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

Russell Sage Foundation
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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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Paul Osterman
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.

Paul Kalanithi
#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 • Esquire • 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.

Praise for When Breath Becomes Air

“I guarantee that finishing this book and then forgetting about it is simply not an option. . . . Part of this book’s tremendous impact comes from the obvious fact that its author was such a brilliant polymath. And part comes from the way he conveys what happened to him—passionately working and striving, deferring gratification, waiting to live, learning to die—so well.”—Janet Maslin, The New York Times

“An emotional investment well worth making: a moving and thoughtful memoir of family, medicine and literature. It is, despite its grim undertone, accidentally inspiring.”—The Washington Post

“Possesses the gravity and wisdom of an ancient Greek tragedy . . . [Kalanithi] delivers his chronicle in austere, beautiful prose. The book brims with insightful reflections on mortality that are especially poignant coming from a trained physician familiar with what lies ahead.”—The Boston Globe

“Devastating and spectacular . . . [Kalanithi] is so likeable, so relatable, and so humble, that you become immersed in his world and forget where it’s all heading.”—USA Today
Paul Osterman
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.

Paul Osterman
America confronts a jobs crisis that has two faces. The first is obvious when we read the newspapers or talk with our friends and neighbors: there are simply not enough jobs to go around. The second jobs crisis is more subtle but no less serious: far too many jobs fall below the standard that most Americans would consider decent work. A quarter of working adults are trapped in jobs that do not provide living wages, health insurance, or much hope of upward mobility. The problem spans all races and ethnic groups and includes both native-born Americans and immigrants. But Good Jobs America provides examples from industries ranging from food services and retail to manufacturing and hospitals to demonstrate that bad jobs can be made into good ones. Paul Osterman and Beth Shulman make a rigorous argument that by enacting policies to help employers improve job quality we can create better jobs, and futures, for all workers.

Good Jobs America dispels several myths about low-wage work and job quality. The book demonstrates that mobility out of the low-wage market is a chimera—far too many adults remain trapped in poor-quality jobs. Osterman and Shulman show that while education and training are important, policies aimed at improving earnings equality are essential to lifting workers out of poverty. The book also demolishes the myth that such policies would slow economic growth. The experiences of countries such as France, Germany, and the Netherlands, show that it is possible to mandate higher job standards while remaining competitive in international markets. Good Jobs America shows that both government and the firms that hire low-wage workers have important roles to play in improving the quality of low-wage jobs. Enforcement agencies might bolster the effectiveness of existing regulations by exerting pressure on parent companies, enabling effects to trickle down to the subsidiaries and sub-contractors where low-wage jobs are located. States like New York have already demonstrated that involving community and advocacy groups—such as immigrant rights organizations, social services agencies, and unions—in the enforcement process helps decrease workplace violations. And since better jobs reduce turnover and improve performance, career ladder programs within firms help create positions employees can aspire to. But in order for ladder programs to work, firms must also provide higher rungs—the career advancement opportunities workers need to get ahead.

Low-wage employment occupies a significant share of the American labor market, but most of these jobs offer little and lead nowhere. Good Jobs America reappraises what we know about job quality and low-wage employment and makes a powerful argument for our obligation to help the most vulnerable workers. A core principle of U.S. society is that good jobs be made accessible to all. This book proposes that such a goal is possible if we are committed to realizing it.

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