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Labors of Love

Nursing Homes and the Structures of Care Work
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Every day for the next twenty years, more than 10,000 people in the United States will turn 65. With life expectancies increasing as well, many of these Americans will eventually require round-the-clock attention-and we have only begun to prepare for the challenge of caring for them. In Labors of Love, Jason Rodriquez examines the world of the fast-growing elder care industry, providing a nuanced and balanced portrait of the day-to-day lives of the people and organizations that devote their time to supporting America's aging population. Through extensive ethnographic research, interviews with staff and management, and analysis of internal documents, Rodriquez explores the inner workings of two different nursing homes-one for-profit and one non-profit-to understand the connections among the administrative regulations, the professional requirements, and the type of care provided in both types of facilities. He reveals a variety of challenges that nursing home care workers face day to day: battles over the budget; the administrative hurdles of Medicaid and Medicare; the employees' struggle to balance financial stability and compassionate care for residents. Yet, Rodriquez argues, nursing home workers give meaning and dignity to their work by building emotional attachments to residents and their care. An unprecedented study, Labors of Love brings new insight into the underlying structures of a crucial and expanding sector of the American health care system.
Contents Acknowledgments ix Introduction: Locating Nursing Home Care Work 1 1 Making the Most of Medicaid 21 2 Staging the Inspections 37 3 Documenting Conflict 57 4 The Costs of Doing Business 77 5 Feeding Residents on a Starving Budget 101 6 The Uses of Emotions 115 7 Making Sense of Death and Abuse at Work 139 8 Connecting Quality of Life and Quality of Work 155 Appendix: From the Poorhouse to the Skilled Nursing Facility 169 Notes 175 References 185 Index 197 About the Author 207
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