-
Introduction
- Johns Hopkins University Press
- Chapter
- Additional Information
Introduction Iwish 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 hospital, told me everything that happened before the emergency medical technicians arrived and while they were there. I had persuaded my grandmother—the brightest star in my childhood galaxy—to move to be near us. I arranged for and coordinated her care, took her to doctors’ appointments and emergency rooms, visited her every few days and talked with her every night, and spent the day spooning with her as she died. Yet these caregivers —one Jamaican and one African American—were the women who did the daily work of caring for her. This book comes from reflection on the connections between elderly grandmothers and mothers in places like Boston, Los Angeles , New York, and Washington, DC, to others in Kingston, Port au Prince, Manila, and Kerala, and patients, like those living with HIV/AIDS; between daughters and granddaughters in the United States to those here from the Philippines and Haiti. These connections, forged from the policies and practices of government officials, international bankers, health care executives and human resource personnel, recruiters, employers, and the choices of indi1 2 long-term care, globalization, and justice viduals, tend to be obscured in discussions of long-term care policy, yet they raise complex and pressing questions of responsibility. Thanks in part to a century of progress in public health and medicine, many people are enjoying longer lives. These changing demographics are generating a greater need for long-term care. In the United States alone, the number of people using nursing facilities , alternative residential care, or home care services is expected to increase from roughly 15 million to 27 million in 2050 (U.S. DHHS and DOL 2003). Yet by all accounts, long-term care is “no longer viable” (Miller, Booth, and Mor 2008, 450). Moreover, experts argue, we are “without an abiding social purpose that we as a society buy into collectively” (451). What Levine, Albert, Hokenstadt, et al. (2006, 305) refer to as the long-standing absence of a “comprehensive, coherent, long-term care public policy” clearly raises profound concerns for the burgeoning population of dependent elderly. This policy void generates problems for family caregivers, who find themselves navigating perilous terrain as they strive to support their loved ones and often suffer ill health themselves. It also threatens long-term care workers , who are born and trained in the United States but find themselves working and living in low-resource conditions. At the same time it has serious implications for the health care workforce and those in need of care in the global South, in countries that are themselves burdened by aging populations, chronic conditions, and, often, HIV and AIDS. As governments in affluent countries confront “growing demands and expectations” [my emphasis] for affordable , quality long-term care services (OECD 2005, 10), health workers, including nurses and paraprofessionals, are migrating from countries in Africa and the Caribbean, from the Philippines, India, China, and South Korea at unprecedented rates to take up positions in long-term care. A recent report argues that the growing reliance on migrant care workers is a symptom of inadequate longterm care policy (International Oranization for Migration 2010, 7). Indeed, atop a long list of worries U.S. experts cite inadequate workforce and family caregiving capacity (Institute of Medicine [3.235.199.19] Project MUSE (2024-03-19 04:34 GMT) Introduction 3 2008; Miller, Booth, and Mor 2008); yet many so-called “source countries” have even more rapidly growing long-term care needs and higher burdens of disease, and at the same time suffer from lower care-worker-to-population ratios than do destination countries like the United States (Weinberger 2007). The state of longterm care policy in the United States is contributing, however indirectly and unintentionally, to global workforce shortages and deepening health inequalities, and, indeed, to what some describe as a global “crisis in health” (WHO 2006a). The central message from the recently convened Global Forum on Human Resources is that workforce shortages in low- and middle-income countries, many of which serve U.S. long-term care needs, are “one of the most pressing issues of our...