Senior care puts care workers into racialized, gendered, and age hierarchies, making it difficult for them to achieve social and economic mobility.
In this series, we ask acclaimed authors to answer five questions about their book. This week’s featured author is Catie Coe. Coe is Professor of Anthropology at Rutgers University. Her book is The New American Servitude: Political Belonging among African Immigrant Home Care Workers.
Roberto Sirvent: How can your book help BAR readers understand the current political and social climate?
Catie Coe: The New American Servitude explores a new axis of inequality in the United States and globally, in which Black immigrants are becoming servants. With the aging of the U.S. population, a new kind of domestic servant—caregiving for U.S. senior citizens—is becoming more and more important, yet is low paid and with precarious work conditions.
Care for America’s growing senior population is increasingly provided by migrants, and the demand for health care labor is only expected to grow. Because of this health care crunch and the low barriers to entry, new African immigrants have adopted senior care as a niche employment sector, funneling their friends and relatives into this occupation. However, senior care puts care workers into racialized, gendered, and age hierarchies, making it difficult for them to achieve social and economic mobility.
In The New American Servitude, I demonstrate how these workers often struggle to find a sense of political and social belonging. They are regularly subjected to racial insults and demonstrations of power—and effectively turned into servants—at the hands of other members of the care worker network, including clients and their relatives, and agency staff. Low pay, few benefits, and the instability of employment, combined with a lack of appreciation for their efforts, often alienate them, so that many come to believe that they cannot lead lives of dignity in the United States. Although jobs are a means of acculturating new immigrants, African care workers do not tend to become politically involved. Because of their bitter experiences, many plan to leave rather than putting down roots in the U.S.
What do you hope activists and community organizers will take away from reading your book?
I hope that activists and community organizers will see care, and domestic work more generally, as critical to labor issues and social injustice in the contemporary era. The problems of care work are a sign of some of the dysfunctions of our society more generally in caring for its population—including senior citizens and workers.
For example, the experiences of home care workers illustrate some of the ways that the Affordable Care Act has succeeded—and failed—for low-income, precarious workers. Before the Affordable Care Act, most care workers I met did not have health insurance. One said, “The people who designed this system have no soul,” because she had no health insurance despite providing health care to others. The lack of health insurance was particularly poignant given the high rates of injury among direct-care workers, as reported by the Institute of Medicine: four times the rate of non-fatal occupational injury than all occupations and higher than that of either construction workers or truck drivers. Most of the injuries were to backs and knees because of the physical effort of lifting and transferring patients. Many direct-care workers did obtain health insurance through the Affordable Care Act, although 26% remain uncovered. The reasons why a quarter of low-wage health workers do not have health insurance reveals why health insurance should not be linked to work. Like other workers in today’s flexible labor market, home care workers have little job security. Home care workers lose their jobs when a patient enters the hospital, passes away, or runs out of money for care. The Affordable Care Act, on the other hand, assumes that workers have stable, full-time work. It requires businesses with more than 50 employees to provide health insurance to its employees who work full time, or 32 hours a week. One agency owner told me, “Our caregivers work full time one week, part time another, and then 6 to 8 weeks full time.” Medicare for All would de-couple health insurance from employment. As this small example suggests, I would encourage activists to see healthcare as an issue that affects workers and Black people in multiple ways and as integrally intertwined with other social justice issues.
We know readers will learn a lot from your book, but what do you hope readers will un-learn? In other words, is there a particular ideology you’re hoping to dismantle?
Sometimes, we focus on the needs of one group, pitting one against the other, such as African-Americans against immigrants, or care workers against senior citizens. We need to see the interconnections between the care needs of aging populations and the care work of others, who will also grow old; the interconnections between the labor experiences of African-Americans in domestic service from slavery to the 1960s and those of immigrants, who face exploitative work conditions under the auspices of a growing domestic labor market, including care for seniors. Capitalism splits workers to see their interests as different, and disconnects the private (care across the life course) from the public (such as work and health insurance). We need to continue to show the interconnections to make a more humane world for all.
Who are the intellectual heroes that inspire your work?
I admire the insights of the scholars of domestic work, who show how complicated and exploitative the relationships are, both historically and in the present: Judith Rollins, Elizabeth Clark-Lewis, Shellee Colen, and Pierrette Hondagneu-Sotelo. An older intellectual hero concerning racism is Frantz Fanon, whose work I have read and re-read. Saidiya Hartman and Michelle Alexander’s work have been inspirational in tracing the ways that new unfreedoms emerge, building upon and transforming older forms of servitude.
In what way does your book help us imagine new worlds?
As for the way forward, I propose a few modest adjustments to the current situation. For care workers in particular, their social mobility would be enhanced by a lattice or ladder within nursing education and the nursing profession such that nursing assistants could advance to positions of seniority and supervision stepwise without the current barriers. Mentoring in home care should happen through formal routes, by more senior and experienced home care workers who have developed strategies for managing confused, demented, and agitated patients, rather than through the current informal social networks among care workers. Lower agency profits directed at raising care workers’ pay and providing more support—perhaps by promoting experienced care workers to assume some supervisory roles or paying overtime—would improve care workers’ sense of fair treatment and belonging. An advance schedule of three weeks—known as fair scheduling—would reduce care workers’ precarity in the face of a client’s change in health status. From the perspective of patients struggling to pay for the cost of home care, a universal long-term-care insurance program, such as those that exist in Japan or Germany, would be helpful. Finally, for workers in general, the Affordable Care Act has expanded low-wage healthcare workers’ access to health insurance, but it has many flaws, including its cost and its lack of employer coverage for contingent and unpredictable work, a condition of work which may well increase, meaning that Medicare for All would be worthwhile for this sector of the workforce.
More radical reforms may be necessary. As the U.S. population ages, both care recipients and care providers should be cared for and have opportunities for dignity. Older adults and care workers are interdependent, and all of us will need care as well as provide care at some point in our lives. As the population of older adults in the United States increases, and the need for care concomitantly grows, this might mean reconfiguring our politics from an emphasis on individual autonomy and self-reliance to an acknowledgment of human vulnerability and interdependence.
Roberto Sirvent is editor of the Black Agenda Report Book Forum.