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Caring on the Clock

Caring on the Clock: The Complexities and Contradictions of Paid Care Work

Copyright Date: 2015
Published by: Rutgers University Press
Pages: 350
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  • Book Info
    Caring on the Clock
    Book Description:

    A nurse inserts an I.V. A personal care attendant helps a quadriplegic bathe and get dressed. A nanny reads a bedtime story to soothe a child to sleep. Every day, workers like these provide critical support to some of the most vulnerable members of our society.Caring on the Clockprovides a wealth of insight into these workers, who take care of our most fundamental needs, often at risk to their own economic and physical well-being.

    Caring on the Clockis the first book to bring together cutting-edge research on a wide range of paid care occupations, and to place the various fields within a comprehensive and comparative framework across occupational boundaries. The book includes twenty-two original essays by leading researchers across a range of disciplines-including sociology, psychology, social work, and public health. They examine the history of the paid care sector in America, reveal why paid-care work can be both personally fulfilling but also make workers vulnerable to burnout, emotional fatigue, physical injuries, and wage exploitation. Finally, the editors outline many innovative ideas for reform, including top-down and grassroots efforts to improve recognition, remuneration, and mobility for care workers.

    As America faces a series of challenges to providing care for its citizens, including the many aging baby boomers, this volume offers a wealth of information and insight for policymakers, scholars, advocates, and the general public.

    eISBN: 978-0-8135-6313-8
    Subjects: Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. List of Figures
    (pp. ix-x)
  4. List of Tables
    (pp. xi-xii)
  5. Foreword
    (pp. xiii-xvi)

    In writing here, I have the privilege and honor of wearing two hats. The first hat, and the reason I initially volunteered to write a foreword forCaring on the Clock, was so that I could reflect, at least briefly, on the many changes in the study of care work since my sister Emily K. Abel and I edited one of the first collections on this topic almost twenty-five years ago.

    To be sure, as we brought together the fifteen chapters ofCircles of Care: Work and Identity in Women’s Lives(1990), we were attentive to a range of the...

  6. Acknowledgments
    (pp. xvii-xviii)
  7. Part I Paid Care Work

    • 1 On the Clock, Off the Radar: Paid Care Work in the United States
      (pp. 3-13)

      A nurse inserts an I.V. A teacher helps a child with his math. A social worker visits a new mother. A personal care attendant helps a quadriplegic bathe and get dressed. A nursing assistant feeds an elderly resident of a nursing home, the meal prepared by a dietary aide. A nanny reads a bedtime story to soothe a child to sleep. Every day workers like these provide critical support to some of the most vulnerable members of our society.Caring on the Clockis about these workers and others like them who perform the essential labor of taking care of...

    • 2 Beyond Outsourcing: Paid Care Work in Historical Perspective
      (pp. 14-26)

      These quotations from feminist scholars who have come before me capture perfectly the two reasons for the critical need for an accurate and nuanced understanding of the history of paid care work. First, we have in the United States a particular social organization of care, a way of defining and dividing up the labor of taking care of people. Importantly, our contemporary landscape of care is neither inevitable nor universal, but rather is the result of specific historical processes. Without an examination of the historical actors and events that led to an organization that links paid care work with women,...

  8. Part II Contexts of Care

    • [Part II Introduction]
      (pp. 27-30)

      In the public imagination, family care represents the gold standard against which all forms of paid care work are measured. Although we know from both research and experience that families can be riddled with problems, paid care is often compared to an idealized version of family in which a loving relationship provides the basis for responsive, person-centered care. In this scenario, not surprisingly, the focus always lands on the shortcomings of care when it is performed as paid labor. However, like real family care, real paid care exists within a range of contexts. Truly understanding paid care, its potential, and...

    • 3 The Best of Both Worlds? How Direct Care Workers Perceive Home Health Agencies and Long-Term-Care Institutions
      (pp. 31-41)

      Care for American seniors and those with extended illnesses or disabilities takes place primarily in two places: institutions and residential homes. Nearly 2 million direct care workers are employed by home health agencies and residential care facilities, and growth in the number of these workers is projected (National Occupational Research Agenda [NORA] 2009). These two settings shape the kinds of labor performed as well as the workers’ subjective experiences of their labor. Similarly, the organization and location of care work influences workers’ outcomes. In home agency work, caregivers’ workplaces and the supervisory, organizational structure are largely independent, whereas for residential...

    • 4 The Business of Caring: Women’s Self-Employment and the Marketization of Care
      (pp. 42-53)

      Most empirical studies of care work focus on employer-employee relationships (Parrenas 2001; Spitzer, Bitar, and Kalbach 2002; Zimmerman, Litt, and Bose 2006). Little research exists on self-employed paid care workers, who hold a different legal and market status. This gap is important, given the expansion of women’s self-employment in many industrialized countries (Brush et al. 2006; Budig 2006a, 2006b; Hughes 2005; McManus 2001; Minniti et al. 2005) and the significant number of self-employed workers engaged in caring labour. Theorists such as Saskia Sassen (2002) and Clare Ungerson (2005), however, highlight the growing role of self-employment in global care work, noting...

    • 5 Are Frontline Healthcare Jobs “Good” Jobs? Examining Job Quality across Occupations and Healthcare Settings
      (pp. 54-66)

      The housekeeper who empties the trash can in the hospital room. The nursing assistant who helps a nursing home resident to the bathroom. The unit clerk who organizes patient charts. The surgical technician who prepares the operating room. These workers—and others with similar skills and compensation—make up the frontline healthcare work force, an often overlooked but large and growing segment of healthcare workers. In this chapter, frontline healthcare workers are defined as those who (1) are in occupations with a low threshold to entry (typically a high school degree with little additional training), (2) provide direct care or...

    • 6 Orienting End-of-Life Care: The Hidden Value of Hospice Home Visits
      (pp. 67-78)

      The location of care, especially at the end of life, is a complex issue that affects care workers as well as care recipients. While today a great deal of the most intensive care leading up to death takes place in institutional settings like hospitals, skilled nursing facilities, or nursing homes (Brown University 2004; Gruneir et al. 2007), most Americans report a desire to remain at home during their final days (Hays et al. 2001; Whittington 2011). There are many reasons this may be so: institutional settings are perceived as cold, uncomfortable, and clinical, while the home is associated with family,...

  9. Part III Hazards of Care

    • [Part III Introduction]
      (pp. 79-82)

      As they care for the bodies and minds of others, care workers regularly put their own physical and psychological health at risk. While understanding the vulnerability of the individuals being cared for, it is important not to obscure the vulnerability of the workers themselves. Some of these hazards have been studied extensively by occupational safety and health researchers, but their findings have rarely crossed over into the care work literature. We bring these literatures together in this section, with chapters that explore the unique hazards encountered by care workers, strategies for reducing these risks, and obstacles to change.

      Not only...

    • 7 The Health Hazards of Health Care: Physical and Psychosocial Stressors in Paid Care Work
      (pp. 83-93)

      Healthcare institutions such as hospitals and nursing homes are places where many people seek and receive medical services to improve their health. Yet the workers who provide that care, including registered nurses (RNs), licensed practical nurses (LPNs), nursing assistants (NAs), and many others, are exposed to conditions on the job that threaten their own health. These hazards cover the full range of risk factors for injury and illness: biological agents such as viruses, toxic chemicals such as cleaning agents, heavy lifting and other types of forceful exertions, physical and verbal assault, and stressors with psychological as well as physiological effects...

    • 8 When the Home Is a Workplace: Promoting Health and Safety for a Vulnerable Work Force
      (pp. 94-103)

      According to the Bureau of Labor Statistics, the first and second fastest growing occupations in the United States are home health aides and personal and home care aides, both of which are projected to grow close to 50 percent by 2018 (U.S. Department of Labor Bureau of Labor Statistics [BLS] 2012a, 2012b). Although the home care industry is one of the fastest growing sectors in the United States, the home care work force is relatively invisible, in part because they are predominantly female, low wage, socially diverse, and often immigrants. The term “home care provider” is used to represent a...

    • 9 Part of the Job? Workplace Violence and Social Services
      (pp. 104-116)

      Sit down with a group of social service workers to discuss workplace violence, and sooner or later someone will explain that workplace violence is simply “part of the job”; around the table heads will nod in agreement. This significant workplace hazard—estimated to impact 1.7 million U.S. workers annually (U.S. Department of Labor Occupational Safety and Health Administration [OSHA] 2012)—is at best accepted, and at worst invisible, among the social service work force. What data exist suggest that, were workplace violence adequately understood, the prevalence would be daunting. A review of studies since 1990 found that 3 to 30...

    • 10 Double Isolation: Immigrants and Older Adult Care Work in Canada
      (pp. 117-126)

      As many of our societies age, we become particularly concerned with the relative availability of care work and care workers, as well as with the appropriateness of the social organization of care for older adults either in the community or institutional sector. Many argue that high-income Western nations have a shortage of care workers, and this shortage is expected to become much more acute with the aging of the population and the parallel aging of care workers (Organization for Economic Cooperation and Development [OECD] 2010). Together, these changes will create an even greater challenge to the sustainability of older adult...

  10. Part IV Identities and Meaning Making

    • [Part IV Introduction]
      (pp. 127-130)

      One objective of this volume is to understand how care workers themselves define, describe, and make sense of their labor. The meanings that paid caregivers attach to their work are complex and at times contradictory. Yet, these subjective experiences of their own identities as care workers have a profound impact on worker outcomes like job satisfaction, burnout, and turnover—which in turn have important implications not only for individual workers but also for the collective provision of care to those who need it. A deep exploration of the cultural meanings of paid care work and the subjective experiences of care...

    • 11 The Caring Professional? Nurse Practitioners, Social Work, and the Performance of Expertise
      (pp. 131-142)

      It is not a rare sight to see the slogan “Doctors Cure, Nurses Care” emblazoned on nurses’ t-shirts or announced on bumper stickers. Although perhaps overstated, this pithy catchphrase hits squarely at the core of nursing’s claims to occupational legitimacy. Since its first efforts to reframe sick care done in the family circle as the province of trained nurses, nursing has sought to elevate care as both a skill and a unique area of expertise. Even though the actual work that nurses perform has become ever more specialized and technical, the profession still understands its work as unique in how...

    • 12 Building a Professional Identity: Boundary Work and Meaning Making among West African Immigrant Nurses
      (pp. 143-152)

      I met Arthurlina, a fifty-year-old nurse from Sierra Leone, on a hot summer’s day in Washington, DC. Arthurlina is a tall, imposing woman with a booming voice and an even bigger laugh. She reflected on a career that began when she trained as a nurse in her homeland after completing her high school education. After migrating to the United States, she worked as a certified nursing assistant while going to nursing school. At the time of our meeting, Arthurlina was the director of nursing at a nursing home in a DC suburb. Women like Arthurlina who migrate from West Africa...

    • 13 Ethnic Logics: Race and Ethnicity in Nanny Employment
      (pp. 153-164)

      Care for very young children is arguably one of the most emotionally fraught areas of market-based care work. Although most Americans accept the educational benefits of institutional kindergarten and even preschool education, care for children birth to age three is still considered to be the realm of mothers (Duffy 2011; Hays 1996). Given their role as maternal substitutes, childcare workers must navigate a perilous line between giving good care and threatening the mother’s place as primary parent (Macdonald 2010). Further, care for the very young has yet to be fully professionalized, so outside of institutionalized day care, education and credentialing...

    • 14 Caring or Catering? Emotions, Autonomy, and Subordination in Lifestyle Work
      (pp. 165-176)

      In interviewing providers of a wide variety of lifestyle services, from personal assistance to interior design to real estate, I was struck by how much they talked about the emotional aspects of their work. Personal concierges,¹ for example, described having to listen to clients’ personal problems “like a therapist.” Gabrielle, a financial advisor, recounted repeatedly driving three hours round trip to have tea with an elderly, recently widowed client not to talk about her portfolio, which was “fine,” but simply because “she’s lonely, and she’s scared.” Zoe, an art advisor, told me her job involved providing “a lot of reassurance”...

  11. Part V Work and Family

    • [Part V Introduction]
      (pp. 177-178)

      It would be impossible to offer a comprehensive view of paid care without also considering the question of family. Work and family intersect for paid caregivers in many noteworthy ways: paid care workers often must juggle their job obligations with unpaid care responsibilities at home, many families rely on paid care workers to meet their essential care needs, and cultural ideologies of family and work permeate the experiences of paid care workers. These chapters show that paying people to do care work is not, as it is often posed, theoppositeof family care. In fact, family care is both...

    • 15 Low-Wage Care Workers: Extended Family as a Strategy for Survival
      (pp. 179-188)

      One might not expect a union bargaining session to be the best place to uncover conflicts over views of the family, but sometimes it is. Take this example. We observed a bargaining session between nursing assistants and the nursing home where they worked. Six “bosses” (as the workers called them), including the white lawyers and the management of the nursing home, sat at the front across from the fifteen people who made up the union negotiating committee (union staff and worker representatives, almost all women and mostly people of color). There were fifteen or so workers in the audience in...

    • 16 “It’s Like a Family”: Caring Labor, Exploitation, and Race in Nursing Homes
      (pp. 189-200)

      Over the last two decades, a “crisis in care” has provoked difficult questions about the meaning and value of purchased care in contemporary society. Historically, family relationships and the market have been considered separate worlds, yet care work, traditionally a taken-for-granted female activity, has increasingly demanded market valuation as millions of women left homemaking for paid employment, expanding the need for hired care providers. The United States’ ever-growing population of elderly and chronically ill people has made long-term care an urgent and complex demand. As in the past, those who enter the low-paid care labor market tend to be poor...

    • 17 Caught between Love and Money: The Experiences of Paid Family Caregivers
      (pp. 201-212)

      In her afterword to the twentieth anniversary edition ofThe Managed Heart, Arlie Hochschild argues that new scholarship on work and emotional labor must consider what she calls the “third sector” of social life, where forces of family and market collide (Hochschild 2003b). Instead of considering labor solely in the context of public life, she asks us to investigate what happens to social norms and work expectations when private space (that is, the home) becomes a site of work. Put succinctly, Hochschild seeks to understand what happens when private life becomes “marketized.”

      Here we take up Hochschild’s call by examining...

    • 18 Paying Family Caregivers: Parental Leave and Gender Equality in Sweden
      (pp. 213-224)

      In the spring of 2013, prominent media in the United States exploded with the report that women were the primary breadwinners in some 40 percent of American families, including single parent families but also dual earner families where wives earn more than husbands (Wang, Parker, and Taylor 2013). This trend causes us to rethink our assumptions about families. It also leads us to a long-standing care-work dilemma in American family life: how to reconcile women’s work as breadwinners with the expectation that they serve as primary caregivers for young, old, and disabled family members. Family care work, still largely performed...

  12. Part VI Paths to Change

    • [Part VI Introduction]
      (pp. 225-228)

      Given the inadequacy of resources in the care work sector, it is not surprising that many of the jobs explored in this volume are what Arne Kalleberg (2011) characterizes as “bad jobs,” with low pay and lack of benefits. In this section, scholars engage with efforts to improve working conditions in the care sector, exploring policy and practice innovations as well as worker perceptions of movements for change.

      Some of these chapters describe efforts that focus on improving the pay and conditions of the “worst” care jobs through grassroots advocacy, unionization, or professionalization. For example, Deborah Little highlights the work...

    • 19 For Children and Self: Understanding Collective Action among Early Childhood Educators
      (pp. 229-239)

      At just twenty-five years old, Camilla already has more than a decade of experience working in early education. Today she is the director of Happy Feet, an early education center located in a midsized suburban community in central Massachusetts. There Camilla manages a budget of more than a half million dollars and a staff of over twenty teachers and assistants. The first time I met Camilla, she was leading a professional development workshop for twenty teachers in her region. The workshop was in a large basement classroom at her center. Despite the absence of windows, cheery yellow paint, student art,...

    • 20 Creating Expertise and Autonomy: Family Day Care Providers’ Attitudes toward Professionalization
      (pp. 240-250)

      While most agree that something needs to be done to raise compensation levels and improve working conditions for care workers, no consensus exists regarding what that something should be. Many suggestions—including those in this volume—rely on some kind of collective action, bringing together groups of workers to advocate for change. These efforts tend to head in one of two directions: either unionization efforts that involve mobilizing as many workers as possible to agitate for change, or professionalization strategies, which attempt to draw boundaries around some workers to justify the raising of status and compensation for that group. For...

    • 21 Building a Movement of Caring Selves: Organizing Direct Care Workers
      (pp. 251-262)

      It is 2012 and I am observing training for a pilot senior certified nursing assistants (CNA) program, jointly developed by the Direct Care Alliance (DCA) and a large nursing home corporation in the New York metropolitan area. The DCA is demonstrating the challenges of building alliances with other stakeholders. They have divided the CNAs into three groups representing employers, workers, and seniors. The workers group is requesting higher wages, while the seniors group is asking for more prescription drug coverage. Jose says, “Without decent pay, you get bad workers. Bad workers can lead to bad medication delivery.” Maria replies, “But...

    • 22 Healthy Diversity: Promoting a Diverse Healthcare Work Force Through Innovative Partnerships
      (pp. 263-274)

      Within paid care occupations, women and ethnic/racial minorities are disproportionately likely to occupy lower status and lower wage positions than their white male counterparts (England 2005). Staffing trends within the healthcare system are no exception; while there is some diversity among entry-level healthcare workers, ethnic/racial diversity within the ranks of more credentialed healthcare providers is lacking (Sullivan Commission 2004). Though 21.9 percent of workers in healthcare support occupations (typically unlicensed positions) are African American (U.S. Bureau of Labor Statistics 2012b), African Americans account for only 5.6 percent of employed nurses (U.S. Department of Health and Human Services [DHHS] 2011). Hispanics...

    • 23 Building Meaningful Career Lattices: Direct Care Workers in Long-Term Care
      (pp. 275-286)

      The long-term care services sector in the United States depends greatly on direct care workers (DCWs). In institutional care, for example, it is estimated that 80 to 90 percent of care is provided by DCWs such as nursing assistants. In addition, there has been unprecedented job growth in home- and community-based care, particularly with home care workers and personal care aides. The demand for DCWs (workers who provide direct care in all kinds of long-term care settings such as nursing homes, adult care homes, and home care) is driven, in large part, by the increased proportion of older adults in...

  13. Epilogue: Making Paid Care Work
    (pp. 287-292)

    Our hope in bringing together this body of research is that it will serve to advance both empirical knowledge and theoretical development across a range of academic and policy arenas. We see this book as part of ongoing dialogue about care, and our expectation is that students, scholars, and policymakers will find within these pages different threads of conversation that connect to their specific areas of interest. In these last pages of the book, we highlight a few themes that emerge from the volume as a starting point for further discussion, research, and advocacy.

    Leo Tolstoy famously wrote inAnna...

  14. References
    (pp. 293-316)
  15. Notes on Contributors
    (pp. 317-324)
  16. Index
    (pp. 325-332)