Inequalities of Aging

Paradoxes of Independence in American Home Care

Elana D. Buch

• Publisher: NYU Press
• Year: 2018
• ISBN:
  9781479837083
• Topic: Sciences sociales
• Subtopic: Anthropologie

The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers Paid home care is one of the fastest growing occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities. Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation’s most pressing concerns—rising social inequality and caring for an aging population—intersect to transform the lives of older adults, home care workers, and the world around them. The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality. Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.

1

Generating Independence

Older Adults’ Life Histories

George Sampson was a slim man, his face and limbs all sharp angles exaggerated by the fastidiously pressed slacks and dress shirt he wore each day. A widower with one child living out of state and two more nearby, he lived alone in a small one-bedroom apartment in one of the Chicago Housing Authority’s (CHA) buildings for seniors.1 His asthma and diabetes had become debilitating about five years before we met. He decided he did not want to move in with any of his children despite his increasing frailty. After a series of hospitalizations, his children had begged him to move into their homes. He said, “I could have moved in with my daughter or Junior or gone to West Virginia. They would come and get me. I had so many offers, you know. They still want me to.” He even tried staying with them after a particularly serious illness, but “They was wearing me to death. I couldn’t have no privacy. They would be up all day, all night. If they’re not asleep or something, they be upstairs or downstairs, where ever I decide to be, and be there. ‘You need so and so. You need so and so.’ They’d call themselves helping.” He rolled his eyes with that last phrase, remembering his exasperation.

Instead, his home care worker Kim Little visited him each afternoon. She made sure he ate a healthy lunch, she prepared a warm supper, and kept his apartment immaculately tidy, the way he liked it. Without Kim, Mr. Sampson struggled to keep his blood sugar steady. He told me he hoped the arrangement would last the rest of his life: “If I can’t do for myself then I don’t know if I would want it then. I wouldn’t want no one to worry about me. No way. As long as I can do something, I’m okay. I’ve been doing for myself ever since I was five or six. It’s just habit. I ain’t helpless, you know.”

Like many of the older adults I knew in Chicago, Mr. Sampson felt his life balanced precariously at a kind of crossroads between the independence of “doing for myself” and an unknown, unwanted future relying on kin. Mr. Sampson had served in World War II and once worked three jobs to support his family. Now he was too frail and sick to manage on his own but was reluctant to be supported by kin. Like many older Americans, Mr. Sampson believed that concern, effort, and goods were supposed to flow from parents to children. He worried that if circumstances reversed this flow, he would burden his descendants.2 Older Americans’ anxieties about burdening younger generations also reflect their fears that they will lose control of their daily lives and become subject to their children’s (and others’) concern and interference.

Many older adults prefer care from paid workers, seeing such care as supporting their independence and sustaining their autonomy. The wages home care workers are paid for their caring labor help older Americans to see themselves as equal participants in market exchanges, rather than dependents whose care is the product of coercive intergenerational obligations. For older Chicagoans, remaining independent did not require them to sustain their lives entirely on their own. Rather, older Chicagoans viewed themselves as independent so long as they could contribute equitably in relationships with those upon whom they relied. Home care became a kind bulwark against the possibility of becoming a burden, and a source of hope against the looming threat of dependence.

Older adults’ concerns about sustaining independence reflect the central role this value plays in dominant American conceptions of personhood. I follow a long history of anthropologists in conceiving of personhood as a culturally and historically variable category of membership in social worlds. Understood this way, personhood is socially made and unmade, through daily practices which are shaped by cultural understandings that vary considerably across space and time. Personhood and subjectivity are bound up with one another, in that individuals’ sense of who they are and their preferences are formed by their experiences, including broader social understandings of personhood.3 Recognizing or refusing the personhood of particular beings has profound consequences. These include determining which kinds of beings are able to participate as full members of communities and polities.

In common US discourse, the notion of a person is synonymous with individual members of the human species. American debates about personhood (for example around abortion or corporation rights) often presume it to be a binary status: either a being is or is not considered a person. In practice, chronological age, work history, citizenship, marital status, race, sexuality, and gender all factor into the ways that individual humans are formally recognized as persons in the United States. For example, citizens over the age of 18 are granted the right to vote; at that age male citizens are currently required to register for the draft. Eligibility for federal retirement programs like Social Security depends on a person’s citizenship, age, and work history.

Around the world personhood is understood quite differently, and those differences help to reveal some taken-for-granted assumptions about personhood in the United States. Across contexts, attributions of personhood allow for gradations of difference encompassing the variety of social roles and experiences related to a being’s membership, status, and relationships in communities. These attributions are fundamentally relational, meaning that beings are recognized (or not) as persons through social relations, rather than prior to these relations.4 Understandings of personhood are also profoundly moral; they reflect and generate expectations of those who participate in social life. I use the awkward phrase “beings” because, in some places, personhood is attributed to ancestors, spirits, plants, animals, and features of the landscape as well as to living human individuals.5 For example, in New Zealand, the Wanganui River was granted status as a legal person after 140 years of advocacy and negotiation by the indigenous Maori Whanganui iwi (kin group), who consider the river an ancestor.6 Even the term “beings” limits our understanding of personhood because in a number of contexts, personhood accrues not to individual beings, but to multiple socially connected beings. For example, in many countries, including the United States and Argentina, business corporations are granted status as legal persons.7 Personhood is sometimes denied to humans for reasons including problematic paternity, disability, race, and age.8

Personhood is a dynamic status, emerging throughout the course of social life. Social understandings of personhood also change in concert with social and technological change. The concept of personhood encompasses changing roles and statuses over time; it is made and unmade through relations that change over each person’s life course. Beings who fall outside of local age- and gender-related norms (as well as norms related to other kinds of social difference) are likely to find their status as persons threatened.9 For example, in the United States young adults gain legal rights of citizenship on the basis of chronological age. However, in many American communities, people are socially considered full adults once they establish households that are physically (and ideally financially) separate from those of their parents. Economic and social conditions that hinder young people’s ability to live independently thus also threaten their status as full adult persons. Maintaining a household is a key marker of personhood in the United States; it is thus no surprise that older adults fear bodily changes that threaten their ability to live under their own roofs.

Across the life course, experiences of care generate people’s understanding of their own personhood and that of others. Most obviously, the ways that people care for others reflect whether those others are recognized as full persons. For example, in the United States, care of a pet might signal that the pet is considered a particular kind of person—a family member, but not an autonomous individual. Similarly, care for children often signals that they are persons-in-becoming—biologically human individuals who do not yet have the developmental or social capacities to function as fully independent persons. More subtly, experiences of care play a key role in socializing people to particular ways of morally imagining what a person is, how persons are expected to behave, and how interdependencies between people should be organized.

Normatively, full adult persons in the United States are thought to exert autonomous agency in the world according to the dictates of their will, which requires that they are mentally, physically, financially, and domestically self-determining and self-sufficient. From a young age, children in the United States are taught to perform these forms of self-sufficiency, often through practices that obscure the central roles parents—and especially mothers—play in producing these performances.10 Children increasingly gain roles, status, and rights as they are able to perform greater physical and financial self-sufficiency, in part because their reliance on others becomes even less visible. Older adults, on the other hand, fear being unmade as adult persons and treated like children if they are seen as less self-sufficient. Older adults who have begun to acknowledge their need for assistance thus find themselves in a precarious position, defending their status as full, independent, adult persons.

This chapter examines how older Chicagoans articulated evolving understandings of care, personhood, and independence as they narrated their life histories to me.11 Older adults’ narratives show how their models of liberal personhood arose in the context of these diverse life histories. Across their stories, experiences of care and family, work and hardship intersect with experiences of race, class, and gender.12 Discourses of independence weave through their specific histories. This shows how dominant discourses are interpreted through life experience and come to shape people’s moral imaginations. The differing understandings of personhood that older adults develop across their long lives played a central role in how they thought about and evaluated care.

A Sense of Independence

The stroke she suffered two years earlier had knocked Harriet Cole for a loop. She did not talk about it much with me, except to emphasize that now she could do nearly everything she did before it happened. She credited her determined independence for her recovery. She told me, “When I first got sick, they said, ‘You need someone to push [you] in the wheelchair.’ I said, ‘Oh, hell, no. Everybody is going to be busy.’ I got in the wheelchair myself and pushed the wheelchair and got all over the house by myself. You got to maintain a sense of independence.” Even so, Mrs. Cole agreed when the hospital social worker suggested that she get a home care worker funded through the CCP program. It was nice to have some help around the small, pristine two-bedroom apartment she shared with her brother. The small co-pay she was charged each month empowered her. She did not see herself as dependent on Virginia Jackson, her home care worker. Mrs. Cole saw herself as the younger woman’s boss.

Mrs. Cole’s determination to remain independent seeped into nearly every aspect of her life. As a black girl growing up in the interwar years in the South, she learned early that she could easily be treated as less than a person because of her age, race, and gender. Mrs. Cole also learned that wealth and property could gain a person status and respect in a racist world. She learned that material prosperity created both care and protection. From these early experiences, Mrs. Cole came to believe that others would treat her as a person only as far as she was able to reciprocate any material or social support she received. She ferociously defended her property as the material guarantee of sustained independence. For her, independence was not defined by an absence of relying on other people, but rather by arranging those interdependencies in the right ways. She believed a person achieved independence through sustained reciprocity, by never being in anyone else’s debt.

Despite the stroke, Mrs. Cole insisted she was very much the same person. Her watchful, proud presence commanded respect. Her dark skin glowed, showing only a few lines despite her more than 80 years. She was svelte and somewhat shorter than the five feet eight inches she told me she had once stood. Many days, she welcomed me wearing the clothes she wore to the building’s exercise class that she had attended earlier in the morning, always apologizing for not having had time to change. Even then, her hair was perfectly coifed, her face recently made up, and bright red or coral lipstick freshly applied. She kept her home fastidiously too. The apartment was a study in white—gleaming white linoleum tile, freshly painted white walls, and all white furniture. Two cream-colored upholstered chairs with gilded wood trim sat empty along one wall of the room, protected by shiny plastic covers. A handsome dark wood cabinet along the back wall held a small television, framed photographs, and a few plants absorbing light from the tinted window above.

About three years before we met, Mrs. Cole’s husband died. Shortly thereafter, Mrs. Cole and her brother moved to their small two-bedroom apartment in one of the Chicago Housing Authority’s subsidized buildings for seniors. She sold most of her furniture. The pieces that had once filled their grand 15-room home were too large and ornate for the utilitarian apartment. When I was not helping Virginia, I sat and chatted with Mrs. Cole at the white Formica table that sat near her small galley kitchen. She spent most afternoons at the table watching her favorite courtroom television shows.

She encouraged those around her to develop the independence she had spent a lifetime cultivating, regularly offering Virginia and me advice on how to make sure we never became dependent on anyone. It was a lesson taught in a thousand ways. At Christmastime, Mrs. Cole told Virginia not to get her any gifts but instead to get something nice for Virginia’s boyfriend because “I don’t matter to you, but he does. Spend your money on him—he helped you move into that third-story apartment because you need him. You have to do things for those that are nice to you, because that’s what keeps you independent.” Even though she had help around the house, Mrs. Cole implied, she remained independent because she was able to reciprocally help the people who took care of her. Mrs. Cole imagined independence as the absence of moral and economic debts, as the freedom to do as she pleased because she did not owe anyone in the making of her life.

The link between material security and independence was a lesson Mrs. Cole learned early. Raised near Savannah, Georgia, she was the middle child of nine. Mrs. Cole remembered sharing a bed with her grandmother, her father’s mother, when she was very young. The family moved to Gary, Indiana, when she was still young. Her father worked in the mills and cleaned a doctor’s office at night. She was grateful for his hard work, saying, “We grew up in nice surroundings. Everything we had, we had from him. Everything that came out new, we had. I don’t know if you remember, ice cream rolls, when they first started bringing that out, we had that. And malts. And the big containers of ice cream, he’d bring those home. He took us to shows. My dad took good care of us.” Mrs. Cole’s father gave her one example of what care might look like: working hard so you could provide nice things for those who relied on you.

Mrs. Cole learned that those who earned a lot of money also earned respect and independence. As much as she admired her father’s hard work, as a girl Mrs. Cole dreamed of following in her Big Mama’s (her mother’s mother) footsteps. Big Mama was rich and beautiful, but she did not rely on anyone else to provide for her. At the time, Big Mama was one of the only people selling insurance in her small Southern town. Mrs. Cole never forgot the power of Big Mama’s reputation, which allowed her a modicum of freedom despite the entrenched racial caste system that limited the movement of the other black people in town. She recalled, “I always wanted to be like her because she always had tons of money and whatever she wanted. She always sent us money. Her house was the first one in the area that had all indoor plumbing and everything. It had a pond in the front yard with goldfish in it. She had an organ upstairs and chickens in the backyard and a fig tree. I would climb that tree and eat figs for days.” She continued, “Remember, black folks in those days, there were all kinds of things we couldn’t do down South. I remember once visiting Big Mama, I wanted some ice cream so I sat at the counter, and my auntie told me ‘You can’t sit there.’ The store lady said, ‘well, that’s Ms. June’s granddaughter so she can sit there.’ She had such a reputation in that town.” Wealth and a reputable job, Mrs. Cole learned early, could enable her to transcend the life circumscribed for black women.

Mrs. Cole started working at a young age and learned quickly that she was expected to support those who supported her by contributing part of her wages to her family. As a young girl, she babysat for the neighbor and then worked in a drugstore. She remembered that “whatever I made, I gave part of it to the household. When I came home from the drugstore flashing five ten-dollar bills, my mother said ‘come over and sit,’ and snatched one of the bills.” Mrs. Cole continued, “Ever since then, I gave back to the household. It teaches independence and something you want to do for yourself to do better.” In Mrs. Cole’s narrative, her mother forcibly required her to contribute to the household upon which she depended. This obligatory reciprocity, Mrs. Cole argued, was central to her learning how to be an independent person.

After finishing high school, Mrs. Cole moved to Chicago and went to a business school where she learned secretarial skills. During these early years in Chicago, Mrs. Cole lived in the Phyllis Wheatley home, a communal residence for young, unmarried, working, African American women.13 Residents lived four to a room and shared a kitchen with the whole house. Rent was cheap, maybe 50 cents a week, which was about all she could manage since she was sending money home to her parents. It was hard making ends meet while earning so little. Living in tight quarters, Mrs. Cole learned that she would have to protect the little she had. For example, Mrs. Cole told me of the time she suspected one of her housemates was drinking her milk from the communal refrigerator, so she poured milk of magnesia into it. The next night, the woman became violently ill. When the emergency personnel asked if she knew what happened, she told them, “Well, if she’ll admit that she stole my milk, I can tell you what happened. But if she didn’t take my milk, then I don’t know nothing about it.’” Telling the story, Mrs. Cole repeated that line over and over, laughing and concluding, “She never stole my milk again, that’s for sure!” Mrs. Cole freely shared her income with her family, seeing this as a fair exchange for the many years her parents had supported her. But she would not suffer those who helped themselves to her few hard-earned things. Those who failed to reciprocate, or even worse, those who took from her without permission, showed a parasitic dependence that she defended herself against.

Mrs. Cole also learned that if she wanted to have control over her life, she was going to have to earn the things she wanted for herself. She worked for a department store and then a law office. She soon realized that “everything I was doing was related to insurances, so I took the test. And then, selling insurance. As long as a customer kept their policy, I got a little check. It taught me independence.” She told me, “I like the good things. I always had some girlfriends, who I thought were sharp and nice, but they were not independent people. One friend had a boyfriend at Ebony magazine. He was very nice to her, I thought. I took her to a Christmas party one night down at a lawyer’s office. Every two seconds she had to stop and call him. I thought, ‘I don’t want this kind of life.’ The heck with that. That’s crazy. I never wanted anybody because of what they had. That’s good. That’s yours. I want to get my own. If you’re going to talk to me, have a job or some kind of career builder or do something for yourself. I liked my own independence.” Mrs. Cole saw that if she could not reciprocate the generosity of others, she would not be able to define the terms of her relationships. She demanded that those with whom she associ...