Making Care Work: Sustaining Personhood and Reproducing Inequality in Home Care of Older Adults in Chicago, IL.

Abstract

This dissertation explores the ways that everyday paid home care of older adults in Chicago, IL reproduces social inequality in the process of making and unmaking independent persons. Integrating theory and methods from social work and anthropology, this dissertation is based on ethnographic research conducted between 2006 and 2008 with supervisors, home care workers, older adults and family members associated with one publicly-funded and one privately-funded home care agency. The dissertation highlights the ways social policy and agency practices intersect with people’s meanings and experiences of home care. Older adults experienced home care as a liminal practice through which the invasion of bureaucratic and corporate ethics into their domestic lives was seen as threatening their independence and personhood. By participating in risky gift exchanges, workers and older adults restored expected domestic relations and positioned one another as moral subjects. Home care workers labored to sustain older adults’ social relations and independence even as the structural conditions of this labor threatened their ability to support their families.

Workers sustained older adults’ independence and personhood by a process I call phenomenological empathy, that is, sensing, imagining and incorporating older adults’ lifetimes of embodied tastes into everyday care practices, all the while suppressing their own. Given the political-economic structures of both private and public home care in the United States, the capacity of workers to sustain older adults as visibly independent persons was actually facilitated by their own social marginality, even invisibility, as predominantly poor women of color or of immigrant status. Paradoxically, the invisibility of care work and home care workers makes possible the reproduction of recognizably autonomous persons, while reproducing social stratification in the process. Disrupting the reproduction of inequality that attends home care work requires public investments that improve the structural position of workers and broader public consideration of the social supports that independence and individualism actually require in practice. The study of paid care thus offers a critical perspective on how some kinds of persons come to be valued, made, reproduced and sustained over others and policies and practices through which these processes might be made more equitable.