An Ethnography of Care Workers and Dementia

Care, whether viewed as acts of civility, acts of compassion and skill, or acts of close personal interaction, is the fundamental process by which society perpetuates and recreates itself. Despite social need and the undeniable benefit of occupations such as Certified Nursing Assistants (CNAs), these workers—mostly female and disproportionally from minority groups—face very low wages, a notable lack of respect, and little public recognition of their abilities. The United States is experiencing what experts call a crisis of care with a current and growing shortage of nurses and CNAs. In U.S. Nursing Centers, the demand for Certified Nursing Assistants, the largest group of employees who operate on the front line of health care, is expected to grow exponentially due to dramatic increases in population aging.

Over the course of a year and a half, Anne K. Vittoria examined the meaning and social construction of care work on an Alzheimer’s Pavilion located in a geriatric facility in the mid-western United States. Through in-depth ethnographic research focused on the local culture and logic of care, Vittoria documents that, when given autonomy in their daily work in an institution, CNAs and the LPN Charge Nurse constructed a systematic body of knowledge and created a language of care—forging a "different" model of personal care in resistance to the medical model of care. This book challenges the assumptions of the outside world that low-level workers are alienated from their work and have minimal skills. Paradoxically, the Pavilion is both a refuge and a site of struggle for the CNAs; they desire to create a world that is the antithesis of the world in which they live on the outside. Women of Color in a World Apart provides a public forum for the voices of women of color, the development of concepts, and a practical as well as theoretical language of care that could be transformational in connecting the meanings of care with the organization of care.