According to the Bureau of Labor Statistics, there were approximately 1.7 million home health aides and personal and home care aides in the United States as of 2008. These home care aides are rapidly ...becoming the backbone of America's system of long-term care, and their numbers continue to grow. Often referred to as frontline care providers or direct care workers, home care aides-disproportionately women of color-bathe, feed, and offer companionship to the elderly and disabled in the context of the home. InThe Caring Self, Clare L. Stacey draws on observations of and interviews with aides working in Ohio and California to explore the physical and emotional labor associated with the care of others.
Aides experience material hardships-most work for minimum wage, and the services they provide are denigrated as unskilled labor-and find themselves negotiating social norms and affective rules associated with both family and work. This has negative implications for workers who struggle to establish clear limits on their emotional labor in the intimate space of the home. Aides often find themselves giving more, staying longer, even paying out of pocket for patient medications or incidentals; in other words, they feel emotional obligations expected more often of family members than of employees. However, there are also positive outcomes: some aides form meaningful ties to elderly and disabled patients. This sense of connection allows them to establish a sense of dignity and social worth in a socially devalued job. The case of home care allows us to see the ways in which emotional labor can simultaneously have deleterious and empowering consequences for workers.
In this revealing look at home care, Cynthia J. Cranford illustrates how elderly and disabled people and the immigrant women workers who assist them in daily activities develop meaningful ...relationships even when their different ages, abilities, races, nationalities, and socioeconomic backgrounds generate tension. As Cranford shows, workers can experience devaluation within racialized and gendered class hierarchies, which shapes their pursuit of security. Cranford analyzes the tensions, alliances, and compromises between security for workers and flexibility for elderly and disabled people, and she argues that workers and recipients negotiate flexibility and security within intersecting inequalities in varying ways depending on multiple interacting dynamics. What comes through from Cranford's analysis is the need for deeply democratic alliances across multiple axes of inequality. To support both flexible care and secure work, she argues for an intimate community unionism that advocates for universal state funding, designs culturally sensitive labor market intermediaries run by workers and recipients to help people find jobs or workers, and addresses everyday tensions in home workplaces.
Through a sweeping analytical narrative, from the Great Depression of the 1930s to the Great Recession of today, Caring for America shows how law and social policy shaped home care into a low-wage ...job, stigmatized as part of public welfare, primarily funded through Medicaid, and relegated to the bottom of the medical hierarchy. Care work became a job for African American and immigrant women that kept them in poverty, while providing independence from institutionalization for needy elderly and disabled people. But while the state organized home care, it did not do so without eliciting contestation and confrontation from the citizens themselves who gave and received it. Authors Eileen Boris and Jennifer Klein trace the intertwined, sometimes conflicting search of care providers and receivers for dignity, self-determination, security, and personal and social worth. This book highlights social movements of senior citizens for disability rights and independent living, the civil rights organizing of women on welfare and domestic workers, the battles of public sector unions, and the unionization of health and service workers. It rethinks the history of the American welfare state from the perspective of care work, all the while re-examining the strategies of the U.S. labor movement in terms of a growing care work economy. An unprecedented study, Caring for America serves as a definitive historical account of how public policy has impacted major modern movements and trends in class, race, and gender politics in the United States. Available in OSO:
The number of elderly and disabled Americans in need of home health care is increasing annually, even as the pool of people—almost always women—willing to do this job gets smaller and smaller. The ...Caring Class takes readers inside the reality of home health care by following the lives of women training and working as home health aides in the South Bronx. Richard Schweid examines home health care in detail, focusing on the women who tend to our elderly and disabled loved ones and how we fail to value their work. They are paid minimum wage so that we might be absent, getting on with our own lives. The book calls for a rethinking of home health care and explains why changes are urgent: the current system offers neither a good way to live nor a good way to die. By improving the job of home health aide, Schweid shows, we can reduce income inequality and create a pool of qualified, competent home health care providers who would contribute to the well-being of us all. The Caring Class also serves as a guide into the world of our home health care system. Nearly 50 million US families look after an elderly or disabled loved one. This book explains the issues and choices they face. Schweid explores the narratives, histories, and people behind home health care in the United States, examining how we might improve the lives of both those who receive care and those who provide it.
Home health, home care, and personal care aides provide most of the paid hands‐on care delivered to seriously ill, functionally impaired individuals in their homes, assisted living, and other ...noninstitutional settings. This workforce delivers personal care, assistance with activities of daily living, and emotional support to their patients. They are often the eyes and ears of the health system, observing subtle changes in condition that can provide important information for clinical decision making and therapeutic intervention. Despite this fact, the growing number of team‐based home care initiatives have failed to incorporate this workforce into their programs. Barriers to inclusion of aides into teams include a basic lack of value and understanding on the part of clinical team members and society in general of the complex tasks that these caregivers perform, inadequate investments in training and education of this workforce to develop their knowledge and competencies, and variation in state delegation laws that limit the scope of practice and consequently the ability of aides to work effectively in teams and to advance in their careers. Building on the few programs that have successfully included aides as key members of home care teams, federal and state policymakers, educators, and health systems and providers should standardize competency‐based training requirements, expand nurse delegation consistently across states, and support evaluation, dissemination, and replication of successful programs. J Am Geriatr Soc 67:S444–S448, 2019.
The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers
Paid home care is one of the fastest growing ...occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities.
Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation’s most pressing concerns—rising social inequality and caring for an aging population—intersect to transform the lives of older adults, home care workers, and the world around them.
The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality.
Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.
The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers
Paid home care is one of the fastest growing occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities.
Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation’s most pressing concerns—rising social inequality and caring for an aging population—intersect to transform the lives of older adults, home care workers, and the world around them.
The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality.
Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.
The Physics of Foraging Viswanathan, Gandhimohan. M.; da Luz, Marcos G. E.; Raposo, Ernesto P. ...
06/2011
eBook, Book
Do the movements of animals, including humans, follow patterns that can be described quantitatively by simple laws of motion? If so, then why? These questions have attracted the attention of ...scientists in many disciplines, and stimulated debates ranging from ecological matters to queries such as 'how can there be free will if one follows a law of motion?' This is the first book on this rapidly evolving subject, introducing random searches and foraging in a way that can be understood by readers without a previous background on the subject. It reviews theory as well as experiment, addresses open problems and perspectives, and discusses applications ranging from the colonization of Madagascar by Austronesians to the diffusion of genetically modified crops. The book will interest physicists working in the field of anomalous diffusion and movement ecology as well as ecologists already familiar with the concepts and methods of statistical physics.
Objective
To examine the relationship between Medicaid home‐ and community‐based services (HCBS) generosity and the likelihood of nursing home (NH) admission for dually enrolled older adults with ...Alzheimer's disease and related dementias (ADRD) and their level of physical and cognitive impairment at NH admission.
Data Sources
National Medicare data, Medicaid Analytic eXtract, and MDS 3.0 for CY2010‐2013 were linked.
Study Design
Eligible Medicare–Medicaid dual beneficiaries with ADRD were identified and followed for up to a year. We constructed two measures of HCBS generosity, breadth and intensity, at the county level for older duals with ADRD. Three binary outcomes were defined as follows: any NH placement during the follow‐up year for all individuals in the sample, high (vs. not high) physical impairment, and high (vs. not high) cognitive impairment at the time of NH admission for those who were admitted to an NH. Logistic regressions with state‐fixed effects and county random effects were estimated for these outcomes, respectively, accounting for individual‐ and county‐level covariates.
Data Extraction Methods
The study sample included 365,310 community‐dwelling older dual beneficiaries with ADRD who were enrolled in fee‐for‐service Medicare and Medicaid between October 1, 2010, and December 31, 2012.
Principal Findings
Considerable variations of breadth and intensity in county‐level HCBS were observed. We found that a 10‐percentage‐point increase in HCBS breadth was associated with a 1.4 (p < 0.01)‐percentage‐point reduction in the likelihood of NH admission. Among individuals with NH admission, greater HCBS breadth was associated with a higher level of physical impairment, and greater HCBS intensity was associated with a higher level of physical and cognitive impairment at NH admission.
Conclusions
Among community‐dwelling duals with ADRD, Medicaid HCBS generosity was associated with a lower likelihood of NH admission and greater functional impairment at NH admission.
In this revealing look at home care, Cynthia J. Cranford illustrates how elderly and disabled people and the immigrant women workers who assist them in daily activities develop meaningful ...relationships even when their different ages, abilities, races, nationalities, and socioeconomic backgrounds generate tension. As Cranford shows, workers can experience devaluation within racialized and gendered class hierarchies, which shapes their pursuit of security. Cranford analyzes the tensions, alliances, and compromises between security for workers and flexibility for elderly and disabled people, and she argues that workers and recipients negotiate flexibility and security within intersecting inequalities in varying ways depending on multiple interacting dynamics. What comes through from Cranford's analysis is the need for deeply democratic alliances across multiple axes of inequality. To support both flexible care and secure work, she argues for an intimate community unionism that advocates for universal state funding, designs culturally sensitive labor market intermediaries run by workers and recipients to help people find jobs or workers, and addresses everyday tensions in home workplaces.
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