Care Falls Apart

Across the United States, home care faces perpetual worker shortages and endemically high turnover levels estimated at between 60% and 90% per year. This chapter examines cases of turnover in rich ethnographic detail, arguing that the inability of agency and public policy to recognize the interdependence of older adults, workers, and their families contributes to this startling statistic. In observed cases of turnover; job loss stemmed from workers’ inabilities to sustain both their own households and those of their older adults without blurring the boundaries between them. Workers lost jobs because of conflicts with family care and because they engaged in unsanctioned reciprocities with clients. Current attempts to protect vulnerable older adults from possible exploitation actually exacerbate the exploitation of care workers and increase instability in home care.