Clare Stacey's very readable book, The Caring Self: The Work Experiences of Home Care Aides describes the experiences of home care workers in two cities in the United States of America (USA): one in California and one in Ohio. With her sociologist's training and a grounded theory approach, she utilised extensive field observation and in-depth interviews with 33 home care aides. In addition, she interviewed public health nurses, social workers and home care agency managers, all of whom worked directly with home care aides. She notes that her intention in doing the research and writing the book was to inform the discussion on long-term care ‘by describing the constraints facing low-skilled caregivers on the front lines of care for the elderly and disabled, whose experiences are rendered invisible by a public that takes only passing interest in their work’ (p. 5). She does this very well.

In the first chapter, ‘The Cost of Caring’, Stacey explores the caring trajectories that characterise most home care workers’ lives. Many of the aides she interviewed believed that they had natural abilities to do the work they did, and they had in fact been performing such work informally and formally for years. They saw themselves as particularly gifted in providing care which allows for a sense of confidence about their abilities but may also ‘obscure what is in fact a lifetime of “constrained choices” ’ (p. 21). As noted by Stacey, the ‘emotional capital’ these workers bring to the job is valuable to the workers and their clients, but is not highly valued by society. The second chapter, ‘Doing the Dirty Work’, further explores the costs of caring in terms of the physical and emotional strains of the job. As she does throughout the book, Stacey presents this information through compelling examples from her interviews, describing the long, sometimes uncompensated hours; physical demands; and, at times, emotional burdens which accompany this work. But the negative aspects of the job are more than balanced by the positive qualities of the work, as Stacey describes in Chapter Three, ‘The Rewards of Caring’. In this chapter Stacey presents her theory regarding the process through which home care workers construct the caring self: by ‘professing their care as natural and innate, emphasizing service to others, and drawing boundaries between themselves and “uncaring others” ’ (p. 107).

The fourth chapter provides an interesting history on the challenges and successes of organising home care aides – a difficult prospect given that there is not a ‘shop floor’ in this work. Perhaps not surprisingly, given the general apathy towards unions in the USA, many workers interviewed by Stacey held ambivalent views towards unions and some were even ignorant of the benefits they had received (such as higher wages) due to previous union organising. Stacey's exploration of the potential for unionisation to improve work conditions for these generally quite isolated workers is certainly one strength of the book. She carries this concept into the final chapter, ‘Improving the Conditions of Paid Caregiving’, in which she reiterates the importance of the relational aspects of the job for home care workers and the importance of bearing that in mind when considering job improvements. She underscores that this relational work can be ‘a source of both inequality and identity for home care aides’ (p. 158) and it is this tension that must be understood in efforts to improve the employment context for these workers. For example, Stacey reports on the current policy debate in the USA regarding modifying the 1938 Fair Labor Standards Act to remove the ‘companionship exemption’ that results in home care workers being exempt from certain wage protections (e.g. overtime pay). She suggests that the current argument presented by advocates – that home care workers are more than companions – is wrongheaded: rather, companionship needs to be promoted as worthy of protection under labuor law. Otherwise ‘workers will have to continually defend their work as “more than companionship,” which not only violates their experiences as workers but reinforces the idea that care work – largely the work of women – is not in fact work’ (p. 168).

The Caring Self is compelling and analytical and makes a significant contribution to the literature regarding both long-term care and women's employment. One shortcoming of the book is that although Stacey correctly notes that there has been less attention given to the work of home care aides relative to direct care workers in nursing facilities, she fails to give credit to a substantial body of research on this topic carried out in the early 1990s by Dr Penny Feldman and colleagues. Nonetheless, this 2011 book is an important new contribution to the field that should be of interest to a broad array of practitioners, students and scholars.