Inequalities of Aging: Paradoxes of Independence in American Home Care

Abstract

In her first book, anthropologist Elana Buch provides a long overdue and thoughtful analysis of the American home care system. What makes Inequalities of Aging: Paradoxes of Independence in American Home Care unusual is that it examines the intersection between home care workers and their elderly clients, underscoring the commonalities of their existence and interdependence. Buch traces the interaction between paid home care workers, specifically home health aides, and their clients through two home care agencies in Chicago. One is ‘‘Plusmore,’’ a public agency with a contract from the State of Illinois, and the other is ‘‘Belltower,’’ a private agency. Buch sets the stage for her book by detailing the commonalities between the clients and workers. Both workers and clients are predominantly women, are working poor or low-income, and rely significantly on government benefit programs such as Medicaid and food stamps, and, for most clients, Social Security. Buch uses this commonality to connect her work to theories of reproductive labor from critical feminist scholars. Building on reproductive labor, Buch introduces the concept of generative labor, which she defines as the ‘‘wide range of moral imaginings, practices, processes, and relations through which people work together to generate life in all its forms’’ (p. 6). Buch uses multiple ethnographic methods to construct themes related to generative labor, including participant observation, interviews, and life histories. The themes emerge around care relationships in practice and the meanings and consequences of the relationships for the home care workers and clients. The book is organized around several thematic chapters that explore the relationships between the home care workers, the home care agency supervisors, and the clients, each of whom has important life issues that often contradict the needs of others in what Buch describes as the triangle of care (client, home care worker, and agency). In Chapter One (‘‘Generating Independence’’), Buch focuses on the histories of several elderly clients, such as Harriet Cole and Hattie Meyers, both of whom are black women, to illustrate how older adults’ cultural constructions of personhood and independence translate into efforts to maintain control over their home. Mrs. Cole, for example, shared the same ethnic background as Virginia, her home care worker, but presented herself to Buch as a generous patron of Virginia, describing Virginia as the equivalent of a domestic servant. Buch observes that Mrs. Cole’s construction of her relationship to Virginia allowed Mrs. Cole to maintain her self-conception of being an independent middle-class woman despite the reality of the multiple financial, physical, and social vulnerabilities that threatened her fac xade of independence. In Chapter Two (‘‘Inheriting Care’’), Buch shifts her focus to the lived experience of the home care workers. Using a historical perspective, she relates the lives of the predominantly low-income women of color and immigrants who staff the home care agencies to the overrepresentation of women and people of color in the domestic, lowwage workforce caused by racism and discrimination in the United States. In Chapter Three (‘‘Making Care Work’’), Buch addresses the impact of the home care agency organizational framework on the client-work relationship. She argues that organizational constraints, such as codes of ethics, professional standards, and policies and procedures, create a unidirectional relationship and one that aggravates inequality between home care workers and their clients, particularly the more affluent clients. Buch 400 Reviews