Research That Matters (January 17 - 20, 2008)


Empire Ballroom (Omni Shoreham)

"Just Treat Me like a Person": the Development of Caring Knowledge in Paid Home Care of Elders in Chicago, Il

Elana D. Buch, MSW, MA, University of Michigan-Ann Arbor.

PURPOSE: In the U.S., many older adults supplement care provided by kin with paid home care services, making home care one of the fastest growing industries in the country (BLS 2007). Paid home care generally brings poor, minority and immigrant workers into wealthier white older adults' homes to assist them with activities of daily living such as bathing, toileting, cooking, feeding and housecleaning. Previous interview-based research suggests that the development of close relationships is an important component of quality care (Eustis, Kane et al. 1993; Piercy 2001; Aronson 2003). This study investigated the processes by which home care workers and older adults develop relationships and the ways that ethnic, class and gender differences influence these processes. METHOD: Research was conducted in one privately funded and one publicly funded home care agency in Chicago, Illinois selected for their similar geographic and demographic characteristics. Within each agency, a nested sample was constructed consisting of five worker-client pairs (n=20), seniors' family members (n=30) and agency supervisors (n=10). This nested sample was enabled intensive data collection about worker-client relations and their social contexts. Data collection methods included eighteen months of structured observations in agency offices and in client's homes, interviews and a review of agency documents. Fieldnotes and transcripts were coded using HyperResearch qualitative software. Following inductive qualitative research practice, data were continuously analyzed over the collection period to identify key themes and patterns. FINDINGS: Over time, workers develop an empathetic, anticipatory, embodied “caring” knowledge of senior clients' particular physical preferences, emotional patterns and social needs. Caring knowledge not only enables workers to continually adapt to changes in seniors' physical, social and cognitive needs, but also positions them as authorities about their particular clients and aging processes more generally. Older adults argue that care workers' development of caring knowledge is a key component of good care. In paid care, socio-economically subordinate non-kin attain this intimate form of interpersonal knowledge, which threatens family members and workers' superiors. Family members fear that seniors have become too emotionally attached to workers, or that seniors will include workers in their inheritances. Workers assert that caring knowledge about particular clients entitles them to continued employment with that client and enables them to speak more authoritatively about aging than their supervisors or other health care professionals, despite their lower educational and occupational status. IMPLICATIONS: By bringing workers into sustained, intimate relations with seniors, paid care work threatens to transfer authority about seniors from experts and family members to workers. In doing so, paid care work threatens not only the assumed relations between seniors and their kin, but also broader intersecting relations of classed, gendered and racialized inequality. Findings suggest that home care policy should enable and reward the development of caring knowledge while training programs prepare care workers to be attentive to the complex social relationships produced through this knowledge. Social workers who act as home care supervisors and case managers can help seniors, family members and care workers adjust to changing family dynamics and find appropriate relationship boundaries.