tell her no, just because of the lack of respect."

It's not hard to see where this is going. Young, educated women are not going to aspire to jobs with poor compensation and even less prestige. Young men aren't yet racing to fill them. Families are smaller. Everyone is working. Unlike Adam Smith, we can't all count on mom (or a daughter, or son) to be around to take care of us. Who is going to fill the gaps to provide loving labour to all those baby boomers about to age out of the economy?

Right now, the solution is immigrant women, who, especially outside of the public system, can be paid a few dollars above minimum wage. That's not giving care fair value. It's transferring it to an underclass of working-poor women. And it doesn't ensure a skilled, caregiving workforce – all the while, as nurses and care assistants will point out, the care itself is becoming more complex, with dementia, mental illness and other ailments.

Ideally, in the future, we'll all live blissfully into old age. But you might need your diaper changed by a stranger some day. Maybe robots can do the job by then. Rest assured, you'll still want someone like Shireen Luchuk to greet you by name in the morning, to pay attention to whether you finish your mashed-up carrots. When she's holding your hand, she will seem like the economy's most valuable worker. Let's hope enough people like her still want the job.

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