A Feminist Lens on Paid Caregiving in Institutional Long-Term Care: Juxtaposing Women as Caregivers and Women as Care Receivers
In general, women live longer than men on average by seven years. Thus, from a demographic perspective, the aging population is largely a female phenomenon. While age itself is not a disease, women face more and different social (e.g., social isolation, poverty, etc.) and health (e.g., comorbidity from chronic diseases) risks compared to men as they age. These social and health risks are often not independent. For example, Alzheimer’s disease and dementia are a double-edged sword for women. On one hand, women face a greater health risk of developing dementia compared to men; on the other hand, they face a greater social risk of providing care to someone with dementia (. Social risk in this instance refers to women’s increased likelihood over men for becoming a caregiver and experiencing all of the potential consequences.
In nursing homes, women’s increased health and social risk become juxtaposed. The most vulnerable older women populate nursing homes, where some of the most vulnerable younger women provide care to them. Roughly two‑thirds (about 65–70%) of U.S. nursing facility residents are women, making long‑term care a strongly gendered institution. The notion of a gendered institution includes the extremely low paid caregivers. Certified nursing assistants or CNAs provide 90% of the direct care to nursing home residents, and 90% are women, themselves. Further, 60% of CNAs represent persons of color, and about 20% of them are immigrants.
In the microcosms of nursing homes, power differentials prevail on two levels. First, frail older women most likely completely depend on the CNAs, who have the power over their well-being. Second, CNAs represent the direct care workforce at the bottom of the nursing home staff hierarchy. In turn, the frail older women depend on the CNAs for multiple health needs. Likewise, the Director of Nursing (DON) and licensed nurses hold power over the CNAs’ workload assignments and hold them accountable for tasks associated with assisting the residents. Treatment of CNAs by licensed nursing staff varies widely, but national studies show that many CNAs report feeling undervalued, excluded from decision‑making, and insufficiently supported.
This study will characterize interpersonal communication between paid caregivers and older residents in nursing homes using qualitative analysis with a feminist lens. The concept of enacted social support will provide empirical evidence for interpersonal communication as a mechanism of social support. I have approximately 40 videos of dyads with paid caregivers and older adult residents, which I anticipate as having a very different kind of emotional support—if at all—and much broader emphasis on instrumental support.
The concept of social support has evolved to include both positive and negative types. Employing a feminist lens to analyze the videos would allow me to be theoretically sensitive to power differentials between the CNAs and residents and explore the nature of how older women residents may be at risk for “interactional starvation” and be deprived of emotional support despite their tendency to need it as women.
