Care Falls Apart

Across the United States, home care faces perpetual worker shortages and endemically high turnover levels estimated at between 60% and 90% per year. This chapter examines cases of turnover in rich ethnographic detail, arguing that the inability of agency and public policy to recognize the interdependence of older adults, workers, and their families contributes to this startling statistic. In observed cases of turnover; job loss stemmed from workers’ inabilities to sustain both their own households and those of their older adults without blurring the boundaries between them. Workers lost jobs because of conflicts with family care and because they engaged in unsanctioned reciprocities with clients. Current attempts to protect vulnerable older adults from possible exploitation actually exacerbate the exploitation of care workers and increase instability in home care.

Independent Living

This chapter argues that taking care of homes is inseparable from caring for persons in home care. The chapter shows how homes are invested with history and memories, becoming a material sign of older adults’ independence. In tandem with maintaining elders’ bodies, workers learn to maintain their clients’ homes to sustain their personhood. They attend to small details and suggest subtle changes to the home to make it safer or more inviting, drawing on their empathic and bodily knowledge of elders to figure out what changes will be palatable. Flows of people, money, and material goods link workers and elders’ homes. Agency policies attempt to restrict these flows, leaving workers struggling to maintain their own homes, pay the bills, and maintain their own sense of aesthetic order.

Making Care Work

In making care into work, agencies justify their existence in the market as managing the predictable tensions that regularly arise in home care. Home care agencies build upon women’s familial experience of care while seeking to transform them into workers whose labor conforms to the ethical and temporal norms of American workplaces. Conflicts regularly arise between people’s moral ideologies about care, the economic pressures of capitalist markets, and the laws that govern labor and elder care in the United States. This chapter traces the transformation of moral values into economic value by focusing on the everyday ethics practiced by home care agency training and management staff as they mediate between national moralities, the needs of their agencies, the needs of clients, and their own ethics. Agencies’ different funding sources affect how they imagine and generate their clients’ independence. Publicly funded care policies view older adults as liberal persons in a democratic state in which rights and services are the result of citizenship and need rather than social position. In privately funded care, older adults’ independence was authorized by their privileged position as consumers whose subjective tastes and preferences determined the kinds and quantity of care they received. Their independence was not the result of fair treatment by an equitable state, but rather determined by their ability to wield economic power.

Inheriting Care

Home care workers typically develop indispensable expertise caring for kin in difficult circumstances. This chapter presents the life histories of two home care workers, to argue that workers’ care for kin generates forms of moral imagination in which care practices are inextricably linked to notions of obligation, reciprocity, and sacrifice. For workers, these moral and domestic lessons become survival skills thanks to long histories of discriminatory social policy that regenerate the racial and gendered contours of poverty while funneling poor women of color into domestic and care jobs. Their stories highlight their resilient and creative responses to poverty, and their central role generating the independence of others.

Embodying Inequality

This chapter analyzes the embodied care practices at the center of home care work. The chapter argues that these practices generate deep but fragile entanglements between the lives and bodies of older adults and those of their home care workers. These practices involve forms of empathy that blur the boundaries between older adults’ and home care workers’ bodies and their personhoods. I show how home care transforms seemingly straightforward tasks like cooking into moral practices that help older adults feel independent. Home care workers’ bodies become the ground upon which moral hierarchies between persons are built, experienced, and justified on a day-to-day basis. Daily home care practices generate ways of embodying social hierarchies and shape individual subjectivities, thereby making those hierarchies feel morally legitimate.

Introduction

This chapter introduces a contextual, theoretical, and methodological framework for analyzing contemporary care work. Building on long-standing feminist critiques, Buch advances the concept of generative labor to analyze the social meanings and effects of daily care practices. The introduction examines the role of independence as a foundational value driving care policy and practice. It argues that paid care work generates independent persons by capitalizing on racial, class, and gender inequality. The introduction also describes the ethnographic fieldwork upon which the book is based.

Conclusion

The conclusion builds on key arguments of the book to suggest several routes toward building a caring economy that generates equitable interdependence. Current methods of organizing care leave people and families across the social spectrum with inadequate and unsustainable ways of sustaining ever longer life spans. The growing demand for care only exacerbates these challenges. Continuing to undervalue generative labor while placing its demands on the backs of those already struggling is simply unsustainable. Instead, I invite readers to imagine with me ways of organizing care work that value familial histories and embodied labors that sustain meaningful ways of life. Valuing care work is a crucial step toward generating a society that values people at every age and from every background.

Generating Independence

The first chapter of the book draws on the life histories of three very different older adults, exploring how elders came to understand the ideas of independence over their long histories of experience. These histories reveal the stakes of care for older adults and how they distinguish good care from bad. Older adults did not imagine independence as requiring them to sustain their lives without assistance from anyone else. They understood independence as generated through reciprocal relationships in which they contributed equitably to the well-being of those upon whom they relied. Older adults took solace in the fact that their home care workers were paid, seeing this as a more independent manner in which to receive care than relying on unpaid but morally obligated relatives. In this way, home care buttressed older adults from becoming a burden on those they loved, protecting them from the always present specter of dependence.