Caregiving — The Futures Collective

The Double Hexagon at a glance. A full walk from foresight to design. Causal Layered Analysis (CLA) surfaces the deep story holding care in place — "care is love, not labour" — and what happens if we shift it. We then cross into Hexagon 2: Day-in-the-life to inhabit the shifted world, and three Design Fiction artifacts (a 2040 caregiver's payslip, a rostering-app notification, a government care-credit statement) that make the myth-shift physical — and reveal what gets lost when care becomes visible as labour.

How to read this example

─── STEP N of 7 ─── HEXAGON <1 / 2> · <PHASE> · <TOOL> ───

Each step ends with Try it yourself.

Confidence note. Care-economy figures (unpaid-care GDP value, caregiver counts, wages) are referenced. The 2040 world, the day-in-the-life, and the three artifacts are constructed. The example deliberately surfaces an ambivalence — making care visible as labour has real costs as well as gains — rather than advocating a position.

Why this topic, why these tools

Care is the largest economy nobody counts. The ILO estimates 16 billion hours of unpaid care work happen daily — roughly 9% of global GDP, about US$11 trillion a year at minimum wage — and women do around 75% of it. (1) In the US alone, ~63 million family caregivers provided care worth ~US$1.01 trillion in 2024; fewer than a quarter are paid anything; a quarter are taking on debt. (2) The reason this enormous economy stays invisible isn't a measurement failure. It's a story: that care is an expression of love, and therefore not labour, and therefore not paid.

That makes CLA the essential tool: the invisibility is held at the myth layer ("care is love, not labour"), and you can't see the system clearly until you name the myth. And Design Fiction is the perfect partner because the myth-shift is best tested by producing the documents that would exist if care were counted — a payslip, a roster, a credit statement. The moment you draft a caregiver's payslip, you feel both the dignity it offers and the thing it flattens. That ambivalence is the lesson.

Focal question: If care became fully visible as labour by 2040, what would the paperwork look like — and what would we have gained and lost?

A note on framing. The "and lost" is deliberate and load-bearing. Most care-economy futures work argues for recognition and compensation (rightly). This example holds the tension: visibility brings dignity and rights — and also surveillance, marketisation, and the risk of hollowing out something that was never only economic. We design into the recognised-care world and let its artifacts show the cost.

STEP 1 of 7 · HEXAGON 1 · FRAME · Causal Layered Analysis

The invisibility is held by a myth — “care is love, not labour” — that also makes it free.

Layer 1 — LITANY

"Family caregivers are an invisible workforce." 63M in the US (+~50% since 2015); ~US$1.01T in annual value; <25% paid. (2)
"Unpaid care is ~9% of global GDP / ~US$11T a year." (1)
"Care work prevents 708 million women from joining the labour market." (1)
"We face a long-term care crisis as populations age and care workers grow scarce." (See Topic 5 — Healthy Ageing.)
"Caregivers are burning out and going into debt." (1 in 4 taking on debt; 1 in 5 in poor health.) (2)

Layer 2 — SYSTEM

Care work classified as low-wage or no-wage; paid care work is gendered, racialised, and often migrant.
Welfare and health systems that assume a free family carer in the background (the "default carer" assumption).
Means-tested, diagnosis-gated public care support that's hard to access.
Pension and social-security systems that don't credit years spent caregiving — so carers are poorer in old age.
Emerging exceptions: paid-family-care programmes (US Medicaid/VA, ~11M receiving some compensation; Washington's WA Cares Fund, benefits from 2026). (2)
The ILO's June 2024 Resolution on decent work and the care economy — the first global tripartite agreement. (1)

Layer 3 — WORLDVIEW

Care as natural female duty — not work, but who-women-are.
The market as the only thing that counts — if it's not paid, it's not in GDP, so it's not "real" economy.
Independence as the norm, dependence as failure — care as a remedial cost, not a universal condition of life.
Efficiency as virtue — care resists efficiency (it's slow, relational), so it's undervalued by a system that prizes throughput.

Layer 4 — MYTH / METAPHOR

"Care is love, not labour." The master myth. It dignifies care and simultaneously justifies not paying for it. Its genius is that contesting it feels like cheapening love.
"It takes a village." Invoked nostalgically while the village is dismantled.
The selfless mother / dutiful daughter. Identity-scripts that make refusal feel like moral failure.
Care as a private matter. It happens behind doors; it's nobody's public business.

Reframe by altering the myth

Candidate myth shift: Care is love and labour — and treating it as only one of these has always been a way of getting it for free.

Trace upward:

Worldview: care moves from "natural duty" to recognised, skilled, valued work that is also relational — both/and, not either/or. Dependence is reframed as a universal life-stage, not a failure.
System: care work is paid, pensioned, credentialed; carer years count toward social security; the "default free carer" assumption is removed from welfare design; care infrastructure (respite, leave, co-ops) is funded.
Litany: the headline shifts from "invisible workforce" to "the care sector" with its own statistics, contracts, and labour rights.

But here's the CLA twist this example insists on: the myth was load-bearing. "Care is love" wasn't only an excuse — it also protected care from being fully marketised, surveilled, and optimised. Shift the myth and you gain rights and dignity; you also risk turning a relationship into a transaction. The reframe is necessary and costly. We'll feel both in the artifacts.

Try it yourself

Run CLA on caregiving.
- Litany — the invisible-workforce / unpaid-value headlines
- System — classification, the "default free carer" assumption,
  pension blindness, paid-care exceptions
- Worldview — care as female duty, market-as-only-real-economy
- Myth — "care is love, not labour"; the selfless mother
Propose the myth-shift — and then name what the *old myth was
protecting*. The cost of the shift is the interesting part.

STEP 2 of 7 · HEXAGON 1 · SCAN · STEEP+++

Economic

Unpaid care ~9% of global GDP (~US$11T/yr); in Latin America/Caribbean ~21% of GDP. (1)
Investing in care could create up to 299M jobs by 2035; ILO estimates ~US$3.76 GDP return per dollar invested. (1)
US family care worth ~US$1.01T (2024), exceeding total Medicaid spend. (2)

Social / Demographic

63M US caregivers (+50% since 2015); ageing populations expanding demand (Topic 5). (2)
Women do ~75% of unpaid care; up to 7× men in some countries. (1)
"Sandwich generation" caring for parents and children simultaneously.

Political / Legal

ILO June 2024 Resolution on the care economy — first global tripartite agreement. (1)
Washington's WA Cares Fund (benefits from 2026) — first US statewide LTC social insurance. (2)
Counter-current: ~US$1T trimmed from US Medicaid over 10 years (2025) — recognition and retrenchment happening simultaneously. (2)

Technological

Care-rostering and care-coordination platforms (matching, scheduling, monitoring) scaling — the "Uberisation of care" risk.
Remote monitoring, fall detection, companion robots (Topic 5).
Time-banking and care-credit digital systems piloted.

Values / +++

A slow shift in some cultures toward valuing care publicly; a counter-pull toward austerity and "family responsibility" rhetoric.
Disability-justice movements reframing care as interdependence and contesting the carer/cared-for binary itself.

Gap check. Heavy on US/ILO macro figures; thinner on the lived texture of migrant care workers, on disabled people's own framing of care (which often resists the "caregiver-centric" view), and on non-Western kin-care systems.

Try it yourself

Scan caregiving across STEEP+++. Deliberately include the disability-
justice reframe (care as interdependence, not one-way "help"). Note
where your sources centre the carer and erase the cared-for's agency.

STEP 3 of 7 · HEXAGON 1 · POSSIBLE WORLDS · Four 2040 care worlds

Two tensions: recognition (care counted/paid ↔ still invisible) × relational integrity (care stays relational ↔ care fully marketised).

A. Counted and Cared-For (recognised, relational intact). Care is paid, pensioned, and credentialed — and designed to protect the relationship (carer rights include time, autonomy, refusal). The both/and ideal. Hard to hold.
B. The Care Market (recognised, marketised). Care is fully visible — as a gig economy. Rostered, rated, optimised, surveilled. Dignified on paper, hollow in practice. This is where our artifacts come from.
C. Invisible Forever (unrecognised, relational). The status quo persists. Care stays love-not-labour; carers stay unpaid, poorer in old age, burning out. Relationship "protected" by being unsupported.
D. Abandoned (unrecognised, marketised). The worst: public support retrenches and what care is purchasable is a thin, transactional market. Austerity plus Uberisation.

We design into B ("The Care Market") — because it's the seductive trap: it looks like the win (recognition!) while quietly losing what mattered. The artifacts will show the seam.

Try it yourself

Sketch four 2040 care worlds on recognition × relational-integrity.
Identify the seductive-trap quadrant (looks like the win, costs the
essence). Design your artifacts from there, not from the utopia — the
trap teaches more.

STEP 4 of 7 · HEXAGON 2 · WORLDBUILD · Day-in-the-life (Scenario B)

Setting: Manchester, UK. A Tuesday in March 2040. Character: Denise, 54. Cares for her mother (dementia, 81). Since the 2037 Care Recognition Act, Denise is a registered, paid Family Care Provider — contracted through a platform, CareGrid, that the council commissions.

06:30. CareGrid pings: her mum's overnight sensor logged three "wandering events." Denise's "care quality score" updates. She hates the score; she also checks it first thing.
07:15. Clocks in on the app. The day's tasks are pre-populated: medication (timed), "meaningful activity: 30 min minimum," personal care, meal prep. Each is billable; each is logged.
09:00. Her mother doesn't want to do the "meaningful activity." Denise sits with her instead, just holding her hand, looking out the window. This isn't a billable category. She logs it as "personal care" so the time counts. The system has taught her to mislabel love as a task.
11:00. A CareGrid "optimisation" notification suggests she could take on a second client (a neighbour, two streets over) in her "idle window" 11:00–13:00. More income. Less slack. She declines, then worries about the score.
13:30. Council care-coordinator video call. Friendly, metrics-driven. "Your activity-minutes are below the cohort median." Denise explains her mum's bad week. The coordinator notes it, kindly, in a box.
16:00. Her daughter visits. For one hour, there is care happening that no app sees — three generations, tea, an argument about nothing. It is the realest care of the day and the only uncounted care of the day.
19:00. Clocks out. Her payslip previews: 7.5 billable hours. Her pension contributions tick up — a genuine gain; pre-2037 these years would have counted for nothing.
21:00. She gets a notification: her care-credit balance (earned for caring) can be spent on respite. She books four hours for Saturday. The first time in years she's had a Saturday. Also real. Also a gain.

What this surfaces. Scenario B is not dystopia. The pension credits and respite are real, hard-won gains — exactly what the care-economy movement fights for. But the same system that delivers them also: scores the carer, taxonomises love into billable units, nudges toward taking on more, and renders uncounted care invisible again — now by a different mechanism. The myth-shift gave Denise rights and took away the protected ambiguity that let care just be care. The day holds both. That's the finding.

Try it yourself

Write a day-in-the-life inside your seductive-trap quadrant.
- Include at least one genuine gain (a right, a payment, a respite)
- Include at least one moment where the system forces the character to
  mislabel or distort the real thing to make it legible
- Include one piece of care that no system sees
End by naming what was gained AND what was lost in the same day.

STEP 5 of 7 · HEXAGON 2 · GENERATE → ARTIFACTS · Three Design Fictions

Design Fiction: a payslip that dignifies care and surveils it on the same sheet.

We make the world physical with three documents from Scenario B. Each is constructed. Together they triangulate the gain/loss ambivalence.

Artifact 1 — The caregiver's payslip

CareGrid Services (commissioned by Manchester City Council)

FAMILY CARE PROVIDER — PAYSLIP

Provider: Denise A. Okafor · Care ID: FCP-MCR-44192 Care recipient: [redacted — relationship: Mother] · Period: 1–7 March 2040

Billable category Hours Rate Amount

Personal care 18.5 £13.90 £257.15

Medication management 5.0 £15.20 £76.00

Meaningful activity 9.0 £12.40 £111.60

Meal preparation 7.0 £12.40 £86.80

Night-presence (passive) 14.0 £4.10 £57.40

Gross 53.5 £588.95

Care-quality adjustment: −£17.70 (activity-minutes below cohort median; see coordinator note) Pension contribution (employer): £41.20 · State Care-Credit accrued: 6.0 credits

Uncounted care is not remunerated. Categories are defined under the Care Recognition Act 2037, Sched. 2.

Billable category	Hours	Rate	Amount
Personal care	18.5	£13.90	£257.15
Medication management	5.0	£15.20	£76.00
Meaningful activity	9.0	£12.40	£111.60
Meal preparation	7.0	£12.40	£86.80
Night-presence (passive)	14.0	£4.10	£57.40
Gross	53.5		£588.95

What it argues: The "night-presence (passive)" rate of £4.10 — below minimum wage, because you're "only" sleeping near someone who might wander — is the clause that detonates. And "care-quality adjustment: −£17.70" turns love into a performance metric with a docking mechanism. The payslip dignifies and surveils in the same sheet.

Artifact 2 — The rostering-app notification

CareGrid · 11:02 🟢 Optimisation available. You have an idle window 11:00–13:00 today. A care recipient 0.7km away (Margaret, 79, low-complexity) needs cover. Accepting adds an est. £28.80 to today's earnings and +2 to your Availability Score. Your Availability Score affects future commissioning priority. [ Accept ] [ Not now ] [ Why am I seeing this? ]

What it argues: "Idle window" — the language of warehouse logistics applied to a daughter sitting with her mother. The "Availability Score affects future commissioning priority" line is the gig-economy coercion engine, ported into care. The cheerful green dot is the tell.

Artifact 3 — The government care-credit statement

UK Care Recognition Scheme — Annual Care-Credit Statement

Citizen: Denise A. Okafor · NI: [redacted] · Year: 2039–40

Care-Credits accrued this year: 287 Lifetime Care-Credits: 1,914

Care-Credits may be redeemed for:

Respite hours (1 credit = 1 hr) — 312 redeemed this year

State Pension top-up (10 credits = 1 qualifying week) — carer years now count toward your State Pension

Transferable to another registered carer (max 50/yr)

Under the Care Recognition Act 2037, years spent in registered care now count toward your State Pension and contributory benefits. Before 2037, these years counted for nothing.

What it argues: This is the artifact of pure gain. "Before 2037, these years counted for nothing" is the single most powerful line in the set — it names the real injustice the reform fixes. Placed beside the payslip and the roster, it forces the honest ambivalence: the same system that scores and Uberises Denise also, finally, counts her. You can't cleanly love or hate this world. That's the design success.

Try it yourself

Produce 2–3 Design Fiction artifacts from your world that triangulate.
At least one should embody the *gain* (a right finally granted) and at
least one the *loss* (the surveillance / marketisation). Use real
bureaucratic register. Put them side by side — the tension between
them is the deliverable.

STEP 6 of 7 · HEXAGON 2 · PROTOTYPE · Experience Prototype (50 min)

Participants: 6–8 — a current family caregiver, a paid care worker, a disability-rights advocate (to contest the carer-centric frame), a pensions/benefits officer, a platform-economy designer, a health economist.
Setup: Hand out the three artifacts together. No briefing.
Run: 10 min read. 10 min — each ranks the three from "most want this world" to "least," silently, on a card. 20 min — debate the split (the rankings will diverge sharply by role). 10 min reveal (2040, Scenario B). 5 min — what would you keep, what would you delete?
Looking for: The caregiver may rank the care-credit statement first (the pension!) and the roster last (the coercion). The disability advocate may reject the entire frame for centring the carer over the cared-for. The economist may defend the night-presence rate. The collisions are the data — and the disability advocate's objection should reshape the whole project.
Harm note: Many participants will have live caregiving experience and grief. Brief, consent, offer an out.

Try it yourself

Design a 50-min prototype around your artifacts. Pick readers whose
roles will rank them differently — include at least one who would
reject your framing entirely. Two facilitator questions. A reveal. A
"keep / delete" closer.

STEP 7 of 7 · HEXAGON 2 · REFLECT

What did the artifacts surface that CLA alone didn't? — The specific seams where recognition becomes surveillance: the night-presence rate, the quality-adjustment docking, the "idle window." Abstractions became clauses you can argue with.
What did the old myth protect, exactly? — The ambiguity that let care be unmeasured and therefore un-optimised. Visibility is double-edged. The example refuses to pretend otherwise.
Whose voice reshaped the project? — The disability-justice reframe: the entire exercise centred the carer. A version centring the cared-for's agency and interdependence would look different — and better.
What 2026 action does this surface? — Push for the gains (pension credits for carers, paid family care, the WA Cares model) while designing against the surveillance/Uberisation from the start — because the platform layer is where the loss sneaks in.
What does this refuse? — To claim recognition is simply good or simply bad. To resolve the gain/loss tension. To centre carers so hard the cared-for disappears.

Try it yourself

Reflect in <60 words each: what did the artifacts surface that CLA
didn't; what did the old myth protect; whose voice should reshape the
project; what 2026 action follows; what does this refuse to resolve?

What this example does and doesn't claim

Documented (with citations):

Unpaid-care GDP value (~9% / ~US$11T); gender split; 708M women excluded; care-investment job/return figures; ILO 2024 Resolution (1).
US caregiver counts (~63M), value (~US$1.01T), low paid-share, WA Cares Fund, the 2025 Medicaid cut (2).

Constructed:

The "Care Recognition Act 2037," "CareGrid," the UK Care Recognition Scheme, Denise, and all three artifacts — entirely fictional.
The four 2040 worlds and the day-in-the-life.

Held in tension (by design):

Whether making care visible-as-labour is net good. The example stages the ambivalence rather than resolving it.

Out of scope:

The lived experience of migrant care workers (a major omission).
The cared-for's own perspective and the disability-justice critique of "care" framing — gestured at, not centred (flagged as the thing that should reshape a v2).
Childcare specifically (overlaps with Topic 8).

References

[1] International Labour Organization. Care economy (16 billion daily hours; ~9% of GDP / ~US$11T; 708M women excluded; up to 299M jobs by 2035; US$3.76 return; June 2024 Resolution). ilo.org/topics-and-sectors/care-economy; ILO, "Unpaid care work prevents 708 million women...". Latin America ~21% figure via UNDP undp.org.

[2] AARP & National Alliance for Caregiving. Caregiving in the US 2025 and Valuing the Invaluable 2026 Update (~63M caregivers; ~US$1.01T value; <25% paid; debt/health strain). aarp.org. WA Cares Fund and the 2025 Medicaid reduction via NPR, "Policy relief for family caregivers seems stalled out" (30 Dec 2025) npr.org.

Methodological references

Inayatullah, S. (1998). "Causal layered analysis: Poststructuralism as method." Futures, 30(8), 815–829.
Bleecker, J. (2009). Design Fiction: A short essay on design, science, fact and fiction. Near Future Laboratory.
Candy, S., & Watson, J. (2014). The Thing From The Future. Situation Lab.