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Journal Examines the Politics of Paid Caring
February 24, 2006
The March issue of Politics and Society is a special issue on paid caregivers that contains several provocative articles about direct-care work.
''Organizing Home Care: Low-Waged Workers in the Welfare State'' explores ''the social struggles that forced the state to recognize its invisible workforce'' by studying the innovative efforts made by California and Oregon to deinstitutionalize care of the elderly and disabled. Authors Eileen Boris and Jennifer Klein put the two case studies in context by outlining the social policies and governmental funding that created the home care industry and established working conditions for personal attendants and other home care aides. In addition, they look at the conditions that led unions to organize home care workers, and consumers and workers to join forces in order to improve job and care quality. ''The process of struggle-as well as the progress to date- has transformed the consciousness of care workers,'' they write, ''along with recognizing the value of the work (even if the pay remains inadequate.)''
''What Can We Expect from Paid Carers?'' explores the question posed by its title, noting that we expect love or filial piety to ensure good care within families and asking what moral bonds ensure good care by paid caregivers. Author Gabrielle Meagher concludes that paid caregivers cannot be expected to reproduce ''an idealized private sphere.'' Instead, she writes, ''we can expect 'good enough' care, supported by a range of normative resources.''
Noting the competitive pressures that often create low-pay/low-quality outcomes in paid caregiving professions, ''Demanding Quality: Worker/Consumer Coalitions and 'High Road' Strategies in the Care Sector'' develops an economic analysis of elder care and other caregiving jobs. Author Nancy Folbre emphasizes the potential to build political coalitions that could push for a high-pay/high-quality alternative.
And in ''Culture Change Management in Long-Term Care: A Shop-Floor View,'' author Steven Henry Lopez looks at the unsuccessful attempt of a nonprofit nursing home to implement a culture change initiative. The home's failure, he writes, suggests that, at least in the home studied, ''culture change founders on the structural problem of inadequate staffing'' due to ''[r]esource limitations imposed by Medicaid and Medicare reimbursement rates.'' Despite above-average staffing levels, Lopez writes, ''Heartland's nursing aides could not complete their work on time without compromising the quality of care by breaking important care rules. Resource limitations also forced management to adopt a series of punitive personnel policies that actively undercut the rhetoric and aims of culture change, turning culture change into a rhetorical device for shifting blame for care problems from structural resource limitations onto the attitudes of nursing aides.''
Click here to access the articles online (non-subscribers must pay a fee for full text.)
Elise Nakhnikian
Communications Specialist
Paraprofessional Healthcare Institute
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