Three Papers On Home Health Care Services In The United States

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Doctor of Philosophy (PhD)
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The United States faces a growing aging population. Many seniors will need both short and long-term care services. Home-based care services are often preferred over facilities because of comfort, lower costs, and better health outcomes. Yet, home health care is beset with a number of challenges, including labor shortages and low-paid aides who experience high turnover. Medical sociology has generally studied hospitals and facilities over home-based care, and sociology of service work and care work have largely focused on workers’ interactions with consumers instead of employer institutions and organizations. In three papers, this dissertation investigates the effect of home health agency’s profit status on aides’ reported job satisfaction; the consolidation and growth of large, for-profit home health care companies in the industry; and how the emotional labor managers perform on front-line staff is part of the structure of large, for-profit home health care. The three papers rely on multivariate analysis of the 2007 National Home Health Aide Survey, the only existing nationally representative survey of home health aides; content analysis of the annual reports of the largest publicly traded home health care companies in 2016; and a year-long organizational ethnography of a large, national, for-profit home health care company (including observational visits to three sites within the company, and interviews with the company’s directors, managers, and front-line staff). Paper one shows that feeling valued by the organization and feeling respected by one’s supervisor account for the for-profit effect on aides’ reported job satisfaction. Paper two shows how vertical and horizontal integration is present among home health care industry leaders, reflecting broader trends in medicine and healthcare. Paper three introduces a concept, emotional economies of scale, to describe how emotional labor on the part of managers allows home health agencies to deliver an intrinsically labor intensive service profitably on a large scale. It offers a view of the industrialization of care, and discusses the role of technology and how intersectional identities of managers and staff reflect longstanding patterns of inequality in care work.

Jerry A. Jacobs
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