Organizing Home Care: - School of Social Service Administration

Draft Paper Not for Citation or Quotation with Authors’ Permission 4/24/2007
employers operating out of sight in tenements, sweatshops, and fields, government social
policies since the 1930s directly have organized the development of home care—
including the beneficiaries of the service, the structure of the industry, and the terms and
conditions of the labor, though implementation of policy varied by states, counties, and
cities. Home care’s history, we show in our larger study, illuminates the public-private
configuration of the American welfare state, the medicalization of care, the workings of
federalism, and the twisted logic of welfare reform.
We argue that home care as a distinct occupation emerged in the crisis of the
Great Depression as work relief for unemployed domestic servants and as an alternative
for fiscally-strained public hospitals. After World War II, broad transformations in old
age and disability policy, which would necessitate a new labor force, occurred as
prevailing notions of public assistance began to shift toward fostering wage work. Home
care further grew in the postwar period as both an expansion of the hospital and as an
attempt to free hospitals from direct care of charity and chronic cases. The Great Society
fostered home care by authorizing new services for the aged with the Older Americans
Act and Medicare and Medicaid. Poverty programs, including manpower training under
the Office of Economic Opportunity (OEO), and workfare incentives, especially
following 1967 Public Welfare Amendments, were to provide the labor force. Expansion
of public welfare thus occurred before Nixon's new federalism and Reagan’s contracting
out relocated responsibility to local levels of governance and privatized the delivery of
services.
Throughout this period, welfare administrators conceptualized care for the
chronically ill and frail as a form of dual rehabilitation. Poor women of color—easily