A Lack of Reciprocity

This chapter examines how workplace conditions and benefits shape care workers’ national belonging. It discusses the home care field, including its historically unregulated character due to its categorization as domestic service. Agencies are currently responding to new regulations regarding overtime and health insurance, which have had contradictory effects on workers. It also discusses the amount of profit agencies are making from care workers. Care workers feel that they are denied reciprocities to which they are entitled through their labor. This is thus a complicated sense of belonging, in which they belong enough to feel entitled to reward, but not enough belonging to feel that they can work in unison against this system. Many, instead, decide that this state of affairs confirms that they belong in their home countries rather than in the United States. It is there that they imagine that they will reap the rewards of their labor and attain a dignity that is denied in the United States.

Reciprocity

Both care workers and patients are concerned about the reciprocities of the relationship between them. From the patients’ side, the reciprocities are framed as issues of money: are they getting sufficient work and respect from their employees, in exchange for the life savings they are spending? Are they subject to theft by the strangers they are allowing into their homes? Patients expect to buy care and respect as consumers. Care workers, on the other hand, attend to respect and appreciation—whether in the form of redistribution or in the form of interpersonal recognition. Furthermore, some see themselves as doing God’s work, spreading love and encouragement by caring for someone, rather than giving their labor in exchange for money. As such, they do not expect reciprocity to come immediately and from their patients, but on God’s time, in their hour of need.

Stories of Servitude

Most of the African research participants in northern New Jersey and the Washington DC metropolitan area told stories of deliberate humiliation or diminishment in which their place of origin or Blackness was used against them. Through these interactions and stories about these interactions, African care workers were becoming familiar with American racial categories, in which they were Black, mixed in with stereotypes about Africans as non-human and about immigrants stealing jobs from citizens. These insults incorporated them into American racial categories as “Blacks” and “people of color,” social categories of person that made little sense in their home countries. As a result, African care workers were becoming more sensitive to the experiences of African-Americans. Care workers take stories of racism to be paradigmatic of their experiences in the United States.

Interlude

Eating together and sharing food is often taken as a sign of community—as in rituals of communion, and it was often a site of conflict. This coda explores care workers’ and patients’ reflections on eating and food—from the smells of “African cooking,” to the joys of patients accepting African foods and kosher dietary restrictions—as meditations on belonging and incorporation by patients and care workers alike.

Conclusion

The conclusion summarizes the main theoretical points established in the book about the ways that recognition and belonging are structured through the relations and exchanges African care workers encounter at work. It proposes some concrete steps which would increase African care workers’ belonging through improving conditions of care work, as well as more radical steps of basing human dignity and rights on vulnerability and interdependence.

Interlude

This coda describes a care worker undergoing a foreclosure on her house and retiring to live in Ghana. To the care worker, this loss is symbolic of her work not bearing fruit, and of the unfairness of the American legal system. Mortgages may be appropriate for workers in a stable job, but home health workers’ monthly income fluctuates because of the precarity of their work schedules.

Interlude

This coda explores the history of domestic service in Washington DC, drawing on the literature, oral history in my own family, and patients’ experiences. It considers why patients considered domestic service different from care work.

Interlude

One of the things that kin do is shape one another. They influence one another’s tastes—in food, music, and leisure activities—by introducing them to these sensations and making these activities meaningful by spending time together over food and play. Patients expose care workers to the sports and games that they like to play. This short piece describes an unusual situation in which a care worker was inspired to learn to play tennis and swim because of her patient.

Making and Breaking Practical Kinship

This chapter explores how some patients adopt their care workers temporarily and to a certain extent, to acknowledge the intimacy generated through care. Techniques of connection with African care workers entail what Bourdieu called practical kinship, which can easily be denied and revoked when the kin relationship is no longer needed. Major financial gifts or support are given to care workers which approximate but are not equivalent to inheritance. Both care workers and patients use kin terms like “younger brother” (said seriously) or “second wife” (said jokingly). Practical kinship is subject to the acknowledgment of others in the patients’ and care workers’ social networks, including official kin and fellow residents of the continuing care community. Death is particularly significant because it marks the end of the practical need for the care worker and because the official kin of patients can deny the kinship of the care worker to their parent.

Interlude

This coda explores the role of home care workers in helping patients and their kin establish rituals and meaning at the end of life. Kin often find themselves having difficulty creating the proper ritual space or sense of union and communion with the dead and with each other. They do not have a cultural script of what to do, which leads to greater grief. This lack of ritual around home deaths speaks to the cultural desire to avoid death as long as possible, the expertise of medical authorities in structuring the dying process in hospitals, and the fact that aging in general is somewhat unstructured, with relatively few rituals in comparison to the transitions of childhood and youth. Given the lack of structure in home deaths, kin are amenable to guidance about new kinds of social actions from others, including from home care workers, who become experts in dying. Such moments draw patients’ kin and home care workers closer together.