Why It’s Crucial to Make the Link Between Better Jobs and Better Care

Deborah Little is the chair of the Sociology department at Adelphi University. Her chapter in Caring on the Clock, a book on direct care work that is due out this fall from Rutgers, looks at DCA’s work to support and empower direct care worker advocates. She recently talked to DCA’s Elise Nakhnikian about what strategies are most effective and why.

Voices Institute students at work with an instructor (far left).

Voices Institute students at work with an instructor (far left).

What got you interested in this topic?

I was hired by DCA to do an evaluation of the pilot senior CNA project that started three years ago. As part of that, Leonila [Vega] invited me to attend a national Voices Institute in Wisconsin, because five participants from the senior CNA project attended that year. At the Voices Institute, I got very interested in the organizing and empowerment work that DCA was doing. I took extensive field notes during the Voices Institute, and spent a lot of time speaking with participants in informal interviews. After that, I expanded my research to look at the DCA blog and the literature on organizing direct care workers.

What got me interested in this topic was a moment that I talk about at the beginning of the paper, where one of the workers at the Voices Institute was willing to give up a wage increase because she thought it would be difficult for her clients to afford the extra cost. I thought, how can this be? How can she not readily see the connection between the quality of her job and the quality of the care she is giving? And how can she be so willing to sacrifice her own needs and the needs of her family?

The other interesting thing was that Leonila pounced on that comment right away, telling the woman: “You’ve got to watch this nature of self-sacrifice because by sacrificing yourself, you are undermining the thing that you care about, which is patient care.” I talked to her about it afterward and she said she knew she had to challenge that mindset because she encountered it all the time. So that intrigued me.

So basically, you’re saying that a lot of direct care workers think it would be selfish to advocate for their own rights because they don’t see that their interests align with their clients’ needs?

Yes. Absolutely.

Some folks seem to think that care workers should do the work for love rather than for money, implying that money undercuts the capacity for emotional connection. This particularly applies to women, because our ideology tells us that women are “natural” caregivers. To say that care workers should do the work solely for love is to suggest that working conditions do not matter. But working conditions in any field need to be decent—that is why we have laws that regulate work.

The ideology about women being natural caregivers also suggests that the work is not skilled, which is absolutely not true. These workers love their clients AND they need to be paid good wages in recognition of both the skill level and the importance of the work. So I wanted to write about how DCA emphasizes the connection between decent working conditions, including wages, and quality care. Rather than seeing labor for money and love as in conflict in care work, DCA recognizes that the relationality of the work, the human connection, is as important and as much a skill as the hands on work of transferring, or bathing, or any of the other things that care workers do to help their consumers. Unions have also stressed the link between quality work and quality care, to some degree. In my research I found that there was language about success in union organizing campaigns of care workers by linking the idea of labor and love, but nobody had actually studied how that link was made.

What lessons can we learn from your research?

There’s the obvious lesson for advocates and organizers, which is that the alleged opposition between labor and love is a very powerful ideology that has been internalized by workers as well as the rest of us. Insofar as they see these things as being in opposition, many care workers will not fight for their own working conditions, because they see it as basically making a lie of their belief about the importance of the relationships they have and the care they provide.

To get workers to advocate for themselves, you have to show them how good working conditions and good care are equally important and reciprocally necessary. In other words, workers need to believe that good working conditions will best allow them to provide the kind of care they want to give. Workers will give you examples of moments when they were not able to do their best. For example, one worker explained that she had to work even when she was experiencing back pain because she had no sick days or health insurance. The pain interfered with her ability to fully attend to the emotional needs of her client. She was able to provide the physical care required, but felt that she was less able to give her full attention to the relationship with her client.

I think another reason more direct care workers don’t advocate for their profession is that they are so used to direct care work being disrespected or treated as if it were invisible that they don’t expect anyone to listen to what they have to say.

That is absolutely true. DCA does a lot of work to counter that lack of respect. They constantly value the work—explicitly, verbally, outwardly. They tell workers and they tell the world how valuable the work is.

Before I went to the Voices Institute, I imagined that it would be very skills-based, teaching things like public speaking, the whole set of skills that are required to do advocacy. Yet much of the time there was spent on emphasizing the importance of the work and the workers. This was not just “You are a great person.” This was about how important direct care work is and that you [direct care workers] as a group bring critical skills to the work along with your care, your love.

Because you’re not likely to put energy into fighting for something if you think it’s a losing battle, or if you’re not entirely sure it’s worth fighting for.

All this is complicated, of course, by issues of gender, since the work is often seen as something that just “comes naturally” to women rather than being skilled labor–something that’s expected. Just as we too often don’t respect women who are full-time homemakers, we don’t respect women who do aspects of that homemaker job for pay.

People in disabilities studies will talk about the fact that disability is so stigmatized that the caregivers that work with people with disabilities often have an associated stigma—“oh, those are the people you hang out with. They’re not worth much, so you’re not worth much either.”

And the same is true of older people, who are often discounted or overlooked by our youth-oriented culture.

That’s right.

What other recommendations do you have for advocates?

One more lesson is that, as DCA and other organizations like DCA move forward, I believe that they should more strongly advocate for adequate public funding of care work. This can be tricky in a country in which so much health care is still privately funded. But many care theorists (academics who study care work) will argue that our society cannot meet the care needs of our citizens without a commitment to public funding. You need that funding to ensure that we have the number of competent caregivers needed to meet human needs.

Advocacy, of course, has many stages. DCA has done tremendous work to organize direct care workers, support their self-advocacy and their rights as workers, and advocate for their clients. Moving forward, I hope that direct care workers and their advocates will move into a second phase of work in which they focus more on adequate funding for care.

Workers want to be sure they’re doing what they need to do to support their clients’ interests while they’re supporting their own interests, and obviously making sure there is enough money to pay for their clients’ care is a huge part of that.