Time, race, gender, and care: Communicative and Strategic Action in Ancillary Care Commentary on Carol Levine’s “Caring for Money”

Monique Lanoix convincingly argues that what she calls ancillary work requires both communicative and strategic action. As she makes clear, in residential care communicative work is foundational both because strategic speech acts are not enough to fulfill the needs of either residents or care providers and because the space in which they live and work is a home; it is not a system but a lifeworld.

As is the case with most interesting articles, this one prompts expansion and additional questions that further complicate the work. I raise some of them below with the goal of promoting further development of the complex issues she addresses. While there are multiple spaces for complementary discussion, I will focus on time, gender and race, and regulations in this sector.

Lanoix shows how the emphasis on clock time, combined with the failure to allow for process time, means that workers are prevented from using their own judgment to personalize care. Although workers “have a privileged insight into the needs of residents” (113), the emphasis on clock time, situated within a medicalized system, limits the possibilities for providing quality care. In my view, this useful discussion of time could be expanded in at least two directions.

First, while she mentions the “two systems of medicine and markets,” the growing emphasis on clock time could be located within the context of the global move to seek profits in health services and to apply market-based strategies to all health services. Caring for the purpose of obtaining money has a different meaning when a corporation owns the home, as Harrington and colleagues have shown (2011, 2002). Even when profits are not the objective, caring is profoundly reshaped when management approaches developed by corporations are applied to residential care. For example, the authors of a recent book on residential care in Scandinavian countries (Kamp and Hvid 2012) show how, with the application of New Public Management, physical tasks not only take priority but also are allowed less time in ways that limit what Lanoix calls communicative and strategic actions. As a consequence, what counts is what can be counted, and counting becomes the basis of time reductions. Emotional communication, both verbal and nonverbal, is difficult to count. It is thus both left out of the time allowed and is rendered invisible.

Second, time has a quite specific meaning in long-term care facilities. Care is, by definition, long term and this means that care providers get to know their residents in ways that are quite different from those providing care in hospitals, where most stays are very brief. As Lanoix makes clear, time for each task and opportunities for communicative action have been reduced. However, the fact that residents stay on average more than two years means that those ancillary workers who provide the majority of care and do so for a significant amount of time each day develop not only the means of resistance she describes but also forms of communicative and strategic action that are tailored to individual residents.

Lanoix argues that the low value attached to this care work cannot be understood simply in terms of women’s work. The low value also results from work that “deals with everyday needs, yet it is situated within a medicalized system” (112). This is an important addition to our understanding of residential care. However, it is also important to remember that gender continues to play a critical role, even as care in such homes becomes increasingly medical and the division of labor more complex. Women constitute a majority not only of the workers but also of the residents, and neither group is highly valued. Nurses have struggled to shed those parts of caring that have long been associated with women, the parts that are now done mainly by ancillary workers (Armstrong, Armstrong, and Scott-Dixon 2008). Moreover, the very limited formal training now offered to ancillary workers reflects the dual assumptions that such work is unskilled and that any woman can do the job. In addition, more formal...