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. Skilled 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. Into 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.
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AnneK.Vittoria is Associate Professor of Sociology, Gender Studies, Social Psychology, Aging, and Consumer Society at the State University of New York Cortland. Support for this research and writing came from the National Alzheimer's Association and the SUNY Dresher Award.
1. In Place on the Pavilion
2. Everyday Ambience and Conflicts
3. "Getting into the Resident's World"
4. Shared Meaning and Identity Work
5. Co-Constructing Trouble
6. Defending the Ethic of Care from Family Intrusions
7. "We're Not a Zoo"
8. Local Intelligence
"Anne Vittoria adds enormously to the literature by zeroing in on a social model nursing home. A compelling and informative read."
Jaber F. Gubrium, Professor Emeritus of Sociology, founding editor of the Journal of Aging Studies.
"Well-written and insightful, Women of Color in a World Apart provides a fascinating glimpse into the world of paid caregivers in an Alzheimer's unit in a long-term care facility. Anne Vittoria goes beyond documenting the paid labor of the LPN and CNAs who work there, uncovering the unpaid caring and skills they employ that serve to construct a sense of family among themselves and with the residents. This book is well worth reading for those interested in the content and dynamics of the informal, local knowledge--what caregivers refer to as "just knowing" the needs of residents--that is at the heart of their work, and the personhood of the residents."
Toni Calasanti, Professor of Sociology, Virginia Tech
"This book takes readers into a world apart: the Alzheimer's care pavilion at a residential geriatric center where one encounters the daily heroism of the nursing staff, most of whom are members of racial minorities. Their undervalued work consists of caring for elderly people who are in the process of losing the ability to care for themselves. Yet many of these residents forcibly reject efforts to care for them and are even abusive to the caregivers. Families ask presumptuous questions and are suspicious about whether their loved ones are receiving proper care. Hospital administrators bring touring dignitaries through the clinic as if it were some kind of zoo. And doctors consistently attempt to impose a one-size-fits-all reductionism on residents. With exemplary ethnographic methods, Vittoria documents the nursing staff's resistance to all of these intrusions as they strive to establish and maintain their own practice of care work-one that is humanely customized in tune with the uniquely evolving self and distinct life-world of each resident."
Michael Flaherty, Professor of Sociology, Eckerd College
"A beautifully written ethnography, Women of Color in a World Apart is incredibly valuable as it will make multiple contributions to the literature in sociology, particularly in the fields of aging, medical sociology, and also the intersectional literature of race, class and gender. Particularly important is this book's contributions to sociological work on aging as well as to the intersectionality literature addressing working class women, especially women of color.
Mary K. Zimmerman, Professor of Sociology, University of Kansas
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