It is 4.45 in the morning, and Sandra Moreno is already up. She moves quietly, so as not to wake her parents, quickly gets ready, and steps out into the traffic of Bogotá, bound for the adult care centre where she has been working for three years. Although she studied early childhood education, life has taken her in another direction, looking after the elderly, a task she now undertakes with patience and dedication.
Her day begins serving a ‘tinto’ (black coffee) or ‘agua aromática’ (herbal tea) to the residents. “Sometimes they even argue over that,” says Moreno. The hours go by, between the daily routines, exercises, recreational activities and the constant surveillance to prevent any falls or defuse any crises. Many have Alzheimer’s, dementia or depression. Others simply want someone to listen to them.
When her shift ends, Sandra does not rest. Her parents, both elderly and in poor health, are awaiting her at home. She manages their medical appointments, picks up their medication and arranges their tests. “Everything falls on me,” she says. She does not have a car, so taking her parents to their appointments often means paying for taxis. “It’s not easy,” she says.
“It’s as if we were care machines,” she laments. “People forget that we are also human beings, with feelings and needs of our own. Sometimes it feels like I’m working double or even triple shifts.”
Although she has a stable job and social security coverage, she feels that neither her pay nor the recognition she receives reflect the effort her work entails. Every morning when she starts her working day, Sandra confirms an uncomfortable truth: in Colombia, caring for the elderly falls mainly to women like her, who are also ageing, also get tired and also need looking after.
Care, a historical and cultural burden for women
In Latin America and the Caribbean, at least eight million older persons need assistance with basic activities such as eating, dressing or bathing, according to a study by the Pan American Health Organization and the Inter-American Development Bank (IDB). As the population ages, by 2050 this figure could triple.
Behind this growing demand lies one constant: most carers are women. In Colombia, for example, 6.2 million people (of all ages) require direct care, and women take on 76.2 per cent of this work in the home, without remuneration.
For Diana Cecilia Gómez at Confederación de Trabajadores de Colombia (CTC), Colombia’s historic trade union confederation, the country has taken valuable steps towards raising the profile of this work. “One major step was to include its measurement in the national accounts, which made it possible to quantify its real contribution to the economy,” she explains.
Unpaid work alone accounts for nearly 20 per cent of Colombia’s GDP. If it were remunerated, it would be the largest economic sector in the country, ahead of commerce or public administration.
But inequality remains intact. While men spend an average of two to three hours a day on these tasks, women devote up to seven. For Gómez, this gap manifests itself as physical and emotional exhaustion, and life trajectories marked by constant dedication, often without recognition.
Susana Barria of Public Services International (PSI) for the Andean region defines it as a structural crisis. For her, the problem lies in the fact that care is assumed to be the responsibility of families and, within families, of women. “It cannot continue to be solely a family [private] matter; it has to be a societal matter, and the state has an essential role to play in this respect,” she says.
Sandra is experiencing this in the flesh. “Sometimes it seems like we only exist to care for others. But we also have families, and we neglect them because of this work. Society doesn’t see that.”
It is a burden that is not individual but cultural. As María Yolanda Castaño, gender secretary at the Confederación General del Trabajo (CGT) labour confederation, says: “Machismo has historically assigned caregiving to women, with very little male involvement. It is a cultural pattern that perpetuates inequalities and limits women’s personal and professional development.”
A national care policy: a commitment now underway?
Colombia took an important step forward in February 2025 when it approved its first National Care Policy (CONPES 4143). For the first time, the country has recognised care as a right, not only for those who receive it—children, older adults and people with disabilities—but also for those who provide it, the majority of whom are women.
The policy takes a comprehensive approach: redistributing care between the state, families and society; strengthening public and community services; and changing cultural patterns that have historically placed this responsibility on women’s shoulders. It is an ambitious undertaking, with investments planned up to 2034.
Beyond the announcement made, a number of questions remain unanswered. How will it be implemented in the territories? What actual resources will be available to ensure the promised changes? What will be done to ensure that women like Sandra see tangible improvements in their situation?
CTC’s Gómez assesses the policy: “Recognising the role of community care is crucial. But raising awareness is not enough: the work must be remunerated, with employment guarantees. It is a job that requires time, training and resources.”
Barria of PSI recalls that, on the international front, the Inter-American Court of Human Rights has already recognised care as a stand-alone right. This places states under the obligation to guarantee decent conditions for those who provide care.
For workers like Sandra, this support is essential: “So many things need improving: working hours, salaries and training, to be able to move up the career ladder. I sometimes feel that we are seen only as carers, not as professionals.”
For Castaño of CGT: “CONPES 4143 has been approved, but it is not yet clear how it will be implemented. The trade union movement urgently needs to adopt a critical stance and demand that the government establish clear mechanisms for coordination with trade unions, to ensure its implementation.”
While the policy represents a milestone, its implementation is only just beginning. Ensuring that it does not become a dead letter will require political will, social participation and the active commitment of the state.
Realities and challenges
Pending the policy’s implementation, the reality for those who care for the elderly continues to be one of excessive workloads, informal employment and a lack of labour guarantees. An IDB survey in Latin America and the Caribbean indicates that many carers work without adequate training, which exacerbates the precariousness of their situation and also affects the quality of care. According to Barria, even in public institutions, up to 80 per cent of contracts are for the provision of services (OPS), with no job stability or social security. “The conditions are very poor, and this has been overlooked in the public debate,” she warns.
Casualisation also reflects internal inequalities in the workplace. The CTC representative explains it clearly: “In a semi-private nursing home, perhaps the manager and one or two nurses have employment benefits. But the cleaning lady – who also provides care – is unlikely to have the same conditions.”
As a worker in the sector, Sandra is well aware of this reality: many of her colleagues work without stable employment contracts or benefits, and she knows all too well what the burden of caregiving entails. “You become overwhelmed by everything you experience. Sometimes I come home frustrated by things I couldn’t resolve, and there’s no one to listen to us. We should have professional support, someone to help us cope. Because this job is also emotionally draining.”
Her testimony reveals an aspect that is often silenced: the emotional impact of caregiving. Not only is there a lack of recognition for the work, but there is also a lack of care and support for those who provide it.
For Castaño, professionalising the care sector is key: “It is not enough to formalise their employment. We need to make progress in certifying and recognising care workers. We need to identify barriers, design sustainable strategies and really understand what people who work in this sector need.”
Shared responsibility
Beyond the lack of policies or resources, a deeply rooted idea persists: that caregiving is inherently a woman’s duty. Gómez, from the CTC, sums it up like this: “Being a nurse, teacher or caregiver is seen as an extension of being a mother. And since all things feminine are undervalued, caregiving is also undervalued.”
Challenging this view requires changes in everyday practices. Gómez emphasises that trade unions can drive change by promoting, for example, paternity leave. “Showing that men also have care responsibilities is a concrete way of building equality,” she argues. “Housework does not get done by itself. Recognising this means accepting that it should be a shared task.”
Sandra Moreno also speaks from experience. “I wish I could say, ‘I don’t want to care for anyone today’, feel entitled to rest, to be cared for. But no one thinks about that. So where does that leave me as a human being?”
Castaño, who has many years’ experience in trade unions, acknowledges that there is still no clear proposal to formalise unpaid care work in the home. This omission even raises questions among trade unions, which have long left care work out of their priorities. Breaking with this inertia, according to the CGT, means opening up the debate, strengthening social coordination and moving towards real shared responsibility, without succumbing to approaches that perpetuate gender stereotypes, but insisting on public services and policies that recognise care as a central pillar of social life.
The role of trade unions in bringing dignity to care work
For years, care workers – both inside and outside the home – have worked silently, shouldering a responsibility that has rarely been called into question. Today, trade unions are beginning to open up spaces for their voices to be heard, recognising that care is also an area of political struggle. “In Colombia, much remains to be done in terms of reflection and going beyond ‘assistentialism’, or welfare support, towards genuine policies that improve quality of life for older adults and those who care for them,” says Gómez.
Barria, of PSI, emphasises that collective organisation is key. “Many care workers feel alone. International solidarity helps ensure that their demands do not remain local; when a conflict is made visible outside the country, it generates political pressure,” she explains.
For the CGT leader, Castaño, the challenge is fundamentally political. To ensure that the policy on care does not become a dead letter, trade unions must take on an active role in dealing with the state. Without such involvement, she insists, achieving concrete change will be very difficult.
Who looks after those who care for the elderly?
The future of care policy in Colombia is hanging in the balance: it could become a tool for bringing dignity to people’s lives, or end up as an empty promise. Care has finally made it onto the political agenda, with responsibilities that can no longer be left on hold.
For Barria, the Andean region has a historical debt to both older people and those who care for them. For her, neither the public nor the private sector currently offers sufficient services or decent conditions for these essential workers. The Covid-19 pandemic also brought this reality into sharp focus: care cannot continue to be treated as a commodity.
“These are human lives we are talking about, vulnerable people. This cannot be left to the market but must be recognised as a public good and a right,” she insists.
Some countries have, however, delegated the provision of care services to private companies. And in much of the Americas, care remains unequal and limited. This is why Colombia is facing up to the challenge of accepting that care is a responsibility of the state.
Without clear and committed public leadership, warns the PSI representative, inequality will continue to determine who receives care, and who is left without.
Meanwhile, women like Sandra Moreno continue to rise before dawn. “I am a listener of stories, a preserver of memories, and a facilitator of moments of peace in the wisest stage of life: old age,” she says.
Her words bring us back to the fundamental question: who cares for those who care for others?
Bringing dignity to care, whether paid or unpaid, is to recognise a truth that is often overlooked but underpins everything else: without those who provide care – in homes, nursing homes, hospitals and so many other places where life is protected – quite simply, nothing would work. Caring is not a minor gesture, it is what allows life to go on and “is essential to all other work”.
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