Rationalized aging: Creative destruction and the subdivision of US eldercare (original) (raw)

Reconceptualizing the relationship between “public” and “private” eldercare

Journal of Aging Studies, 2003

Recent changes in patterns of care provision for the elderly, including a withdrawal of the formal system and increasing reliance on family care providers, call for new conceptualization and theoretical development. Existing models of the relationship between formal and informal care are reviewed, but found wanting in neglecting the dynamic relationships between formal and informal providers as they negotiate the nature and allocation of caregiving as work. Data from a Canadian study of community nurses providing care to frail elders over the age of 65 years, and family members also providing such care, are used to illustrate the utility of a new model grounded in socialist-feminist thought. Study findings suggest a number of implications for future theory development and research. D

The Caregiving Dilemma: Work in an American Nursing Home. Nancy Foner

American Anthropologist, 2009

seminar made up of medical anthropology graduate students and residents-in-haining. using this book as a starting point for discussion. Students coming out of such a class would be well prepared to integrate anthropology and medicine, not only theoretically but also practically. These, at least, are my optimistic responses to the book. Kaufman movingly documents the best of medicine in the 20th century. Although

Paul Osterman: Who Will Care for Us? Long-term Care and the Long-term Workforce

Administrative Science Quarterly, 2018

This important book focuses on ways to improve the quality and cost of services for elders and disabled individuals who need help over long periods with daily activities, such as shopping and getting dressed, as well as help coping with physical and developmental disabilities, especially chronic conditions such as heart disease and diabetes. Policy makers, managers, and workers in the field of long-term care should attend carefully to the thoughtful and cogent proposals that Osterman makes to improve services in this field. This book also matters for a great many of us, because we are either aging or have responsibility for the welfare of aged family members and friends. In 2015, 33 million Americans reported that they had difficulty taking care of themselves or living independently. Aging baby boomers will soon make this number look small. The book's main argument is that it is both desirable and feasible to improve the jobs and circumstances of so-called direct care workers-the individuals who provide most long-term care services. These workers fall into three groups: unpaid family and friends; home care aides; and, in nursing homes, certified nursing assistants (CNAs). Osterman argues that expanding the role of direct care workers will save money and result in better health outcomesreducing unnecessary visits to emergency rooms, hospitals, and nursing homes-by shifting tasks to lower-paid occupations. Osterman proposes that, in their new roles, direct care workers would work in teams to better leverage their skills; focus on managing the multiple chronic conditions that are common to aging and disabled individuals; and manage transitions from acute care to home settings and, as needed, to nursing homes. The book focuses mainly on home care aides, in part because they are the most understudied of the three types of direct care workers, but more importantly because elderly and disabled individuals overwhelmingly prefer to live at home, and home care aides must play a major role to make this happen. The book consists of three sections. In part 1, ''The State of Play'' (chapters 1-5), Osterman describes the long-term care workforce, discussing who they are, what they do, how they are treated and viewed, and the nature of their labor market. A key point is that direct care workers receive little respect. Powerful actors, including physicians, hospital managers, regulators, elected officials, and insurance companies, do not think that home care aides can be real members of a care team. Osterman (p. 7) puts it starkly and well: ''Home care aides are seen as unskilled companions, or glorified babysitters, with little education and little potential. Belief in them is scarce. The fact that home care aides are women and disproportionately racial minorities or immigrants does

Families and Elder Care in the Twenty-First Century

The Future of Children, 2011

Although most Americans know that the U.S. population is aging, they are far less informed about the reality of providing elders with personal care, health care, and social support. Families-particularly women-have always been critical in providing elder care, but the entry of so many women into the paid labor force has made elder care increasingly difficult. Ann Bookman and Delia Kimbrel show how changes in both work and family life are complicating families' efforts to care for elderly relatives. Because almost 60 percent of elder caregivers today are employed, many forms of caregiving must now be "outsourced" to nonfamily members. And because elders are widely diverse by race and socioeconomic status, their families attach differing cultural meanings to care and have widely different resources with which to accomplish their care goals. Although the poorest elders have access to some subsidized services, and the wealthiest can pay for services, many middle-class families cannot afford services that allow elders to age in their homes and avoid even more costly institutional care. Six key groups-health care providers, nongovernmental community-based service providers, employers, government, families, and elders themselves-are engaged in elder care, but their efforts are often fragmented and uncoordinated. All six groups must be able to work in concert and to receive the resources they need. Both employer and government policies must be improved. Although large businesses have taken up the elder care challenge, most small and mid-sized firms still do not offer flexible work arrangements. Social Security and Medicare have provided critical support to families caring for elders, yet both face significant financial shortfalls. The Older American Act and the National Family Caregiver Support Program have broadened access to elder services, but need updating to address the needs of today's employed caregivers and elders who want to "age in place." And just over half of the nation's workforce is eligible for the unpaid leave benefits provided by the Family and Medical Leave Act. The authors close by reflecting on the need for a coordinated, cross-sector movement to create an "aging-friendly" society in the United States-a society that values well-being across the life span and supports citizens from diverse cultures and income levels as they age.

Aging enacted in practice: How unloved objects thrive in the shadows of care

Journal of Aging Studies, 2024

In this paper, we explore the seeming stability of aging. More precisely, we offer an empirical account of how aging – images of aging, embodiments of aging, feelings about aging – is enacted in company practice, both in place and across time. Drawing on ethnographic fieldwork conducted at SMCare, a small-to-medium sized company active in the care technology sector, we show how aging achieves its stability not through practices that are characterized by affection, or purposefully targeted at maintaining or caring for aging, but due to ongoing re-enactments in the shadows of other care practices. In so doing, we mobilize STS care literature that foregrounds the often-invisible relationships among objects that are otherwise neglected, marginalized and excluded. In particular, we interrogate the interlinkages between aging and caring practices as emerging in the shadows of care. In these blind spots, we find, certain unloved and disliked objects such as aging may aggregate and grow, becoming stable and durable as they are incidentally brought into existence, drawing energy from, and feeding off, other care practices.

The economic shift and beyond: Care as a contested terrain in contemporary capitalism

Current Sociology, 2018

This article argues that we are witnessing a fundamental transformation of capitalism. Under the auspices of an economic shift, social reproduction and constituent care and care work are undergoing a process of reorganization. The first part draws on Karl Polanyi’s analysis of the relation between market and society and on contemporary revisions of his approach. Referring to core arguments from his perspective on the market society it identifies processes of commodification, marketization and quasi-marketization, which we can understand as an economic shift driving the development in the field of care and care work. The second part refers to empirical studies in Austria and Germany and reflects in terms of a Polanyian double movement on how far care and care work – in the case of elder and child care and, more precisely, home care agencies, residential care communities and the social investment state – have become a contested terrain. The third part, the conclusion, points out how t...