Long-term Care, Globalization, and Justice

3 Tracing Injustice in Long-term Care

49 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 in which the configuration of political, economic, and other social and institutional structures—the “apparatus”1 that transcends national boundaries and organizes long-term care labor—imperils the elderly and their caregivers and serves to deepen health disparities in less-privileged parts the world where care workers are scarce or absent altogether. By eroding conditions and capacities for care— especially (but not exclusively) in countries constituted to export care labor—over time it operates to sustain and reproduce spaces of deprivation. I will go back and forth in discussing implications for family caregivers and paid care workers, but most of this chapter focuses on the plight of emigrant care workers. Following a general discussion of the implications for source countries, I consider the particular circumstances of the Philippines, the Caribbean, and India. I CHAPTER THREE Tracing Injustice in Long-term Care 50 long-term care, globalization, and justice also explore possible consequences for the United States and other countries that draw on care labor from abroad. Shaping the Subjectivities of Those Who Care Seasoning Many, maybe most, family caregivers desire to provide assistance to loved ones in need of long-term care; there is, however, good reason for concern about the caregivers themselves. There is now abundant evidence to suggest that care-giving responsibilities, doled out and taken on through gender norms and the social and institutional policies that exploit them, have profound effects on family caregivers, including effects on their sense of identity, agency, and self-worth (Nelson 2002). They report feelings of isolation and disrespect and a tendency to defer or even abandon their goals, both personal and professional (Levine 1999; Goldsteen, Abma, and Oesburg, et al. 2007). The racial and cultural stereotypes at work in the global division of care labor help shape the identities of women who migrate and work in the paid care labor sector. Filippinas, for instance, are constructed as caring, obedient, meticulous workers and “sacrificing heroines” for their countries (Schwenken 2008); Caribbean women are seen as naturally warm-hearted and joyful; and Indian women as having “natural capacities” as carers (Abraham 2004). Such constructions serve the aims of governments, industry organizations , employers, and recruiters,2 and even family caregivers in the North, yet they also perpetuate stereotypes and can constrain the imaginations and opportunities of women and girls (Brush and Vasupuram 2006; Rodriguez 2008). Roland Tolentino’s study of Filipinas’ “integration into the circuits of transnationalism” (1996, 49) through the trade in mailorder brides provides an interesting comparison to care labor emigration . Both phenomena are “situated in the historical positioning of Filipina bodies into a transnational space inscribed in [gendered], colonial, militarist, and capitalist histories” (49) and involve their Tracing Injustice in Long-term Care 51 “packaging” and use as “a tool for (limited) economic empowerment ” (53). In the same way that Filipinas are stereotyped and homogenized as “loyal, disciplined, and obedient” (Tyner 1996, 411), and their body parts—like their “nimble fingers”—idealized for work in the assembly lines spawned by the global economy, Filipinas are constructed as model export brides: “The preparation of the female [imagination and] body for work in multinational operations incipiently also prepares [them] for transnational work as a mail-order bride,” argues Tolentino (1996, 55). With major capital at stake, governments in the global South have been “only too eager to provide this habitat [my emphasis]” for producing these subjectivities, determined by cost-benefit analyses to be valuable as export (53). And just as the Sears and Roebuck mail-order catalog—made possible by the expanding postal system’s circulation of the colonies’ products to the United States (63)—facilitated the emergence of the mail-order bride, the Web sites of contemporary nurse-recruitment agencies help to move nurses and other care workers from their homes in low- and middle-income countries into long-term care settings in the United States. Overlapping varieties of nationalist rhetoric that support neoliberal economic policies operate in synergy with gender and racial stereotypes. One variety is organized around specific...