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By Lisa A. Eckenwiler . Published by The John Hopkins University Press Baltimore , 2012 . ISBN 13:978-I-4214-0550-6 Hardback 154 Pages

Reviewed by Dr Helen Rawson

Deakin-Southern Heath Nursing Research Centre, Deakin University, Victoria

Long-term Care, Globalization, and Justice provides a comprehensive examination of current social and ethical issues relating to the care of those who are elderly, including those who have a disability or chronic condition, and the impact of this globally, from the perspective of the United States. The ageing population trend affecting many countries across the world, including the US, is having a significant impact on the need for – and the provision of – long-term care. This book details how the management of long-term care goes beyond US national policy, and is centred across a “global landscape of care work” (p3). The author explores how the globalisation of long-term care has implications for global justice and health equity.

The author draws on an extensive background in philosophy, health administration and policy, as well as healthcare ethics, and adopts the epistemological framework ‘ecological thinking’, to provide an understanding of the ethics and politics involved in the global organisation of paid and unpaid long-term care work.

The complexities surrounding long-term care in the US are comprehensively outlined. The book carefully explores and explains many key issues involved in providing quality long-term care, including the impact of the vulnerable dependent elderly, the inadequate workforce providing care, the inappropriate training of Registered Nurses in the care of older people and the very limited training of Nursing Assistants, home health aides, and personal/home care aides, who provide the vast majority of paid care for older people in long-term care. The constrained work of family caregivers – primarily women – and the challenges they face in managing the care of an older relative, in addition to paid work and family commitments, often with little or no support, is clearly and adequately explored. Of particular interest is the explanation of the highly gendered and minority world in which long-term care work exists in the US and the challenges this presents for its participants.

A key strength of the book is the presentation of the global implication and consequence of managing long-term care needs in the US, and the inequalities and injustice in the sourcing of care workers from low- and middle-income countries. The socio-political and economic factors that affect immigrant care-workers are examined. These source countries also have the challenge of meeting a significantly growing long-term care need with a low care-worker to population ratio, compared to the US. The author provides a thorough understanding of the injustice immigrant care workers, both legal and illegal, can face in the US.

The ecological thinking used to examine and explain the ethics, politics and injustice involved in long-term care provision is also strategically used to discuss how global justice can be achieved for all involved in the long-term care debate. The importance of positioning long-term care within the arena of the global ‘us’ as ecological subjects “intersubjectively constructed” (p84), is well discussed.

Although the author does not state a specific target audience, this book would be a valuable reference for students and professionals within the health and public health fields, as it offers a clear explanation of the global impact of managing the increasing long-term care need. Within the global arena, this book provides a clear overview of the structure of long-term care delivery in a high-income country, as is the US, and the injustice of this structure on low- and middle-income countries where many care-workers are sourced.

The author states that consideration of long-term care in countries other than the US was beyond the scope of her project. While the book does offer a detailed and insightful overview of long-term care in the US, some readers outside of this context might question its relevance to other countries. I would conclude that this book is valid and relevant for all countries including Australia and New Zealand, given that long-term care of older people and those who have a disability or a chronic illness is situated within a global economic and political context. The theoretical concept of ecological thinking provides a process for understanding and organising healthcare that enables justice for all involved.

On the whole, this book is very well written and is easy to read and understand. Its case is clearly presented and the reader is left in no doubt about the global, ethical impact of having an ageing population, and the challenge of meeting this population's long-term care needs.