A 2023 Swedish study looked at older parents who were receiving support and asked what role their adult children played.

34% of those adult children were identified as providing care according to the study's definition.

Which means 66% weren't.

But did that necessarily mean they weren't actually caring?

When we asked Isabelle von Saenger, a postdoctoral researcher at the Aging Research Center (ARC), Karolinska Institutet and Stockholm University about that larger group, she pointed us towards something interesting.

Emotional support and social contact, she explained, are not always captured by measures of informal care, particularly those focusing on practical caregiving. Social contact, emotional support and practical caregiving are different things, although they can overlap.

That made us wonder:

What actually counts as care?

We decided to follow the question a little further.

What we can count

Practical care is relatively easy to comprehend, document and quantify:

• Shopping and cooking

• Cleaning and transport

• Appointments and medication

• Medical attention and personal care

And increasingly, technology is becoming extraordinarily good at supporting many of these needs. Sensors can detect falls. Medication can be monitored. Health data shared. Appointments coordinated. Homes adapted. Services delivered remotely.

The technology is becoming eye-wateringly impressive. As more care moves into the home, technology will play an increasingly important role in making that possible. And rightly so.

But perhaps there's another side of caring that is much harder to design around, because it is much harder to see, never mind measure.

What we can't easily count

What if some of the most important forms of caring are the hardest ones to measure?

• Devotion

• Meaningful involvement

• Being known by someone who matters

• Feeling that your daughter is still part of your life

Shopping, visits, hours of caregiving, even phone calls can all be documented.

But what those things actually mean to the person experiencing them is much harder to register.

Two daughters might each call their mother several times a week.

One makes hurried but important calls, organising this or that for her mother. The other listens, laughs, remembers and knows from the sound of her mother's voice when something isn't quite right.

Yet the data may record exactly the same thing:

Several phone calls.

But the care being experienced may be completely different.

If we're designing around what's being done and what can be measured, maybe we also need to ask: what is being felt?

Perhaps the 66% are caring differently

Other SWEOLD data Isabelle shared with us show that social contact between older parents and their adult children, both in person and remotely, is common.

That doesn't tell us what those relationships mean. Frequency isn't the same thing as closeness, and social contact isn't the same thing as practical caregiving.

But it does make the original 66% worth thinking about differently.

Perhaps they weren't necessarily absent.

Perhaps some of them were caring differently.

And importantly, that doesn't mean we should find ways to turn the 66% into the 34%.

Perhaps we should be asking whether there is a meaningful role people can play, without necessarily becoming practical carers.

It matters who

Talk to people involved in caring for older people and a remarkably simple observation keeps appearing.

However good the care, however attentive the service, sometimes what people want is something so simple and meaningful that no care system can provide it:

I want to talk to someone I love.

Not simply someone to talk to, but someone who matters to them. A son, a daughter, even an old friend. Someone who knows them.

Someone with whom they share a history. Someone who notices when they don't sound quite right.

Someone who isn't there because caring for them is their job.

A robot might eventually shop, cook, clean, monitor medication and detect a fall. AI might coordinate virtually everything else.

But neither can substitute for a relationship that matters.

The burden paradox

There is another side to this.

Caring differently doesn't necessarily mean caring less.

A daughter living hundreds of kilometres away may provide none of the practical care we can easily see, while still carrying the worry.

Has Mum eaten? Did she take her medication? Why hasn't she answered? Is somebody checking on her?

Practical care has a workload. Emotional care can carry a load too.

And therein lies a paradox.

The forms of caring that are hardest to see and measure may also be the ones whose burden is easiest to overlook.

For us, the 66% therefore raises two questions, not one.

What might they still be giving?

And what might that giving still be costing them?

The missing inequality

And then there are those for whom nobody is making those calls.

Some people have children nearby. Others have children abroad. Some have partners, friends, neighbours and strong social networks.

Others have very few meaningful relationships at all.

What about the lifelong single person? The older person without children?

As technology becomes increasingly capable of providing physical safety and practical support, what happens if much of the emotional infrastructure surrounding life at home still depends upon relationships that some people simply don't have?

Some can pay for companionship and additional support.

Others can't.

Two people might therefore receive exactly the same formal care at home while experiencing completely different lives.

Equal provision doesn't necessarily mean equal capacity to live well at home.

Caring in Place

Perhaps this is where Caring in Place becomes different from simply delivering more care into the home.

Ageing in Place asks how we enable someone to remain safely and independently where they live.

Caring in Place might ask something more:

What does someone need for that place to remain home?

Safety matters. Independence matters. Practical care matters.

But so might being known. Being remembered. Remaining involved in other people's lives. Having somebody who notices when something isn't quite right.

Technology could have an extraordinary role in helping protect that human connection.

Not necessarily by replacing human caring, but by absorbing more of the exhausting coordination, administration and practical burden surrounding it.

Giving people some of their time, attention and energy back.

Allowing a daughter to remain a daughter.

A son to remain a son.

A friend to remain a friend.

Perhaps we've been asking:

How much more practical care can technology provide, automate or completely replace?

When another question might be far more impactful:

How could technology make it easier for more of us to remain meaningfully involved in the lives of the people we care about?

Even when we can't be there.

Research informing this Perspective

von Saenger, I., Dahlberg, L., Augustsson, E., Fritzell, J. & Lennartsson, C. (2023). Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden. European Journal of Ageing, 20, 28. DOI: 10.1007/s10433-023-00755-0.

This Perspective also draws on correspondence with Dr Isabelle von Saenger at the Aging Research Center (ARC), Karolinska Institutet and Stockholm University, and on additional SWEOLD data concerning older parents' social contact with their adult children.