Labors of Love: Nursing Homes and the Structures of Care Work

Labors of Love: Nursing Homes and the Structures of Care Work

Labors of Love: Nursing Homes and the Structures of Care Work

Labors of Love: Nursing Homes and the Structures of Care Work

Synopsis

Every day for the next twenty years, more than 10,000 people in the United States will turn 65. With life expectancies increasing as well, many of these Americans will eventually require round-the-clock attention- and we have only begun to prepare for the challenge of caring for them. In Labors of Love, Jason Rodriquez examines the world of the fast-growing elder care industry, providing a nuanced and balanced portrait of the day-to-day lives of the people and organizations that devote their time to supporting America's aging population. Through extensive ethnographic research, interviews with staff and management, and analysis of internal documents, Rodriquez explores the inner workings of two different nursing homes- one for-profit and one non-profit- to understand the connections among the administrative regulations, the professional requirements, and the type of care provided in both types of facilities. He reveals a variety of challenges that nursing home care workers face day to day: battles over the budget; the administrative hurdles of Medicaid and Medicare; the employees' struggle to balance financial stability and compassionate care for residents. Yet, Rodriquez argues, nursing home workers give meaning and dignity to their work by building emotional attachments to residents and their care. An unprecedented study, Labors of Love brings new insight into the underlying structures of a crucial and expanding sector of the American health care system.

Excerpt

“Jason is helping me out, so he can hear all of this,” said Andy Fischer, the administrator of Rolling Hills Extended Care and Rehabilitation Center, a nonprofit and secular nursing home. Eli, a sick old man with shaggy white hair and thick glasses, pedaled his wheelchair until he came to a standstill in Andy’s doorway. Eli looked tired and somewhat disheveled, wearing an oversized red-and-black flannel shirt, gray cotton shorts, white socks pulled up toward his knees, and an old pair of loafers. His right arm was held in a sling that looked uncomfortable. Andy leaned forward in his office chair, elbows on his knees, and explained to Eli that his check for “room and board” had bounced for the fourth consecutive month. In his typically informal and homespun style, Andy asked Eli, “What’s going on dude?”

Eli was not sure. He knew he was “behind on the rent,” but did not know why; his daughter was supposed to pay the nursing home with his pension checks. She assumed control over his finances after he moved into Rolling Hills about a year earlier. Later, Andy wondered aloud to me whether Eli’s daughter took his money for herself, which he claimed happened more than occasionally. But during the meeting, Eli told Andy that his daughter had a doctorate in chemistry and “could buy you and me,” defending his daughter against the implication that she was pocketing his money. Andy too did not understand how Eli had been allowed to fall so far behind, and commented, “It’s clear you two aren’t on the same page.” Andy suggested that Eli make Rolling Hills his representative payee, which meant that the nursing home would receive his pension and Social Security checks directly, pay his “room and board,” then deposit what remained into a personal funds account. Eli agreed, or perhaps he acquiesced. Then, upon leaving, he turned to wheel out of Andy’s doorway and noticed his friend and co-resident nearby. He explained sarcastically, “I just got called to the principal’s office.” Andy closed the door. I told him that I felt bad for Eli. Andy squinted in disbelief and shook his head. “No,” he huffed, “you should feel bad for me. He hasn’t paid us in four months!” Yet a few minutes later, when Andy had cooled down a bit, he confided to me that he never wanted to pursue money from residents.

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