The demand for long-term care is rising all over the globe. While in the global north the increasing demand for care workers results from an increased ageing population, the global south additionally is burdened by HIV and AIDS. The first section of this book describes the current care situation and the trend in long-term care in the United States of Ameica (USA), with a focus on the situation of the dependent elderly and their caring relatives. It is stated that an insufficient number of family care-givers are attempting to satisfy the increasing demand for long-term care: with only very weak family leave policies, care-giving becomes a burden, especially to the mostly female care-givers. Although care and health worker migration is not new to the USA, this rising demand for long-term care causes a growth in the number of immigrant care workers. Most care workers emigrate from their home countries in order to improve their own family's economic situation. However, in many source countries recruitment industries have developed and become more and more aggressive, and local governments have introduced the American curriculum to nursing schools in source countries, in order to export care workers to the USA. The majority of the paid care workers are women from the global south, namely from the Philippines, Caribbean countries and from India. Chapter 2 describes the poor living conditions of these immigrant workers in the USA. Long-term care workers, in general, and immigrant care workers, in particular, not only suffer from low status and income, but they also report high rates of job stress and poor health conditions. Many immigrant care workers additionally suffer from low legal status due to their missing residency.
The next chapter attempts to trace injustice in long-term care. Unfortunately, the author goes ‘back and forth in discussing implications for family caregivers and paid workers’ (p. 49) as well as the special situation of migrant care workers. Although some of the threats of doing care work applies to all, family care-givers, paid workers and immigrant workers, it is the latter and especially undocumented non-citizens, who are the most vulnerable. A more structured description of disadvantages of immigrant care work, with a focused discussion of the consequences on the individual, national and transnational level, would have further improved this section. The most noteworthy finding is that health and care migration worsens global health inequalities and therefore produces global injustice. Health and care migration not only causes numeric shortages in the source countries, it also withdraws the most-qualified workers from the global south. Source countries invest in the education of care workers and rich destination countries benefit from the investment.
Chapter 4 discusses the theoretical approach of the book in more detail. The author states that ecological thinking would prevent social injustice in long-term care. Ecological thinking mainly aims at considering the future instead of the past and present: it emphasises the interconnection between individuals, institutions and locations, and highlights the local effects of global actions. In sum, an ecological subject acts responsibly and sustainably towards its environment. Ecological thinking in long-term care planning therefore would prevent global care and health inequalities and create sustainability within the care sector.
The policy implications given in Chapter 5 are not surprising, but definitely relevant. ‘The United States and other countries must participate in efforts at the global level to manage their long-term care needs and promote [global] health equity’ (p. 92). A brain drain must be prevented and more attention is needed for local demands of (health) care. Health and labour policy must support paid native as well as migrant care-givers, and family leave policies need to be improved in order to support family care-givers.
The book misses its purpose to explore ‘the global landscape of care work’ (p. 3), but it does offer a detailed view on care work and care immigration to the USA. It discusses the consequences of care migration in both the source countries and the destination country and gives an example of how injustice is produced and reproduced through the transnational organisation of care work. The situation in the source countries is well researched, but needs to be explored in more detail in further research: this book can only offer a hint at the main difficulties. The ecological approach is used to appeal for a more sustainable organisation of global care work. ‘Long-term Care, Globalization and Justice’ is worth reading for researchers as well as practitioners who focus on work migration and global care supply. Although once in a while a little more evidence would have been desirable, the book shows how global injustice is produced by something very private: the desire to provide care to beloved elderly relatives.
