Clare Stacey
While on the job, home care aides construct a unique self-identity that Clare Stacey, an assistant sociology professor at Kent State University, calls “the caring self.” Her new book, The Caring Self: The Work Experiences of Home Care Aides (Cornell University Press), examines in detail this identity, and how it contributes to the social inequalities that are present within the field of direct care.
Following is a conversation PHI recently had with Stacey in which she discusses some of the themes in The Caring Self.
PHI: What led you to write this book?
CS: I’m a medical sociologist, and I’m interested in health care inequalities broadly. I wanted to write my dissertation about [home care aides'] experiences, but I soon learned that — apart from a few articles here and there — there really hadn’t been an extensive treatment of their experiences.
I talked to 33 aides. I started in California, so that was the first phase of the study. And then when I moved to Ohio, I interviewed more workers to see if the stories were the same, because the context is very different in Ohio and California. In terms of unionization, for example, there’s obviously a big difference. But as it turns out, in terms of how they talk about their work itself, there isn’t a huge difference.
PHI: You describe perceiving an inner tension with home care aides: they know that it’s a job, but at the same time, what they do feels more like a calling to them. You write that, consequently, many feel as if the fact that they get paid for their work dilutes or cheapens their “caring selves.” Does some people’s unique capacity for caregiving create an exploitative situation, in your view?
CS: If you just look at the structural constraints, it’s an exploited workforce. Home care aides are not paid well; depending on the state they’re paid terribly. They often have no benefits and often can’t get full-time work. So an outsider looking in would think, Yes, this workforce is exploited. But that doesn’t necessarily mean that’s how [the workers] perceive it — or if they do perceive it that way, it’s complicated by the fact that they are working in a home context.
“It’s difficult for home care workers to reconcile the fact that they need a living wage when they talk about the people they work for as family.”
I think that’s what fascinates me about these workers: By working in the home, [they experience] what sociologists call the “feeling rules” that are associated with being a woman in a home, caring for a dependent. So it becomes very difficult for them to reconcile the fact that they need a living wage and fair hours [since] they talk about the people they work for as family.
The bottom-line message is not, “Yes, home care aides are exploited.” Rather, their exploitation happens in a context where they develop intimate ties with people, which makes it very difficult for them — and for people who advocate for them — to think about how to better their situation.
It’s also important to put their experiences in context. For me — an upwardly mobile, middle-class, white woman — I look at [home care] and say, I couldn’t do that job; I certainly couldn’t do it and be paid what they’re paid. But a lot of these women are coming to these jobs from their own homes, where they’re not being paid for care, or they’re coming from other service jobs that are paid pretty crappy and gave them no autonomy. So relative to that, a lot of them enjoy home care as a job in which they can actually define the terms of their labor. That doesn’t mean they’re not still exploited — they are. But recognizing [this context] is necessary to move forward in determining how to protect these workers.
PHI: You also write that home care typically involves low-wage workers caring for a generally low-income population. What are some of the unique consequences of this “poor caring for the poor” dynamic?
CS: I think it makes things even more precarious when both sides are disadvantaged by their social location — when, say, you have a poor person who is on [California's In-Home Supportive Services program] being cared for by another low-income person. First, it means that the client is dependent on state moneys, which in the current climate are shrinking. And when money is tight, I think a lot of these workers feel like they’re “in it” with the client. They know their social circumstances, so they’re willing to give a little bit more, stay a bit longer. There were women I interviewed who gave money to their clients even though they didn’t have very much money either.
PHI: Better wages and benefits are the most commonly offered solution to high turnover and low recruitment rates. But your book makes the point that there are nonmaterial, emotional factors that contribute to workers’ “caring selves,” and these also affect recruitment and retention.
CS: First of all, I want to say that I don’t think this job is worth doing unless there are fair wages and benefits attached. Some people have misinterpreted [my book] as saying, We don’t really need to pay [home care aides] fairly because they love what they do. That’s absolutely not what I’m saying. My argument is that — assuming that we give people fair wages and benefits — attracting people to the job depends on recognizing that high emotional aptitude is a skill.
“Home care workers are not just making widgets; they’re creating a sense of well-being and safety and health in another person.”
Then, once [the workers are hired], a lot of the agencies — especially the for-profits — must continue to recognize that emotional work is part of what these women are doing, and that there is burnout that’s associated with this emotional labor. I would like to see [workers] have access — within reason — to sick days or respite days when they are burned-out emotionally.
But also, these agencies [must] recognize that intimate ties are often formed between clients and their caregivers. If [a home care aide] has been caring for someone for two years and they pass away, or if all of a sudden there’s a caseload change and they’re moved to a different set of clients, the agencies need to recognize that that puts a lot of strain on workers emotionally. [Home care aides] are not just making widgets; they’re creating a sense of well-being and safety and health in another person, and that takes a lot of emotional labor.
PHI: You argue in the book that one way to get people to recognize that companionship actually is a form of labor would be to do something about the companionship exemption to the Fair Labor Standards Act.
CS: Absolutely. The companionship exemption comes from a legacy of not seeing women’s work as work. We need to really change our view of that; after all, women disproportionately work in service jobs.
The home care field is growing exponentially, and we can’t get fair pay for these workers just by arguing that what they do is real physical labor, which is, I think, the way some of these advocacy groups have gone: “It’s hard work, it’s backbreaking work, it’s real labor.” I understand the temptation to go that route, because it’s pragmatic. But I also think we need to be pushing the Department of Labor and legislators to really think about emotional labor itself as work that should be fairly compensated.
– by Matthew Ozga
