Caring for America: Home Health Workers in the Shadow of the Welfare State

Caring for America: Home Health Workers in the Shadow of the Welfare State

Caring for America: Home Health Workers in the Shadow of the Welfare State

Caring for America: Home Health Workers in the Shadow of the Welfare State


In this sweeping narrative history from the Great Depression of the 1930s to the Great Recession of today,Caring for Americarethinks both the history of the American welfare state from the perspective of care work and chronicles how home care workers eventually became one of the most vibrant forces in the American labor movement. Eileen Boris and Jennifer Klein demonstrate the ways in which law and social policy made home care a low-waged job that was stigmatized as welfare and relegated to the bottom of the medical hierarchy.

For decades, these front-line caregivers labored in the shadows of a welfare state that shaped the conditions of the occupation. Disparate, often chaotic programs for home care, which allowed needy, elderly, and disabled people to avoid institutionalization, historically paid poverty wages to the African American and immigrant women who constituted the majority of the labor force. Yet policymakers and welfare administrators linked discourses of dependence and independence-claiming that such jobs would end clients' and workers' "dependence" on the state and provide a ticket to economic independence. The history of home care illuminates the fractured evolution of the modern American welfare state since the New Deal and its race, gender, and class fissures. It reveals why there is no adequate long-term care in America.

Caring for Americais much more than a history of social policy, however; it is also about a powerful contemporary social movement. At the front and center of the narrative are the workers-poor women of color-who have challenged the racial, social, and economic stigmas embedded in the system.Caringfor Americatraces the intertwined, sometimes conflicting search of care providers and receivers for dignity, self-determination, and security. It highlights the senior citizen and independent living movements; the civil rights organizing of women on welfare and domestic workers; the battles of public sector unions; and the unionization of health and service workers. It rethinks the strategies of the U.S. labor movement in terms of a growing care work economy. Finally, it makes a powerful argument that care is a basic right for all and that care work merits a living wage.


The Personal Is Prologue

In March 2003, as the Bush administration launched its attack on Iraq, we came together to hammer out a conference paper on the role of public policy in shaping America’s long-term care system. Our collaboration clicked, but how we each came to write this book illustrates the ways that personal narrative intersects with scholarship. It’s not just that the past is prologue, as the very stonework of the National Archives in Washington, D.C., declares—so is the personal. Here are our stories.

Eileen’s Story

Barely settled in California in June 2001, I responded to a call from the United Domestic Workers of America to testify before the Santa Barbara County Board of Supervisors. The year before, the state legislature had mandated that all counties become, for collective bargaining purposes, the employer of In-Home Supportive Services (IHSS) workers. I was to use my position as a professor to argue for the creation of a public authority to set standards and provide training for personal attendants and other home aides. It wasn’t my explanation of how the care we applaud as a labor of love deserves living wages and benefits that led the supervisors to pass enabling legislation. I’d like to think that it was the testimony of the givers and receivers of care, and their daily struggles for dignity, that convinced the elected officials that care work is worthy of compensation. Probably the county supervisors looked at the budget and figured that because home care, with its low-wage workforce, is cheaper than institutionalization, they’d rather cut a deal with the union than lose state funding.

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