Abstract
This book provides a very detailed account of how the history of home care in the USA has shaped the employment terms and conditions of the ‘home health workers’ providing this care.
Although the terminology of home care varies greatly across cultures, eras and ideologies the key role of the home health worker remains the same, to ‘perform intimate daily tasks […] that enable people to live decent lives at home’ (p. 5). This includes attending to their health care, personal hygiene, well-being and home environment. Their clients are those whose physical or mental health prevents them from fulfilling their own care needs, typically older or disabled people. Yet as Boris and Klein so passionately question, ‘How did we arrive at this point that the labor necessary to sustain life became invisible, under-compensated and defined as not really work?’ (p. xiv).
This is the core question that the book addresses throughout: why are home care workers so belittled? The first section of the book charts the development of home care in the USA throughout the 20th century and analyses the impact of key activities and policies. Although the authors focus on the USA, there appears to be a depressingly similar situation in the UK. The book highlights multiple reasons for the devaluation of home carers’ labour. These include attempts to reduce the costs of home care; the stigma attached to receiving or giving care; the privatization of care services; sexist, racist and class stereotypes about suitable home care workers; the conflict between health and social care in terms of the role and responsibilities of home care; tensions between the needs of clients and care workers; government policies; and limited and decreasing union power.
In many ways the undervaluation of home care appears more extreme in the USA than is the case in the UK. The authors highlight the exclusion of home health workers from employment legislation because their work takes place in someone else’s home. Thus they are rarely even recognized as workers and are often denied minimum wages, sick pay, health care or other employment rights and benefits. Additionally, the book reveals that American home care suffers further stigma as it is an occupation into which welfare recipients have been forced, either as a condition of their own benefits or as a form of rehabilitation, thus further promoting the perception of home care as both an undesirable and unskilled job. The authors ask whether this stigmatization benefits the state, which is able to meet both care and welfare requirements at lower costs as a result of the negative representations of home care.
Surprisingly despite – or perhaps because of – such adversity, the fight for unionization for home care workers in the USA seems to be a key part of their history. A large section of the book is devoted to explaining the history of the different unions’ campaigns for home carers to be recognized as workers with appropriate employment rights. The complexity of home care workers’ employment relations and the difficulties in identifying an official employer have resulted in long and drawn-out battles for the unions.
The authors reveal that the nature of home care required union adaptation. In this context this meant a shift into community organizing, grass roots campaigns and linking the needs of clients and workers together, for instance through joint protests. It seems that the unions had some successes in this, including increasing pay and conditions for some home care workers. Yet they faced many internal battles, such as conflicts over strategies for organizing home care, as well as external ones, such as the lack of recognition of home care as work.
By the end of the book, the authors have reached this decade and their account suggests that union power has been severely diluted. The current recession and changes in healthcare are argued to have had a profoundly negative effect on home care, undermining working conditions in the sector. The authors argue that the receiving or providing of care has been further devalued by government policies. Yet, simultaneously the book demonstrates that the USA’s need for care continues to expand at pace, due to its aging population. The authors call for a revaluation of care work based on the relationships care workers create with their clients, comparing it to occupations such as teaching, in order to recognize ‘care as productive and necessary labor’ (p. 225).
This is an important book that will help develop understandings of how home care has been actively devalued and the challenges that workers face in gaining recognition for the value of their work. It would be particularly suited for researchers interested in union organizing, home care and employment relations.