Caring Self , livre ebook

T HE C ARING S ELF
The Work Experiences of Home Care Aides
C LARE L. S TACEY
ILR P RESS
AN IMPRINT OF
C ORNELL U NIVERSITY P RESS
I THACA AND L ONDON
For my parents
C ONTENTS Acknowledgments Introduction: On the Front Lines of Care 1. The Costs of Caring 2. Doing the Dirty Work: The Physical and Emotional Labor of Home Care 3. The Rewards of Caring 4. Organizing Home Care Conclusion: Improving the Conditions of Paid Caregiving Appendix: Methods Notes References
A CKNOWLEDGMENTS
Meeting and talking to nursing aides over the last ten years has given me a very real appreciation of what it means to care for another person. Watching aides interact with elderly or disabled clients opened my eyes to the stresses associated with care, and also convinced me that caregiving—especially when carried out in the right conditions—can affirm social ties and give lives meaning, whether we are on the giving or receiving end. I am indebted to the paid caregivers who agreed to talk with me and share their daily experiences. I thank them for opening up their homes and sites of work, and for their candor in talking about both the rewards and constraints of the job. It is my hope that the reading public will take note of their stories and begin to question the low wages and lack of labor protections afforded these workers.
In writing this book, I benefited from the care and support of many people. At the University of California-Davis, mentors, friends, and colleagues read through rough drafts, listened to inchoate ideas, and supported me unconditionally, even during my most neurotic and disorganized moments. Many faculty members were instrumental in guiding me through graduate school, including Carole Joffe, Debora Paterniti, John Hall, and Mary R. Jackman. I am particularly grateful to Vicki Smith and Ming-Cheng Lo for their advice and encouragement. Thanks also to Janet Gouldner and the editorial collective of Theory and Society for keeping me on my toes. My writing group pals, Jeff Sweat and Anna Muraco, saw me through the dissertation year, while Andreana Clay, Magdi Vanya, and Zach Schiller sustained me with friendship and critical conversation. For helping me gain access to home care workers, I thank the many supervisors and administrators at In-Home Supportive Services (IHSS), as well as the social workers and public health nurses who allowed me to shadow and interview them. I also wish to acknowledge the Institute for Research on Labor and Employment at UC Berkeley for granting me a dissertation-year fellowship in 2003–4.
My postdoctoral years at the Institute for Health Policy Studies at UC San Francisco provided me with a strong foundation in health policy, training that helped me think through the wider implications of my findings. Marty Otanez and Stuart Henderson helped me adjust to post-doc life and modeled how to balance the career of a scholar with the joys and challenges of being a parent. While at UCSF I also had the good fortune to work with Daniel Dohan, a mentor who convinced me that medical sociologists can and must make their work relevant beyond academia. Dan also gave me considerable time to be with my child, Lily, after she was born, no questions asked. For that, I am forever grateful.
To my colleagues at Kent State University, thank you for giving me the encouragement and resources to complete this book. Richard Serpe championed the project from day one, while Kristen Marcussen, Dave Purcell, Susan Roxburgh, Manacy Pai, Kelly MacArthur, and André Christi-Mizell offered good humor and unwavering support. Special thanks go to Joanna Dreby, who provided constructive feedback on early drafts, and Jerry Lewis, who reassured me that I was doing things right. Several graduate students lent hours of their labor to transcribing interviews and editing the manuscript. For their dedication and attention to detail, I thank Lindsey Ayers, Christi Gross, and Timothy Adkins. I also appreciate the gift of time (in the form of a research leave) given to me by the Division of Research and Graduate Studies at Kent State during the fall of 2008.
I consider myself lucky to have support networks that seem to hold up well against time and distance. Sarah Fenstermaker inspired me to become a sociologist during my undergraduate years at UC Santa Barbara, and she remains an invaluable mentor. I am also humbled by the exceptional scholars I have met via the Carework Network, who continually push me to think more critically about my arguments. There are too many names to mention here, but I would be remiss if I didn’t at least acknowledge Mignon Duffy, Amy Armenia, Mary Tuominen, Ellen Scott, Teresa Scherzer, Julie Whitaker, Mary K. Zimmerman, and Rachel Sherman. At Cornell University Press, the editors and reviewers helped mold my thoughts into a more compelling sociological story. Thanks to Fran Benson, Sioban Nelson, Suzanne Gordon, Katherine Liu, and Eileen Boris for taking my work seriously and for guiding me through the publication process. I also benefited from the professional editorial skills of Veronica Jurgena, whose trained eye improved the manuscript considerably.
Since the early stages of this project, my friends have provided many laughs and much-needed reminders that I shouldn’t take myself so seriously. My dear pals in Sacramento sustained me with food, drink, and merriment during the first few years. I am especially thankful to Kim Dochterman and Sarah Singleton, whose stories from the field piqued my sociological interest in home care. In Kent, I benefited from regular and relaxing get-togethers with the children and adults of the Prospect Street community. I feel truly blessed to live among such a wonderful group of people. The children deserve special thanks, for reminding me that a little bit of play every day is absolutely necessary.
I would not have found the courage to finish this project without the love of my family. My parents, Rod and Chris, are to be credited for instilling in me a sense of wonder and for supporting me unconditionally as I discovered my passions. Matt and Helen, my siblings, have politely listened to my sociological rants and have forgiven the time spent away from family gatherings and events. To my family in England, I have fond memories of respites abroad; I hope to return more frequently in the coming years. Closer to home, my daughter, Lily, and my husband, Zach, bore the brunt of the stress that writing a book produces. Lily, mature beyond her years, seemed to know when I needed an extra cuddle or a quiet moment to myself. I thank her for bringing perspective to my life. Zach never wavered in his promise to help me see this through. His patience, brilliant cooking skills, and commitment to a life of balance fueled my productivity and kept me going during the slumps. I treasure our partnership.
Some interview material in the book originally appeared in C. L. Stacey, 2005, “Finding Dignity in Dirty Work: The Constraints and Rewards of Low-Wage Home Care Labour,” Sociology of Health and Illness 27 (6): 831–54.
I NTRODUCTION
On the Front Lines of Care
MR. JONES AND KEISHA
On a warm spring day in April, I accompanied Christina, a white public health nurse, to the home of an elderly African American man who suffers from heart disease, renal failure, diabetes, and mild dementia. Mr. Jones is a seventy-six-year-old man who lives alone in a subsidized housing complex in a low-income suburb of Central City. 1 His only regular visitor is his caregiver Keisha, a young African American woman who is paid to cook, clean, and care for him daily. As we approach his apartment building, Christina is sanguine about Mr. Jones’s isolation, recalling that she’d seen much worse while on her religious missions to Zimbabwe and Mozambique years ago.
As we approach Mr. Jones’s apartment, Christina motions to be quiet. After standing at Mr. Jones’s door for a few minutes, Christina realizes that there is a faint sound coming from the front window of the house. We move toward the sound as Christina calls out Mr. Jones’s name loudly. From inside, a man’s voice pleads for help. Christina straddles a bush and pushes her face against the closed window. She asks Mr. Jones to unlock the door if he can. Mr. Jones, fatigue in his voice, tells us that he has fallen out of bed and cannot get up. At this moment, we notice a young African American woman coming toward us. She introduces herself as Jodi, the acting “super” of the building. Christina asks Jodi whether she knows Mr. Jones, and she replies, laughing, that of course she knows Mr. Jones. Christina determines that Jodi does not have a key to the apartment but that Keisha, Mr. Jones’s home care aide, does. Unfortunately, Jodi has no idea how to reach Keisha.
Christina turns away from the small crowd that has now gathered outside Mr. Jones’s apartment, pulls out her cell phone, and dials 911. After about ten minutes, a fire truck pulls up in front of Mr. Jones’s apartment. In what seems like seconds, the paramedics are inside the apartment; Christina and I follow close behind. The paramedics, two young men, ask us to wait in the living room while they assess Mr. Jones’s condition. From the living room we can hear the paramedics speaking loudly to Mr. Jones, followed by the sound of a collective grunt as the patient is lifted into his wheelchair. Within minutes, Mr. Jones is wheeled out into the living room, where we wait seated on a couch covered with disheveled bed linens.
Seemingly unaware of the commotion surrounding him, Mr. Jones beams at Christina when he sees her. I assume at first that Christina has a well-established rapport with the man, but soon realize his smile is a vacant one, not one of recognition. Christina approaches Mr. Jones and asks him to tell her what happened. Mr. Jones does not respond but stretches out his hand toward Christina. Christina pauses, puts on her rubber gloves, and then takes Mr. Jones by the hand. She agai