Inequalities of Aging Anthropologies of American Medicine: Culture, Power, and Practice General Editors: Paul Brodwin, Michele Rivkin- Fish, and Susan Shaw Transnational Reproduction: Race, Kinship, and Commercial Surrogacy in India Daisy Deomampo Unequal Coverage: The Experience of Health Care Reform in the United States Edited by Jessica Mulligan and Heide Castañeda Inequalities of Aging: Paradoxes of Independence in American Home Care Elana D. Buch Inequalities of Aging Paradoxes of Independence in American Home Care Elana D. Buch NEW YORK UNIVERSITY PRESS New York NEW YORK UNIVERSITY PRESS New York www.nyupress.org © 2018 by New York University All rights reserved References to Internet websites (URLs) were accurate at the time of writing. Neither the author nor New York University Press is responsible for URLs that may have expired or changed since the manuscript was prepared. Library of Congress Cataloging-in-Publication Data Names: Buch, Elana D., author. Title: Inequalities of aging : paradoxes of independence in American home care / Elana D. Buch. Description: New York : New York University Press, [2018] | Series: Anthropologies of American medicine : culture, power, and practice | Includes bibliographical references and index. Identifiers: LCCN 2017044866 | ISBN 9781479810734 (cl : alk. paper) | ISBN 9781479807178 (pb : alk. paper) Subjects: LCSH: Home care services—United States. | Older people—Home care— United States. Classification: LCC RA645.35 .B83 2018 | DDC 362.14—dc23 LC record available at https://lccn.loc.gov/2017044866 New York University Press books are printed on acid- free paper, and their binding materials are chosen for strength and durability. We strive to use environmentally responsible suppli- ers and materials to the greatest extent possible in publishing our books. Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 Also available as an ebook To my parents, Ray and Lindy Buch, who cared for me first, and through it all. Contents List of Abbreviations ix List of Key People xi Introduction 1 1. Generating Independence: Older Adults’ Life Histories 33 2. Inheriting Care: Home Care Workers’ Lives 62 3. Making Care Work: Training and Supervision in Home Care Agencies 88 4. Embodying Inequality: Empathy and Hierarchy in Daily Care 126 5. Independent Living: Housekeeping as Personkeeping 151 6. Care Falls Apart: Turnover and the Limits of Independence 176 Conclusion 201 Acknowledgments 217 Notes 221 Bibliography 241 Index 257 About the Author 263 vii List of Abbreviations ADA— Americans with Disabilities Act ADC— Aid to Dependent Children ADLs— Activities of Daily Living AFDC— Aid to Families with Dependent Children CCP— Community Care Program CHA— Chicago Housing Authority CNA— Certified Nursing Assistant DON— Determination of Need FLSA— Fair Labor Standards Act HCBS— Home and Community Based Services HUD— Housing and Urban Development IADLs— Instrumental Activities of Daily Living NDWA— National Domestic Workers Alliance PRWORA— Personal Responsibility and Work Opportunity Reconciliation Act SEIU— Service Employees International Union TANF— Temporary Assistance for Needy Families ix