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“A Culture of Caring”: Documenting Home Health Care Workers

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This guest post is by Professor Bob Bussel of the University of Oregon Labor Education and Research Center in Eugene, who organized the documentary team that produced the collection now online as “Taking Care”: Documenting Home Health Care Workers that is part of the Occupational Folklife Project

A group of photographs of five men and women.
A few of the participants in this project to document the occupational folklife of home health care workers. Left to right, Edward Smith, Olga Yakimchuk, Neftali Garcia, April Shattuck, and Terry Haydon.

Home care workers represent what scholars describe as a “dispersed work force” that performs an invaluable public service within the privacy of a home setting. They provide their clients, who are sometimes members of their own families, with the most intimate forms of assistance, including bathing, grooming, dressing, and feeding. Their work combines both physical and “emotional labor,” with the latter term embodying deep levels of engagement that require considerable interpersonal dexterity. Although often viewed as unskilled, home care workers invariably make complex decisions that affect their clients’ health and well-being.

In my capacity as a labor educator at the University of Oregon, I first became acquainted with workers who provide home health care services for seniors and people with disabilities back in the early 2000s.

Most of the workers I encountered were members of Service Employees International Union (SEIU) Local 503. They had just organized a union with the aim of improving their working conditions, obtaining a voice on the job, and providing quality care for the people they served.

Although many caregivers were quick to observe that their experiences are varied and distinctive, we found a host of common themes in their stories that illuminate the “culture of caring” associated with providing home care.

As I heard the workers discuss their experiences, I began thinking about ways to tell their stories to a broader audience. Then in 2014, Nathan Moore, a University of Oregon folklore student and activist friend, told me about the Archie Green Fellowships available through the American Folklife Center.  We submitted a proposal titled “Taking Care: Documenting the Occupational Culture of Home Care Workers” and following its acceptance, conducted 35 separate interviews with a diverse group of home care workers during 2014 and 2015. Along with Nathan and me, our “Archie Green Team” team included my University of Oregon colleague Helen Moss and videographers Sonia De La Cruz and Don Stacy.  We recruited most of our interviewees through their union, SEIU Local 503, along with a few others selected by members of our research team. The interviews were conducted both in union offices and at the homes of workers.

Prior to our interviews, we assumed that many caregivers regarded their work as a “calling” marked by a deep sense of purpose and pride.  This view was affirmed repeatedly during our interviews. One interviewee asserted that caregiving “takes a lot of heart.” Other caregivers also reflected this sentiment, with one observing that “you are in the wrong business if you don’t care or can’t make your client feel better.”

Many caregivers used words such as “dignity,” “respect,” ”freedom,” and “independence” in referring to the feelings they wanted their clients to experience.  As one provider commented, helping people “have the life they want to have” made her feel especially good about her work.  In describing his work with a disabled consumer, another provider observed: “I am her legs, her dancing shoes, her walking through the mall.”

Most of our interviewees described the development of close relations with the people they care for. Inevitably, they share confidences, stories, and jokes. For some interviewees, the relationships became quasi-familial, underscored by occasions when caregivers invited their clients to attend family events in their homes. In other cases caregivers noted how clients regarded them as their “best friend,” yet another manifestation of the intimate bonds that emerge from the caregiving relationship.

However, while one provider described the caregiving relationship as “an amazing journey with each client,” others noted the difficulties and challenges inherent in their work. Caring for people who are often in continual pain and emotional turmoil demands that caregivers develop multiple strategies for helping their consumers feel more comfortable.  These strategies often encompassed giving consumers choices regarding what clothes they wear, food they eat, or outings they take.  One provider turned bathing, which can evoke feelings of embarrassment or physical pain in consumers, into a “spa day” as a way to turn a potentially traumatic event into a festive occasion.  These examples demonstrate the creativity and inventiveness that providers must continually tap to help clients affirm their dignity and independence despite a diminished ability to make decisions about their lives.

Most of the workers we interviewed are members of SEIU Local 503, and we asked all interviewees about their relationship with the union.

The union has served several important functions for home care workers. Reflecting a widely shared sentiment, one worker declared that the union has helped to “professionalize” the field and given the occupation of home care an “identity.” Others referred to the psychological dimensions of union involvement, describing how the union had given them “a voice and a purpose,” served as a source of support, and made providers into “bona fide workers.” These comments confirm our perception that a “quiet revolution” has occurred in the field of home health care. Unionization, collective bargaining, and political engagement have played integral roles in improving the lives of providers and their clients and enhancing the ability of home care workers to act as effective citizens.  And for a group of workers that often labors in isolation, involvement in the union has enabled them to experience the sense of connection and camaraderie that comes with being part of a distinct community.

The American Folklife Center funded interviews have formed the foundation for a short documentary film, “The Care Revolution: The Transformation of Home Health Care in Oregon,” that we completed several months ago. The documentary has been received enthusiastically by audiences, and we look forward to showing it widely in the coming months.

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