Abstract
As we confront the aging of the U.S. population, the growing need for care, and the shortage of direct care workers to meet that need, we need to understand the experiences of the workers who provide care, particularly for the growing number of elderly and disabled living at home. Clare Stacey’s detailed ethnography of home care aides is a wonderful contribution to this understanding.
Stacey makes three important contributions to the literature on care work. First, she documents the career paths of the aides she studies, a path she calls a “caring trajectory.” Home care aides begin by providing informal care to family and friends, often for long periods, before becoming paid care workers. This care work becomes part of a narrative in which workers see their emotional capital as a natural skill that they bring to their work.
Second, Stacey reminds us that the context in which care is provided matters. Relationships between care recipients and care providers are obscured when the boundaries of home and work are not clearly marked, leading, for example, to situations in which workers are asked to perform surplus, unreimbursed care. More important, she argues, is the fact that these care workers often share the same disenfranchised social status as their clients. When both employer and worker are relatively disempowered by their respective race, age, ability, or socioeconomic status, the usual employer/employee hierarchy is blurred and the work relationship is more apt to mimic informal caring bonds than is the case in other care work settings. In this situation, Stacey finds that the emotional connection between care worker and care recipient, and the labor associated with that connection, become central to the work experience.
Workers respond by constructing a “caring self,” a situated workplace identity that permits aides to “communicate to themselves and others that their work is altruistically motivated and of high quality” (p. 107). With this contribution, Stacey fills a major gap in our understanding of why care workers continue to perform this labor despite stigma and exploitative working conditions. It is not solely the case that workers remain in care work because of their limited labor market opportunities. Instead, Stacy documents that many of the workers choose this kind of work over other types of care work or low-wage employment. Given the difficult working conditions documented by Stacey in the first half of the book including financial strains, unpredictable work, chronic physical injury, high levels of responsibility with insufficient training, bureaucratic constraints, and extensive emotional demands, why do workers continue to perform care work? The answer, she argues, lies in the caring self.
In the second half of the book, Stacey demonstrates how home care aides engage in “identity work” and “identity talk” to construct the caring self. The aides emphasize that care work offers functional and relational autonomy, personal rewards, and a sense of dignity that they do not find in other service sector jobs. In their identity talk, aides claim that their care is natural or innate, emphasize the ways in which their work involves service to others (downplaying their needs for adequate wages), and draw boundaries between themselves and uncaring others. Thus, the work conditions and relational demands that lead to exploitation also lead to the construction of a work identity that provides dignity for these direct care workers. Relying on their caring trajectory, workers identify the emotional capital gained from years of experience as a natural ability. The workers find autonomy to provide care on their own terms in a work setting removed from daily interference by superiors or the client’s family. This autonomy includes freedom to schedule and perform work tasks and, more importantly, freedom to invest emotionally in clients by cultivating companionship on their own terms. Finally, aides draw boundaries between themselves and family members or doctors by emphasizing their superior understanding of care recipients and caregiving skills. They distinguish themselves from other aides who are incompetent or uncaring. By drawing boundaries “above” and “below,” the aides craft an altruistic work identity for themselves. In a brief analysis of race and racism, Stacey finds that nonwhite aides engage in the same type of boundary drawing to construct their own caring work as superior to that of white care workers.
Stacey also discusses the possibilities for organizing home care workers, weaving existing research on organizing caregivers into a discussion of views expressed by the aides. While her sample is small, Stacey argues that the subjective voice of workers is needed in the literature on organizing. She asks whether the caring self enables or impedes workers’ beliefs in collective labor rights and concludes that labor organizers should place the relational aspects of care work at the center of organizing efforts. Organizers and care researchers should pay attention to this book.