AMAA on Inequalities of Aging: Paradoxes of Independence in American Home Care

Questions developed by the members of CU Denver’s ANTH4600/5600, S2021: Kaylynn Aiona, Delilah Chavarria, Darcy Copeland, Keaton Green, Ari Jones, Caitlin Konchan, Chris Kuelling, Kuba Kwiecinski, Rosa Lawrence, Destinee Murray, Alexa Powell, Benin Rahma, George Sanchez, Emma Vittetoe, Renee Watson, and Abby Welch

Instructor’s note: Reading “Inequalities of Aging” during an ongoing pandemic and struggles for racial justice lent Elana Buch’s book an acute sense of timeliness and heaviness. Students responded to Buch’s clear prose, vivid ethnographic observations, and oral history methodology. Many of us offered our own, intimate deliberations with the pressures of care and inevitabilities of ageing in relating to the material. As a class, students grappled with deeper questions about labor and capitalism in an ageing society, both as they are lived and as they’re theorized in the social sciences. In teaching the text again, I would devote lecture space to more explicitly unpacking a genealogy of these keywords as they’ve unfolded in anthropological thought. Because many students in this class worked in health services and research, our discussions focused on how different institutions mediate care and the consequences of demarcating – theoretically, practically, and financially – different kinds of care.

I. On concepts and consequences

Q: The concept of “liberal personhood,” and independence as key value or moral imaginary, kept returning throughout the book. But I wonder if in your daily interactions with caregivers & caretakers, you nevertheless encountered traces of alternative, more relational concepts of personhood present in the US culture?

A: This is a fascinating question, though to answer it requires some gentle reframing. I would argue that all forms of personhood are relational forms of personhood. This is true in multiple ways. First, all forms of personhood are recognized and attributed in and through social relations; membership in this category cannot be determined by observing individuals. Second, anthropologists and other scholars use labels like “liberal personhood” to describe the particular relations through which beings come to be recognized as part of social worlds. Given this, liberal personhood is a form of relational personhood. It’s perhaps a strange form of relational personhood because in both its contemporary and historical forms, recognition of the liberal person demands the social erasure of the very relations that make this form of personhood possible. In the case of the contemporary United States, recognition of liberal personhood often indicates that the “independent” person sits in a relatively privileged position within bodily, social, economic, and racial hierarchies that enables them to appear self-sustaining by rendering invisible the labor of others in less privileged positions in those hierarchies.  Obscuring this interdependence, often through capitalist wage/labor exchange, also renders invisible (and sometimes illicit) coexisting forms of reciprocity, mutual obligation and responsibility.

I was also surprised by the diversity of understandings people in Chicago articulated around the meanings of independence. This indicates that while liberal personhood is hegemonic in the United States, it is not monolithic.  Chicagoan’s discourses of independence described different relations to render a person independent. For example, several the people I knew described independence as participating in relations of mutuality and ongoing reciprocity rather than as self-sufficiency. People still called this “independence,” but they meant something quite different than the kinds of independence enshrined, for example, in welfare reform legislation. And, as I describe in the book, some older adults and care workers tried very hard to practice more sustaining forms of reciprocity with one another, though these practices were prohibited by agencies.

I did not observe people explicitly describe alternative forms of personhood in my research, although those certainly may have existed and been articulated/practiced outside of the spaces in which I was observing. I sometimes caught glimmers of possible alternatives. For example, home care workers who talked about providing care that went beyond the strict bounds of their jobs because they wanted someone to provide similarly attuned care to them one day might have been articulating a cosmology of reciprocal contribution and reward quite different from the cosmologies that animate liberal personhood. The agency supervisor who moonlit as an overnight care worker for a wealthy client (in violation of her agency’s “non-compete” policy that disallowed this kind of private work) in order to provide care and housing to younger and older kin in both Chicago and abroad seemed less interested in her individual independence than in her family’s collective survival. My sense is that these alternatives exist, especially outside of majoritarian spaces and communities, but also that there are alternative formulations that exist within discourses of liberal personhood.

Q: Do you think that the Americanized concept of independence is more so “harmful” or “helpful” (or neither) in the context of receiving and giving home care? Do you attribute a part of the inequalities seen with care workers as a byproduct of the Americanized concept of independence and its importance to being a “whole” person?

A: Yes.

To expand a bit: I do think that contemporary American ideologies of independence are harmful to both older adults and home care workers. Moreover, I think ideologies of independence are a core animating component of the ageism, ableism, racism, classism, and sexism that structure inequality in the United States. Ideologies of independence also obscure our ability to see how we are all sustained through relationships to the earth and all its inhabitants in ways that are devastating the planet.

The violent erasures embedded within contemporary ideologies of independence are not new: the original Constitution of the United States enshrined a system in which landowning, white men were the only people granted full citizenship and suffrage; the logic was that these wealthy white men would be relatively immune to economic bribery and other pressures to sway their votes. Each vote cast by this relatively small group of wealthy white men went to elect representatives who would govern over women, children, non-landowning employees, and enslaved people.  In this sense the independence and equality of those original forefathers was based on the dependence and inequality of those over whom they ruled. While the centuries since have brought numerous struggles to expand access to citizenship, suffrage, and independence, it’s worth asking if the kinds of independence we imagine are liberatory instead require hierarchy and oppression. 

Of course, I am just one of many feminist scholars making these arguments. We, along with many of our intellectual ancestors, recognize that liberal personhood is frequently imagined and upheld as liberating people from being confined to and defined by the relationships within which they come into this world. And many of us imagine and study emerging, experimental, and longstanding ways of figuring relations and personhood that do not understand liberation and relationality as opposed to one another (Hooks, 2000; Kowalski, 2016; Povinelli, 2006; TallBear, 2019).

Q: How would you fairly compensate for all the emotional labor of being a hired care worker? Do you think it is possible to pay someone fairly based on the experience of the emotional work they have been doing their entire life (i.e., the skills gained when taking care of their own kin)?

A: We regularly compensate people for emotional labor and reward people for skills they gained outside of the workforce. When we reward people for speaking and reading in “standard” English, as we do in high stakes standardized tests, we are often rewarding them for having grown up in households in which “standard” English is spoken (and penalizing those who have to learn this speech style somewhere else). We are skilled at compensating people with elite social networks, usually gained through connections from family and/or elite schools, by offering these people positions in financial institutions and on corporate boards because they are able to raise funds from their connections in those networks. Given the declining rates of social mobility in the United States, I think we have strong evidence that it is possible to compensate people for experiences and skills they’ve gained outside of school, formal training, or the workforce. Whether it’s possible to do this “fairly” or not is a complex question, but it is clearly possible that we can compensate people generously for skills gained in daily life when we value what they contribute.

One method that’s been promoted by some of the organizations that research and advocate for the home care workforce (e.g. PHI National and the National Domestic Worker’s Alliance) is creating job and wage ladders for care workers. These job ladders would enable those individuals with substantial skill to earn higher incomes.  Potentially more skilled workers would care for older adults with more complex conditions, or they would provide mentorship for new care workers. I particularly like the later proposal, which would provide greater compensation for experienced care workers while enabling inexperienced workers to train under someone with substantial mastery. This kind of apprenticeship model is regularly used in other fields that require substantial amounts of craft and situational knowledge.  Marrying an apprenticeship model to job and wage ladders would better compensate worker’s emotional and practical skill. Foundational to this approach is that entry-level care workers would earn a wage that allows them economic and social stability, access to health care and paid leave. Without compensation that enables entry-level workers to sustain their own lives, we cannot expect to grow a workforce able to also sustain the lives of older adults.  

II. On methodology and praxis:

Q: You repeatedly speak to the importance of empathy for home health workers which often comes with a toll on the worker. As an anthropologist, empathy also seems like an important trait in order to adequately ingest and tell others’ stories. Do you agree?

A: I am not sure if ethnographic research is an inherently empathic exercise; there are longstanding debates about if empathy is an appropriate or even possible enterprise in ethnographic research. I am circumspect about the value of empathy as a tool for anthropological knowing. What can we really know of another’s experience? Perhaps this is a contradictory statement from someone whose book describes in detail the ways that practices of empathy and attunement enable care workers to sustain older adults’ lives and personhoods. And yet, I worry that the assertion of empathy as method carries with it a great deal of hubris. I think there are many ways to do ethnography well, and many ways to learn about and share the stories and experiences of the people with whom we work and learn. Empathy is one tool, but it also risks us assuming that what we understand to be another’s experience is their experience. This is especially challenging when we attempt to use empathy as interpretive tool to reach across forms of social difference that substantially shape experience. As or more important than the exercise of empathic imagination is the work of asking, observing, and listening carefully to what the people with whom we learn tell us about their experiences.

On the other hand, to paraphrase Marilyn Strathern (2018), ethnography is a method of learning about social relations by being in social relations, and empathy can be helpful in building relations of mutuality and trust. In my work, this kind of empathy has been helpful for communicating to those with whom I work that I am profoundly interested in them and their experiences of the world. For those older adults and home care workers who were lonely or felt invisible, I think it was meaningful to them that I was interested in them, their stories, and their experiences.

Another key role for empathy in ethnography is that it can help ethnographers attend to, account for, and push against our own socialized ways of knowing and being in the world. Bourdieu (2018) talks about the importance of reflexivity for heightening our awareness of the ways our particular social positions and histories shape our subjectivities. Combining empathy with reflexivity enables us to recognize and ask questions about the ways that ethnographic knowledge is produced in relationships between people with different subjectivities and social positions. In this sense, the ethnographic engagement of empathic reflexivity pushes us to ask questions that account for people’s complex subjectivities rather than using empathic attunement itself as a source of answers or evidence.

Q: Much of this ethnography seems like it required a large investment of emotional effort to complete. What (if any) aspect of the research process was the most emotionally challenging for you and why? How did you deal with it in a way that enabled you to maintain a professional manner?

A: I interpret this as a question about how to think about emotions and ethics in fieldwork. The term “professionalism” can mean a lot of things, and is bound up with concerns about status, expertise, and neutrality/objectivity in ways that I don’t think are necessary for – or even beneficial for – ethnographic fieldwork. Dominant understandings of “professionalism” in the United States tend to imagine that emotions cloud rationality and judgement, or that emotions lead to favoritism and bias rather than even-handed decision making. This ideology of affect has deeply gendered and racialized histories, which obscure the ways that emotion is implicated in all human relations, including “professional” ones. So, I worry (and worried) less about “professionalism,” than about being in ethical relations. So, then the question is: how might an ethnographer’s emotions matter in ethical ethnographic practice?

I have become increasingly suspect about ethnographic practice and writing that valorizes the suffering of the ethnographer. I’m wary of doing that here, while also wanting to acknowledge that I found this fieldwork enormously challenging, or at least that it coincided with an enormously challenging period in my life. Much of this had to do with the loneliness, isolation, and uncertainty I experienced at that time in my life, combined with doing ethically, socially, and emotionally complex fieldwork in these intimate settings. I found that my training in anthropology had not prepared me to think about how to develop empathic, ethical, mutual relationships with the people with whom I was working while also honoring my own limits.

Ethnographers are always themselves in their ethnographic research, and we bring our particular histories and ways of being in relation with others to our ethnographic relations. These relations are, themselves, frequently fraught with hierarchy and inequality – true in most human relations and amplified by the complex dynamics in ethnographic engagements across multiple forms of difference. At the time I was doing my research, I was in my late 20’s, single, and had relocated to Chicago to conduct this research. During fieldwork, my own grandma, with whom I was close, was dying back in Michigan. As I mention in the book, my dad was diagnosed with Parkinson’s in the middle of fieldwork, which brought its own fears and challenges.  It was often confusing and uncomfortable to be in Chicago doing fieldwork with older adults rather than being nearer to my family. In short, I was lonely.

Many of the older adults who turned out to be willing to allow me into their homes were also quite lonely. In some cases, the older adults reminded me of my own kin, and one older adult felt like someone inhabiting a possible future of my own. This generated some kinds of emotional and practical entanglement that eventually proved unsustainable. In one case, for a short period of time, one older adult came to depend on me to pick up her groceries, which I worried created ethical concerns around consent. Given my other obligations, I worried my availability would prove too inconsistent to meet her urgent need. In this case, I was able to inform the home care agency’s supervisor of the problem (with the older adult’s permission), and they were able to link with other service providers to maintain her food security.  In other cases, home care workers with whom I had grown close asked me to advocate for them with the agencies that employed them, which I had limited ability to do given the institutional ethical guidelines that bounded the research. 

In each case, it was emotionally and ethically fraught to figure out how to respond in the context of the multiple hierarchies and institutional demands woven into these relationships. Recognizing my own institutional and social privileges, I often wanted to do more than was sustainable to support the people with whom I was working. With guidance from academic mentors and kin, I eventually worked to develop clearer awareness of what I was and was not responsible for, and what I could and could not ethically change given broader context in which I was working. This didn’t change how I related to or felt about the older adults and workers I was spending time with, but it did enable me to have a clearer sense of my responsibilities to those with whom I was conducting fieldwork. In the years since, and with much better access to mental health care, skilled therapists have helped me think about how to build ethical relationships and navigate the emotional complexities that arise in fieldwork.  

Elana Buch is an Associate Professor in the Department of Anthropology at the University of Iowa. She is a sociocultural and medical anthropologist who studies aging, care, and inequality.  She asks questions about how different ways of practicing human interdependence are connected to large scale social changes, and how these forms of interdependence generate social difference and inequality across the life course.

Ask-Me-Almost-Anything (AMAA): Centering Student Engagement with Ethnographic Monographs” is a series edited by Christine Sargent.

Sources Cited:

Bourdieu, P.  & Wacquant, L. J. D. (1992). An Invitation to Reflexive Sociology. University of Chicago Press.

Hooks, B. (2000). Feminist Theory: From Margin to Center. Pluto Press.

Kowalski, J. (2016). Ordering dependence: Care, disorder, and kinship ideology in North Indian antiviolence counseling. American Ethnologist, 43(1), 63–75. https://doi.org/10.1111/amet.12263

Povinelli, E. A. (2006). The Empire of Love: Toward a Theory of Intimacy, Genealogy, and Carnality. Duke University Press.

Strathern, M. (2018). Relations. Cambridge Encyclopedia of Anthropology. https://www.anthroencyclopedia.com/entry/relations

TallBear, K. (2019). Caretaking Relations, Not American Dreaming. Kalfou, 6(1), 24–41.

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