Cover

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Series Page

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p. i

Title Page, Copyright

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pp. ii-iii

Contents

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pp. v-viii

List of Figures

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pp. ix-x

List of Tables

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pp. xi-xii

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Foreword

MARGARET K. NELSON

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pp. xiii-xvi

In writing here, I have the privilege and honor of wearing two hats. The first hat, and the reason I initially volunteered to write a foreword for Caring on the Clock, was so that I could reflect, at least briefly, on the many changes in the study of care work since my sister Emily K. Abel and I edited one of the first collections on this topic almost twenty-five years ago. To be sure, as we brought together ....

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Acknowledgments

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pp. xvii-xviii

The editors wish to acknowledge the many individuals, organizations, and institutions that helped bring Caring on the Clock to fruition. First and foremost, we would like to thank the contributing authors for their patience and perseverance, and for producing what we think are some of the best pieces around on paid care. We are so grateful that you embarked on this journey with us. There are several people who read...

Part I. Paid Care Work

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pp. 1-2

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1. On the Clock, Off the Radar

Mignon Duffy, Amy Armenia, Clare L. Stacey

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pp. 3-13

A nurse inserts an I.V. A teacher helps a child with his math. A social worker visits a new mother. A personal care attendant helps a quadriplegic bathe and get dressed. A nursing assistant feeds an elderly resident of a nursing home, the meal prepared by a dietary aide. A nanny reads a bedtime story to soothe a child to sleep. Every day workers like these provide critical support to some of the most vulnerable members of our society. Caring on...

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2. Beyond Outsourcing

Mignon Duffy

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pp. 14-26

These quotations from feminist scholars who have come before me capture pefectly the two reasons for the critical need for an accurate and nuanced understanding of the history of paid care work. First, we have in the United States a particular social organization of care, a way of defining and dividing up the labor of taking care of people. Importantly, our contemporary...

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Part II. Contexts of Care

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pp. 27-30

In the public imagination, family care represents the gold standard against which all forms of paid care work are measured. Although we know from both research and experience that families can be riddled with problems, paid care is often compared to an idealized version of family in which a loving relationship provides the basis for responsive, person-centered care. In this scenario, not surprisingly, the focus always lands...

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3. The Best of Both Worlds?

Kim Price-Glynn, Carter Rakovski

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pp. 31-41

Care for American seniors and those with extended illnesses or disabilities takes place primarily in two places: institutions and residential homes. Nearly 2 million direct care workers are employed by home health agencies and residential care facilities, and growth in the number of these workers is projected (National Occupational Research Agenda [NORA] 2009). These two...

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4. The Business of Caring

Nickela Anderson, Karen Hughes

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pp. 42-53

Most empirical studies of care work focus on employer-employee relationships (Parrenas 2001; Spitzer, Bitar, and Kalbach 2002; Zimmerman, Litt, and Bose 2006). Little research exists on self-employed paid care workers, who hold a different legal and market status. This gap is important, given the expansion of women’s self-employment in many industrialized ...

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5. Are Frontline Healthcare Jobs “Good” Jobs?

Janette S. Dill

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pp. 54-66

The housekeeper who empties the trash can in the hospital room. The nursing assistant who helps a nursing home resident to the bathroom. The unit clerk who organizes patient charts. The surgical technician who prepares the operating room. These workers—others with similar skills and compensation— make up the frontline healthcare work force, an often overlooked but large and growing segment of healthcare workers. In...

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6. Orienting End-of-Life Care

Cindy L. Cain

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pp. 67-78

The location of care, especially at the end of life, is a complex issue that affects care workers as well as care recipients. While today a great deal of the most intensive care leading up to death takes place in institutional settings like hospitals, skilled nursing facilities, or nursing homes (Brown University 2004; Gruneir et al. 2007), most Americans report a desire to remain at home during their final days (Hays et al. 2001; Whittington...

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Part III. Hazards of Care

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pp. 79-82

As they care for the bodies and minds of others, care workers regularly put their own physical and psychological health at risk. While understanding the vulnerability of the individuals being cared for, it is important not to obscure the vulnerability of the workers themselves. Some of these hazards have been studied extensively by occupational safety and...

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7. The Health Hazards of Health Care

Alicia Kurkowski, Jon Boyer, Laura Punnett

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pp. 83-93

Healthcare institutions such as hospitals and nursing homes are places where many people seek and receive medical services to improve their health. Yet the workers who provide that care, including registered nurses (RNs), licensed practical nurses (LPNs), nursing assistants (NAs), and many others, are exposed to conditions on the job that threaten their own health. These hazards cover the full range of risk factors for injury and illness...

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8. When the Home Is a Workplace

Pia Markkanen, Margaret Quinn, Susan Sama

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pp. 94-103

According to the Bureau of Labor Statistics, the first and second fastest growing occupations in the United States are home health aides and personal and home care aides, both of which are projected to grow close to 50 percent by 2018 (U.S. Department of Labor Bureau of Labor Statistics [BLS] 2012a, 2012b). Although the home care industry is one of the fastest growing sectors in the United States, the home care work force is relatively invisible, in...

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9. Part of the Job?

Jennifer Zelnick

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pp. 104-116

Sit down with a group of social service workers to discuss workplace violence, and sooner or later someone will explain that workplace violence is simply “part of the job”; around the table heads will nod in agreement. This significant workplace hazard—estimated to impact 1.7 million U.S. workers annually (U.S. Department of Labor Occupational Safety and...

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10. Double Isolation

Ivy Bourgeault

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pp. 117-126

As many of our societies age, we become particularly concerned with the relative availability of care work and care workers, as well as with the appropriateness of the social organization of care for older adults either in the community or institutional sector. Many argue that high-income Western nations have a shortage of care workers, and this shortage is expected to become much more acute with the aging of the population and...

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Part IV. Identities and Meaning Making

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pp. 127-130

One objective of this volume is to understand how care workers themselves define, describe, and make sense of their labor. The meanings that paid caregivers attach to their work are complex and at times contradictory. Yet, these subjective experiences of their own identities as care workers have a profound impact on worker outcomes like job satisfaction, burnout, and turnover— which in turn have important implications...

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11. The Caring Professional?

Latonya J. Trotter

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pp. 131-142

It is not a rare sight to see the slogan “Doctors Cure, Nurses Care” emblazoned on nurses’ t-shirts or announced on bumper stickers. Although perhaps overstated, this pithy catchphrase hits squarely at the core of nursing’s claims to occupational legitimacy. Since its first efforts to reframe sick care done in the family circle as the province of trained nurses, nursing has sought to elevate care as both a skill and a unique area of expertise...

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12. Building a Professional Identity

Fumilayo Showers

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pp. 143-152

I met Arthurlina, a fifty-year-old nurse from Sierra Leone, on a hot summer’s day in Washington, DC. Arthurlina is a tall, imposing woman with a booming voice and an even bigger laugh. She reflected on a career that began when she trained as a nurse in her homeland aft er completing her high school education. Aft er migrating to the United States, she worked as a certified nursing assistant while going to nursing school. At the time ...

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13. Ethnic Logics

Cameron Lynne Macdonald

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pp. 153-164

Care for very young children is arguably one of the most emotionally fraught areas of market-based care work. Although most Americans accept the educational benefits of institutional kindergarten and even preschool education, care for children birth to age three is still considered to be the realm of mothers (Duffy 2011; Hays 1996). Given their role as maternal substitutes, childcare workers must navigate a perilous line between giving good ...

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14. Caring or Catering?

Rachel Sherman

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pp. 165-176

In interviewing providers of a wide variety of lifestyle services, from personal assistance to interior design to real estate, I was struck by how much they talked about the emotional aspects of their work. Personal concierges,1 for example, described having to listen to clients’ personal problems “like a therapist.” Gabrielle, a financial advisor, recounted repeatedly driving three hours round trip to have tea with an elderly, recently...

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Part V. Work and Family

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pp. 177-178

It would be impossible to offer a comprehensive view of paid care without also considering the question of family. Work and family intersect for paid caregivers in many noteworthy ways: paid care workers oft en must juggle their job obligations with unpaid care responsibilities at home, many families rely on paid care workers to meet their essential care needs, and cultural ideologies of family and work permeate the experiences of paid...

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15. Low-Wage Care Workers

Naomi Gerstel, Dan Clawson

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pp. 179-188

One might not expect a union bargaining session to be the best place to uncover conflicts over views of the family, but sometimes it is. Take this example. We observed a bargaining session between nursing assistants and the nursing home where they worked. Six “bosses” (as the workers called them), including the white lawyers and the management of the nursing home, sat at the front across from the fifteen people who made...

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16. “It’s Like a Family”

Lisa Dodson, Rebekah M. Zincavage

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pp. 189-200

Over the last two decades, a “crisis in care” has provoked difficult questions about the meaning and value of purchased care in contemporary society. Historically, family relationships and the market have been considered separate worlds, yet care work, traditionally a taken-for-granted female activity, has increasingly demanded market valuation as millions of women left homemaking for paid employment, expanding the ...

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17. Caught between Love and Money

Clare L. Stacey, Lidnsey L. Ayers

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pp. 201-212

In her afterword to the twentieth anniversary edition of Th e Managed Heart, Arlie Hochschild argues that new scholarship on work and emotional labor must consider what she calls the “third sector” of social life, where forces of family and market collide (Hochschild 2003b). Instead of considering labor solely in the context of public life, she asks us to investigate what happens to social norms and work expectations when private...

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18. Paying Family Caregivers

Mary K. Zimmerman

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pp. 213-224

In the spring of 2013, prominent media in the United States exploded with the report that women were the primary breadwinners in some 40 percent of American families, including single parent families but also dual earner families where wives earn more than husbands (Wang, Parker, and Taylor 2013). This trend causes us to rethink our assumptions about families. It also leads us to a long-standing care-work dilemma ...

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Part VI. Paths to Change

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pp. 225-228

Given the inadequacy of resources in the care work sector, it is not surprising that many of the jobs explored in this volume are what Arne Kalleberg (2011) characterizes as “bad jobs,” with low pay and lack of benefits. In this section, scholars engage with efforts to improve working conditions in the care sector, exploring policy and practice innovations as well as worker perceptions of movements for ...

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19. For Children and Self:

Clare Hammonds

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pp. 229-239

At just twenty-five years old, Camilla already has more than a decade of experience working in early education. Today she is the director of Happy Feet, an early education center located in a midsized suburban community in central Massachusetts. There Camilla manages a budget of more than a half million dollars and a staff of over twenty teachers and assistants. The first time I met Camilla, she was leading a professional...

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20. Creating Expertise and Autonomy

Amy Armenia

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pp. 240-250

While most agree that something needs to be done to raise compensation levels and improve working conditions for care workers, no consensus exists regarding what that something should be. Many suggestions—including those in this volume—rely on some kind of collective action, bringing together groups of workers to advocate for change. These efforts tend to head in one of two directions: either unionization efforts that involve...

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21. Building a Movement of Caring Selves

Deborah L. Little

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pp. 251-262

It is 2012 and I am observing training for a pilot senior certified nursing assistants (CNA) program, jointly developed by the Direct Care Alliance (DCA) and a large nursing home corporation in the New York metropolitan area. The DCA is demonstrating the challenges of building alliances with other stakeholders. They have divided the CNAs into three groups representing...

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22. Healthy Diversity

Michelle C. Haynes, Meg A. Bond, Robin A. Toof, Teresa Schroll, Michelle D. Holmberg

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pp. 263-274

Within paid care occupations, women and ethnic/racial minorities are disproportionately likely to occupy lower status and lower wage positions than their white male counterparts (England 2005). Staffing trends within the healthcare system are no exception; while there is some diversity among entry-level healthcare workers, ethnic/racial diversity within the ranks of more credentialed healthcare providers is lacking...

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23. Building Meaningful Career Lattices

Jennifer Craft Morgan, Brandy Farrar

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pp. 275-286

The long-term care services sector in the United States depends greatly on direct care workers (DCWs). In institutional care, for example, it is estimated that 80 to 90 percent of care is provided by DCWs such as nursing assistants. In addition, there has been unprecedented job growth in home- and community-based care, particularly with home care workers and personal care aides. The demand for DCWs (workers who provide direct care in all kinds of long-term care settings such as nursing...

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Epilogue

Mignon Duffy, Clare L. Stacey, Amy Armenia

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pp. 287-292

Our hope in bringing together this body of research is that it will serve to advance both empirical knowledge and theoretical development across a range of academic and policy arenas. We see this book as part of ongoing dialogue about care, and our expectation is that students, scholars, and policymakers will find within these pages different threads of conversation that connect to their specific areas of interest. In these last...

References

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pp. 293-316

Notes on Contributors

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pp. 317-324

Index

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pp. 325-332