Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as they try to become a positively valued unified occupation: “direct care workers.” Before this occurs, these workers must overcome negative definitions imposed by three powerful institutions: professional guilds, employers, and states. Care workers’ legitimacy is challenged as nursing labels them “unlicensed, assistive personnel,” defining them in terms of their task relationship to nurses rather than their social relationship to clients. Care workers’ identity is obscured as corporate rationalization nullifies their unique contributions with task unbundling, part-time work, short staffing, and turnover undermining bonding with colleagues and clients. State regulation impedes care workers’ integration, segmenting similar workers under different regulatory regimes, defining workers negatively rather than by their educational attainments and competencies. Overcoming this triple negation will require not just cultural change, but also real structural changes, and can occur only through concerted actions involving coalitions. Labor market intermediaries, public authorities, labor unions, workforce investment boards, philanthropic organizations, and government interagency groups are among those supporting direct care workers’ advancement by strategically coordinating licensing, purchasing, and developing the workforce. Recent federal policy changes and health reform legislation have enhanced recognition of this occupation and are providing new resources for its development.
Konrad, T.R. (2011), "The Direct Care Worker: Overcoming Definitions by Negation", Jacobs Kronenfeld, J. (Ed.) Access to Care and Factors that Impact Access, Patients as Partners in Care and Changing Roles of Health Providers (Research in the Sociology of Health Care, Vol. 29), Emerald Group Publishing Limited, Bingley, pp. 43-75. https://doi.org/10.1108/S0275-4959(2011)0000029005
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