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Your Health
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UCSB Scholar Examines Social Policy and Home Health Care

In her book Caring for America, Eileen Boris examines how home care became attached to welfare

Why is it that, in the United States, middle-class individuals with the benefit of some financial resources often cannot get adequate long-term home care for themselves or their loved ones?

Eileen Boris
Eileen Boris

In her new book, Caring for America –– Home Health Workers in the Shadow of the Welfare State, Eileen Boris, Hull Professor and chair of feminist studies at UC Santa Barbara, takes on that question in a narrative history that covers the period from the Great Depression of the 1930s to present day.

“This book explains how public policies on the federal level, and as implemented by states and localities, created a system that relied on the underpaid labors of disproportionately black, Latina and immigrant women,” Boris said. “It examines how home care became attached to welfare, and, thus, became a question of how to get care work on the cheap.”

In Caring for America, Boris and co-author Jennifer Klein, a professor of history at Yale University, demonstrate the ways in which law and social policy made home care a low-waged job that was stigmatized as welfare and relegated to the bottom of the medical hierarchy. For decades, they contend, these front-line caregivers labored in the shadow of the welfare state that shaped the conditions of their occupation.

“It’s also a story of how what was private –– that is, in the home and within families as a form of intimate labor dealing with the activities of daily living, from brushing teeth, to bathing, to food preparation –– became public through various forms of social agencies and different forms of state funding, and, thus, subject to political struggle on the part of the people who need care, their families, health-care workers and employers,” Boris said.

The history of home care illuminates the fractured evolution of the modern American welfare state since the New Deal, and its race, gender and class fissures, the authors write. The history itself reveals why there is no adequate long-term care in America. That being said, they argue, a system such as home care is a product of political economy and policy-making and, therefore, can be changed.

Such changes may be in the offing, Boris notes, with President Barack Obama’s proposal last December that the “companionship exemption” be removed from the Fair Labor Standards Act. Without the exemption, employers would be required to pay home-care workers at or above minimum wage, and to pay overtime when they work more than 40 hours a week.

“They’re health workers, not companions,” Boris said. “They should be covered by labor law.”

Employers –– some of whom are agencies, while others are the individuals actually receiving care –– have argued that raising wages and requiring overtime pay would be detrimental to home-care workers because it would decrease the amount of work the employers could provide and, thus, the amount of money the workers could earn. Boris suggests, however, that their concern is unfounded.

“Very few workers actually spend enough time with any one employer to require overtime pay,” she said. “So it’s all ideological.”

The Obama administration is deliberating the new rules and is expected to make a decision sometime this summer.

The book highlights social movements of senior citizens for disability rights and independent living; the civil rights organizing of women on welfare and domestic workers; the battles of public sector unions; and the unionization of health and service workers. While re-examining the strategies of the U.S. labor movement in terms of a growing care work economy, the book rethinks the history of the American welfare state from the perspective of care work.

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