An Interview with Eileen Boris and Jennifer Klein

In their new book, Caring for America (Oxford University Press), Eileen Boris and Jennifer Klein trace the history of home care work in the U.S. from its New Deal–era roots to its current professionalized state. Along the way, Boris and Klein — professors at the University of California, Santa Barbara, and Yale University, respectively — explore how the gendered and racialized conceptions of home care work have affected workers’ wages, benefits, and unionization patterns. The authors show how home care work began — and, in many cases, remains — a state-funded “jobs program on the cheap.” They also outline the trajectories of both the medical and social-welfare models of home care. Recently, Boris and Klein spoke with PHI about the themes of their book. Following are excerpts from that conversation:

On developing the idea for the book:

Klein: I was a fellow at the Robert Wood Johnson Foundation in health policy and was part of a reading group on long-term care. And I felt that, when discussing the challenges of home care and how to provide home-based benefits, the social-science and gerontology literature always seemed to focus on who the clients were. It often didn’t think about the issue in terms of workers. There seemed to be continual talk about the problems of turnover and workforce instability, and workers were seen as the cause of these problems. It seemed like not enough had been brought into this story from the perspective of what it actually meant to be a woman worker, and how the labor market itself had come to be structured, historically.

Boris: From my involvement with local struggles over In-Home Supportive Services (IHSS), I became intrigued with home care as a topic to discuss the valuing of labor in the home, the racialization and feminization of certain kinds of work, the relationship between home and work, and the role of the state in creating an occupation. Jen was doing her work, I was doing my work, and we realized that we were interested in the same workers. We began collaborating, and it clicked.

On the evolution of home care work:

Boris: Our book shows how work that was thought of as private — as something that wives, mothers, daughters, and family members did in the intimacy of the home — was made public through state policies, through funding streams, through various social-welfare benefits given to people who received care. But always done on the cheap.

Eileen Boris

But, by becoming public, home care work became subjected to political struggle, to a rethinking of the meaning of this labor, to a recognition that it isn’t just private: It’s part of the creation of a social good. It’s part of what it means to be a society, to be concerned with the interdependency of us all — and not just about ending dependency.

We show how home care work was constructed as labor, from the New Deal onward, through a series of decisions. Sometimes they’re political decisions, sometimes they’re bureaucratic decisions, sometimes they’re legal. But people weren’t just acted upon; they were actors.

Klein: We’re looking at the way in which the state itself created a particular, low-wage labor market, and maintained it over a number of decades as a racialized and gendered labor market. But we also look at the way in which social movements act on that and apply pressure to restructure it. And the social movements are not just reactive in terms of what the state programs are doing — they can fundamentally change what the state programs are.

Boris: Policy isn’t just made from above; it’s made in this dynamic way. This history tells us that change is possible. If something is made, it can be unmade and remade. And that’s really important.

On the unique challenges associated with organizing home care workers:

Jennifer Klein

Klein: A number of things had to be overcome before home care workers could take collective action to improve their working standards. One of them was home care workers thinking of themselves as workers, and being able to get their labor recognized as real work. I think that’s where the different social movements — from the welfare rights movement to the domestic workers’ rights movement to the labor movement — have made tremendous strides: bringing people out of the home and giving them the opportunity to meet and talk to other people who do this labor. A lot of women we spoke to said, “Wow, I didn’t realize there were so many other people who are doing this.” They began to actually see themselves in a collective way as real workers in a broader workforce. And once you see yourself that way, then you start to think about labor standards, and whether you are getting the same rights of employment [as other workers]. I think that’s a pretty significant shift.

Boris: But there is this problem: These workers are not recognized by labor laws in quite the same way as other workers. In fact, there was a loss in 1974-75: When domestic workers gained full access to the Fair Labor Standards Act, home care workers, as we well know, got defined as “elder companions,” when previously they were understood as a cross between health aides and housekeepers. They got written out of the act at that moment.

So we really see in such specific moments how public policy has transformed the job — sometimes for better, but often for worse.

Klein: For several reasons, including the way their labor has been structured and the lack of a single place of employment, traditional collective bargaining under the rules of the National Labor Relations Board has never really applied to home care workers. So as home care workers began to see themselves as part of the workforce, they decided to use direct-action pressure to say: “Well, you know what, we are the workers. We are the ones who are here in the agency, and we are going to collectively represent ourselves and shift the terms.”

Boris: Unions for a long time were not particularly interested in home care workers. It required different kinds of strategies to make visible those who were invisible. Some of the organizers who came out of the welfare rights movement, for example, tried shaming people like reluctant employers or state officials at the Department of Welfare or Department of Aging into making a public claim that they were there and they did important work.

On the perception of home care as a rehabilitative program for the poor:

Klein: I think one of the most profound things we found, from the New Deal through the present, was the way state agencies directly targeted poor women on public assistance and pushed them into low-wage, poverty-level home care jobs. Yet, meanwhile, these agencies constantly claimed that doing this form of domestic, caretaking work would somehow “rehabilitate” poor women so they’d no longer be dependent on public assistance. From the ’40s and ’50s, into the War on Poverty in the 1960s, and up through workfare in the ’80s and ’90s, policymakers and welfare administrators never shook their faith in the idea that putting poor women of color back into domestic labor jobs would somehow end their dependence on the welfare state and end their poverty — even though there’s no evidence that’s the case.

On balancing care provision with job quality:

Klein: There’s an assumption that the provision of long-term home care is a zero-sum calculation: You can either provide more care to more people or you can pay the workers better, but you can’t do both; if you pay the workers minimum wage or above minimum wage, then that will mean less care. We have to move beyond this. These women have long labored in poverty, and they have struggled mightily to maintain themselves as well as another family — and yet, long-term care has become increasingly insecure. And now their wages are being cut, their hours are being cut, the covered services are being cut, and we don’t actually see more people receiving the service! Suppressed wages has not meant more care. It is not a constructive route for dignity and security for recipients or providers.

Boris: One solution, of course, has been training. “Let’s train them in higher levels of care — to use machines, to know certain techniques. Let’s create job ladders.” But that doesn’t solve the problem of the fundamental devaluing of the relational work of care. Until we as a society embrace interdependence and revalue care as a human right, then these zero-sum games of pitting workers and users against each other keep working.

It’s in the self-interest, we would argue, of the middle class to be concerned with the structuring of home care, even though most home care has been paid through Medicaid rather than by Medicare or private insurance. Most middle-class people can’t even afford to pay anyone to take care of their loved ones unless it’s in the “gray market,” the shadow economy. So we all have a stake in creating a long-term care system, because we’re all going to need it.

– by Matthew Ozga