Caring for America: Home Health Workers in the Shadow of the Welfare State

Home-Care Workers Aren’t Just ‘Companions’
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While a burgeoning number of academic studies have been published on the increased employment of domestic workers often migrants in welfare states, home health workers have remained largely invisible. Yet, according to Boris and Klein, home care is one of the fastest growing occupations in the US, and at the centre of the economy p.

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The restructuring of the welfare state, and in particular of the health-care system, coupled with the changes that have taken place in white middle-class families, where women have taken up paid employment, have led to a structural demand for home care. In the absence of public policies providing and protecting long-term care at home for those in need, a large variety of workers, such as personal attendants, in-home support workers, home- maker-housekeepers, and home health aides, are employed.

Their interest in the topic is not only intellectually inspired but also linked to their personal experiences. Confronted with the caring needs of their parents and grandparents, they experienced how difficult it was to obtain good home care, even for people with financial resources.

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To understand why this is so difficult, and in particular why this form of care is so undervalued, underpaid, and invisible, the authors hope to show how such a health-care system developed. Their book provides a much needed history of home-care workers in the United States, and in doing so it unravels the intimate relationship between home care, the politics of public health care, and the many struggles experienced by workers and unions to secure recognition for their essential work.

Eileen Boris

Whereas home care has long been treated as a private issue, Boris and Klein show that it has become the core of the new care economy. Instead, cheap and flexible labour is found at home among African-American and immigrant women. The fact that, like domestic work, home health care is greatly gendered and racialized perpetuates its invisibility, marginality, and lack of recognition. For a long time the labour movement in the US neglected care work at home. In addition, home care was heavily dependent on state funding, workers were dispersed over a multitude of private homes, and employers were individuals in need of care instead of private companies in search of profit.

Yet, despite these challenges, home health workers were able to organize themselves in such a way as to affect the membership, goals, and strategies of the labour movement. How they succeeded in doing so is described in detail in this book. In their first three chapters Boris and Klein describe and analyse the history of home care since the s in the light of government policies and programmes, both at the national and the federal level. They show how home care as a profession developed in political periods such as the New Deal s , the postwar years s , the War on Poverty s , and the Reagan era s.

They pay special attention to the states of New York, California, Illinois, and Oregon, where home-care workers and recipients of care were actively involved in the development of social programmes. While these chapters could be read as a history of a hitherto fairly unknown part of the health-care workforce, they also show the importance of individuals in the development of home health care and related policies.

In addition, these chapters show the intricate, and increasingly close, link between the public and the private sectors in the United States; right from the start, public welfare programmes were dependent on a wide range of private organizations, such as charities, non-profit organizations, and vendor agencies. Yet the balance between public and private changed drastically with the privatization of the health-care sector in the s and s, a trend that has intensified in the past two decades. Flexible labour policies, increased outsourcing, and the continuous search for profit have turned home-care workers into casual employees excluded from legal protection.

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The last four chapters focus on the struggle for the recognition and rights of home- health workers. Related: Men in female-dominated jobs.

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Many of these workers are also not as educated -- often with no more than a high school diploma. So it would make sense that these workers have far less bargaining power against the large associations and companies lobbying against a change.

Keeping the cost of home care affordable for the elderly is key. Medicare and Medicaid funding cuts due to healthcare reform as well as state budget constraints are also a factor. The industry argues that if they're forced to pay minimum wage and overtime, they'll have to restrict workers' hours to 40 hours a week or less.

That could actually lead to a reduction in pay for live-in workers.

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Giving poor families more choices in where to live can greatly improve health

Live texting your surgery. Live in a glass-walled home. Establishing the legitimacy of care as productive, necessary labor — a real job — would recognize the realities of both our aging society and our service economy.


It would also begin the long-overdue work of updating labor standards for the workplaces of a new century. But if the Labor Department delays issuing a final rule, home-care workers could remain unprotected in the shadows of the low-wage economy. Its deeper possibility is the potential to re-establish some notion of labor standards, rights and security after decades of gutting them. Tell us what you think. Please upgrade your browser. See next articles.

Caring for America

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Credit Mallory Noe-Payne. They argue that state policies enabled workers, recipients of care, and political constituencies to demand better wages and better care. Another legal challenge ensued, from an association of home care agencies. It treated women who labored to support their families as if they were teenagers picking up some spending money. Taken from: "Caring for America. Boris and Klein introduce the reader to a decades old struggle for dignity which has witnessed twists and turns but in order to sustain itself must rely on its own energy rather than the good-will of outsiders. Americans generally want to remain in their homes even if they develop chronic health problems or disabilities that qualify them for nursing home care.

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