Who Will Care For Us?: Long-Term Care and the Long-Term Workforce

Russell Sage Foundation
Free sample

The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us? economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care.

Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the well-being of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops.

Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers.

As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.

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About the author

PAUL OSTERMAN is Nanyang Technological University (NTU) Professor of Human Resources and Management at the M.I.T. Sloan School of Management.
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Additional Information

Publisher
Russell Sage Foundation
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Published on
Sep 6, 2017
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Pages
231
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ISBN
9781610448673
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Language
English
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Genres
Business & Economics / Human Resources & Personnel Management
Social Science / Death & Dying
Social Science / Disease & Health Issues
Social Science / General
Social Science / Gerontology
Social Science / People with Disabilities
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Content Protection
This content is DRM protected.
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As the elderly population continues to increase, the need for suitable housing will continue to rise as well. This handbook is designed to help individuals and families determine the feasibility of starting a small home business providing residential home services for one or more elderly persons. Persons interested in starting a business of this type will find this unique book a goldmine of important information. Residential Care Services for the Elderly is a valuable decision-making tool which helps readers determine if this type of business venture is appropriate and, if so, how to start and maintain a residential care service for the elderly. Thorough coverage of background and implementation details provides potential operators with a rationale and necessary information. Numerous self-assessment and resource inventories in this practical handbook will guide readers in determining their areas of interests and competencies. Opportunities for networking among state licensing/standards agencies, funding agencies, and a listing of elder care organizations and advocacy groups adds value to this time-saving resource, ensuring a quicker and more likely success. Case studies, detailed guides, and the discussion of positive and negative aspects of being the owner of a small residential care business, based on interviews with people currently running elder care residential services, are also included. All aspects of business operations are covered in Residential Care Services for the Elderly, including sources of funding and potential incomes; emotional and financial cost/benefit factors; parameters of organizing the business including personnel, respite care workers, need for registered nurses, and food service; special needs of clients; details of financial plans with outlines and sample forms; and variables of success and failure. Graduate and undergraduate students taking classes in regard to gerontological business and long-term care related alternatives will also find this statistic-filled handbook a useful reference.
According to the Bureau of Labor Statistics, there were approximately 1.7 million home health aides and personal and home care aides in the United States as of 2008. These home care aides are rapidly becoming the backbone of America's system of long-term care, and their numbers continue to grow. Often referred to as frontline care providers or direct care workers, home care aides--disproportionately women of color--bathe, feed, and offer companionship to the elderly and disabled in the context of the home. In The Caring Self, Clare L. Stacey draws on observations of and interviews with aides working in Ohio and California to explore the physical and emotional labor associated with the care of others.

Aides experience material hardships--most work for minimum wage, and the services they provide are denigrated as unskilled labor--and find themselves negotiating social norms and affective rules associated with both family and work. This has negative implications for workers who struggle to establish clear limits on their emotional labor in the intimate space of the home. Aides often find themselves giving more, staying longer, even paying out of pocket for patient medications or incidentals; in other words, they feel emotional obligations expected more often of family members than of employees. However, there are also positive outcomes: some aides form meaningful ties to elderly and disabled patients. This sense of connection allows them to establish a sense of dignity and social worth in a socially devalued job. The case of home care allows us to see the ways in which emotional labor can simultaneously have deleterious and empowering consequences for workers.

Older people who would prefer to stay in their homes and states whose funds are being depleted by the rising costs of Medicaid payments to nursing homes find the current system of long-term care unsatisfactory. From Nursing Homes to Home Care arms educators, policymakers, public health professionals, gerontologists, and advocacy groups with the information they need to participate knowledgeably in the debate about aging and long-term care needs. The book shows readers where things are, where they are going, and where they need to be in changing the system of long-term care. From Nursing Homes to Home Care evaluates future needs for long-term care by analyzing on-going systems and assessing key features of proposed long term programs in the context of population aging. Readers gain a thoughtful analysis of the complex dimensions of making future long-term care policy and program decisions as they read about: patterns of demographic aging, disability, and health needs intersections of formal and informal care including intergenerational equity issues long-term care services needs and accessibility planning for funding, quality assurance, and range of services implications of shifts from the current system to a system of home and community-based services Chapters in From Nursing Homes to Home Care express the collective thinking of leaders in long-term care policy and research. Contributors address implications for changing the current system in relation to the emerging needs of the aging population and use this as a basis for examining alternative decisions. Information in the book helps readers determine how to best blend formal and informal services, how to assure quality of care and quality of life in long-term care policy, how to finance devised programs, which health needs to address, and whether to use regulatory or competitive approaches. Professionals, educators and students, and policymakers at all levels learn about factors to consider in policy planning and decision making, including features of aging baby boomers; trends in the growth of the aged population; newly emerging trends in morbidity, disability, and mortality and their effect on the demand for long-term care in the short and long term; access issues from the perspective of the historical evolution of publicly funded long-term care services, the distribution of formal and informal systems of care; utilization patterns of the minority and poor; how to pay for care, how to design an appropriate mix of services, how to maintain quality with efficiency, and how to mesh services with social and family values. From Nursing Homes to Home Care is an invaluable resource in evaluating and advocating policy changes and decisions for an improved long-term care system.
The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers

Paid home care is one of the fastest growing occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities.

Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation’s most pressing concerns—rising social inequality and caring for an aging population—intersect to transform the lives of older adults, home care workers, and the world around them.

The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality.

Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.
We live in an age of economic paradox. The dynamism of America's economy is astounding--the country's industries are the most productive in the world and spin off new products and ideas at a bewildering pace. Yet Americans feel deeply uneasy about their economic future. The reason, Paul Osterman explains, is that our recent prosperity is built on the ruins of the once reassuring postwar labor market. Workers can no longer expect stable, full-time jobs and steadily rising incomes. Instead, they face stagnant wages, layoffs, rising inequality, and the increased likelihood of merely temporary work. In Securing Prosperity, Osterman explains in clear, accessible terms why these changes have occurred and lays out an innovative plan for new economic institutions that promises a more secure future.

Osterman begins by sketching the rise and fall of the postwar labor market, showing that firms have been the driving force behind recent change. He draws on original surveys of nearly 1,000 corporations to demonstrate that firms have reorganized and downsized not just for the obvious reasons--technological advances and shifts in capital markets--but also to take advantage of new, team-oriented ways of working. We can't turn the clock back, Osterman writes, since that would strip firms of the ability to compete. But he also argues that we should not simply give ourselves up to the mercies of the market.


Osterman argues that new policies must engage on two fronts: addressing both higher rates of mobility in the labor market and a major shift in the balance of power against employees. To deal with greater mobility, Osterman argues for portable benefits, a stronger Unemployment Insurance system, and new labor market intermediaries to help workers navigate the labor market. To redress the imbalance of power, Osterman assesses the possibilities of reforming corporate governance but concludes the best approach is to promote "countervailing power" through innovative unions and creative strategies for organizing employee voice in communities. Osterman gives life to these arguments with numerous examples of promising institutional experiments.

#1 NEW YORK TIMES BESTSELLER • PULITZER PRIZE FINALIST • This inspiring, exquisitely observed memoir finds hope and beauty in the face of insurmountable odds as an idealistic young neurosurgeon attempts to answer the question What makes a life worth living?

NAMED ONE OF THE BEST BOOKS OF THE YEAR BY The New York Times Book Review • People • NPR • The Washington Post • Slate • Harper’s Bazaar • Time Out New York • Publishers Weekly • BookPage

Finalist for the PEN Center USA Literary Award in Creative Nonfiction and the Books for a Better Life Award in Inspirational Memoir

At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.

What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.

Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. “I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything,” he wrote. “Seven words from Samuel Beckett began to repeat in my head: ‘I can’t go on. I’ll go on.’” When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.
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