Abstract
Labors of Love: Nursing Homes and the Structures of Care Work offers readers a rich insight into how for profit and not-for-profit nursing homes respond to the ever-increasing financial and regulatory demands, and how these demands dictate a resident’s care as well as the health-care worker’s experience. This study adds to our understanding of the personal experiences of health-care workers. This understanding is critical for social workers, as health care is projected to continue to add substantial jobs due to our aging population, the newly enacted Affordable Health Care Act, and the increase in health-care spending. It is critical to understand how the industry’s policy requirements and pressures impact the care our aging population receives as well as the treatment of its’ “invisible” care employees who are predominantly women of color.
The book offers data from an 18-month ethnographic study that describes the Medicaid and Medicare fee for service reimbursement policy, which the author posits “incentivizes the dependence and incapacity of residents, rather than encouraging independence and restorative care” (p. 17). These findings regarding how care is reimbursed are based on how long the state estimates the individual care should take and offers invaluable information to family, community, and professionals alike. Rodriguez’s findings suggest that the reimbursement process and pressure from administration impacts care workers, the care workers reported a sense of frustration and resentment toward the reimbursement and regulatory systems. Rodriguez argues that the care workers were “nudged into doing care work that seemed to serve the needs of those systems more than the residents” (p. 115).
Labors of Love offers candid and extensive information about what and how care is delivered to one of our most vulnerable segments of our population: the aging and the ill. The book, although at times repetitive, is clearly written and informative, opening with an analysis of nursing home reimbursement policies and regulations, and behind the scenes look into how these homes prepare for health and safety inspection teams that monitor regulatory compliance. These efforts, the author found, mask significant structural issues such as work overload and chronic understaffing. The next section takes these findings and shows how these challenges generated conflicts between line and administrative staff as well as severe revenue crises which was found to harm the residents’ quality of life and the morale of the workforce. The book offered insights into the worker’s experience, how they channeled their experience within an unyielding system and focused on what mattered to them: the care and emotional attachment to the residents and families. Through his interviews, Rodriguez shows how the care workers derive meaning and a sense of integrity from their work through emotional labor, “a skill earned through trial and error that helped staff construct dignity at work within a system that was fraught with things to feel bad about” (p. 116). Rodriguez found that these carers, though disenfranchised from the processes that informed the resident’s experience, turned inward to construct meaning and dignity in their work.
This is a must read for social work students, professionals, and professors alike, as the aging of our U.S. population presents unique social and political challenges. The book also has value for those committed to the interests and rights of women and disenfranchised workers by presenting the experience of “other nursing home care workers” whose experiences previously were invisible from the nursing home research.