HOME VISITING

Home Visiting Workers: Evaluating the Characteristics & Skills



Home Visiting Workers: Evaluating the Characteristics & Skills

Introduction

Home care is one of the fastest-growing components of the U.S. health care industry. The term home care encompasses three models of care: skilled home health care, home-based long-term care services, and high-tech home care. Growth in this industry has been fueled by several important trends: (a) advances in the technological capacity to provide complex care at home, (b) the search for less costly alternatives to hospital and nursing home care, (c) the emergence of third-party payment for a variety of forms of home care, and (d) the strong and consistent preferences of consumers and their families to receive care in their homes whenever possible.

Home Visiting Workers: Evaluating the Characteristics & Skills

This study examines home care practices because they are seen as an important site for elucidating competing interpretations of the needs of frail elderly persons and, thus, the character of home care work. We focus on home care workers-women hired in the formal organizational world of service agencies but whose actual work is carried out in the informal world of older people's homes. These formal carers are doing many of the same types of helping that is being done by informal carers “next door.” Thus home care workers are strategically located for understanding the contradictions and tensions that result when a formal system enters private worlds to do work that was formerly publicly invisible. Understanding the complexity of providing care in such settings is critical to ensuring that caring labor is assured value in future program developments.

Barbara and Donna (2000) mentions as the brief overview of literature in the next section illustrates, research and program discussions tend to focus on either formal or informal care systems, seemingly, because the two systems have differing sets of concerns. Differences are seen to become problematic only when the two worlds of care are forced to meet, and jostle with each other, in the home of the elderly client. This jostling is constructed in the home care literature as a problem of adjusting and meshing formal and informal systems of care rather than as a signal of underlying conflicts of interests. The formal sector, by far the more powerful in terms of human and financial capital, has an interest in controlling the meshing process because the informal sector actually provides over eighty percent of the daily care. Put differently, if this unpaid labor were suddenly withdrawn, health care priorities would be forced to fundamentally change. In recent years, feminist scholars have been instrumental in making visible just how costly this informal care work is to women.

As long as it remained conceptually locked into the world of family relations, informal caring labor could be recognized, eulogized or pathologized as a private issue outside the realm of public policy (Barbara and Donna, 2000). However, due to the financial and demographic trends mentioned earlier, this formerly private issue of caring for social dependents increasingly is seeping out into the ...