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Long-term Care, Globalization, and Justice

Lisa A. Eckenwiler

Publication Year: 2012

Long-term care can be vexing on a personal as well as social level, and it will only grow more so as individuals continue to live longer and the population of aged persons increases in the United States and around the world. This volume explores the ethical issues surrounding elder care from an ecological perspective to propose a new theory of global justice for long-term care. Care work is organized not just nationally, as much current debate suggests, but also transnationally, through economic, labor, immigration, and health policies established by governments, international lending bodies, and for-profit entities, in a manner that raises pressing questions of local as well as global responsibility. Taking an epistemological approach termed “ecological knowing,” Lisa A. Eckenwiler examines this organizational structure to show how it creates and sustains injustice against the dependent elderly and those who care for them, including a growing number of migrant care workers, and weakens the capacities of so-called source countries and their health care systems. She identifies those who are harmed by the existing long-term care system—the elderly, family caregivers, and paid care workers, especially migrants and populations in source countries—and from there offers a corrective philosophical framework. By focusing on the fact that a range of policies, people, and places are interrelated and mutually dependent, Eckenwiler is able not only to provide a holistic understanding of the way long-term care works to generate injustice, but also to find ethical and practicable policy solutions for caring for aging populations in the United States and in less well-off parts of the world. Deeply considered and empirically informed, this examination of the troubles in transnational long-term care is the first to probe the issue from a perspective that reckons with the interdependence of policies, people, and places, and the first to recommend ways policymakers, planners, and families can together develop cohesive, coherent long-term care policies around the ideal of justice.

Published by: The Johns Hopkins University Press

Title Page, Copyright, Dedication

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pp. i-vi


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pp. vii-viii

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pp. ix-xii

I owe thanks, first of all, to the Center for American Progress for offering me a fellowship in 2006 that enabled me to begin the necessary research for this project. Special appreciation goes to Jonathan Moreno and Sam Berger for their generous support. I am ...

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pp. 1-12

I wish I could remember her exact words. “Don’t cry honey,” urged one of my grandmother’s regular evening caregivers when I came back to her room from the hospital. “It will keep her spirit from passin’ ” . . . or something close to that. Later that day, the night aide who had called at 4 a.m. to tell me they had taken her to the ...

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1 The Plight of the Dependent Elderly and Their Families

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pp. 13-26

The past several decades have seen significant improvement in the health of older adults. In the United States and many other parts of the world, people are living longer and with less chronic disability than ever before (WHO 2003; Federal Interagency Forum on Aging Related Statistics 2006). The aging population is burgeoning....

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2 The Plight of Paid Workers in Long-term Care

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pp. 27-48

The 500,000 registered nurses (RNs) and licensed practical nurses (LPNs) now working in long-term care in the United States provide direct care as well as care coordination and supervision in high and mid-level management positions (Reinhard and Young 2009). Direct care workers, however, play the most integral ...

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3 Tracing Injustice in Long-term Care

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pp. 49-69

Explored from an ecological perspective, long-term care comes into view as a landscape made up of a set of interrelated, interdependent populations and habitats, all suffering under varying degrees of stress and strain, and some facing threats to survival. In this chapter I situate long-term care work in a global context and suggest that an ecological orientation helps to make clear the ways...

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4 An Ecological Ethic

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pp. 70-86

Ecological thinking allows us to trace the structures and processes that organize long-term care labor and connect people around the world: the elderly and their loved ones (mostly daughters) in the North; the poor women, increasingly from the South, who support them; and people needing care in source countries. By ...

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5 Realizing Justice Globally in Long-term Care

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pp. 87-106

How can we move forward, having shifted the lens so that the focus is a bit less on individual agents and a bit more on their interdependence with others and need for certain kinds of habitats, places in which they can become and endure under conditions of equality? Who are the responsible agents and what are they to do? ...


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pp. 107-112


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pp. 113-146


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pp. 147-154

E-ISBN-13: 9781421405513
E-ISBN-10: 1421405512
Print-ISBN-13: 9781421405506
Print-ISBN-10: 1421405504

Page Count: 144
Publication Year: 2012