Large and growing numbers of the frail elderly and disabled depend on paid workers to assist them in daily life. Who Cares for Them? is the first book to document employment conditions in the home care industry and to address issues relating to job satisfaction and turnover among the paraprofessional (home aide) work force. By zeroing in on the workers who are the foundation of the burgeoning home health industry, the authors are able to identify the critical factors that affect the working conditions and job satisfaction of this group. Feldman, Sapienza, and Kane also evaluate the impact of programs that have been designed to improve work life, reduce turnover, and contribute to greater continuity of care, and they present the broader implications for both home care managers and policy makers.

Part I explores the home aide labor market. New survey data on the demographic characteristics and attitudes of home aides in five U.S. cities are presented, and financial conditions in the home health care industry that impact on work life issues are analyzed. Parts II and III report on three unique experiments that used changes in pay and benefits, training and support, and hours of work to reduce turnover and increase continuity of care provided by home aides. The case studies of the experiments and the overview of their results provide detailed information that will prove useful for the design and implementation of work life changes in home care agencies. Management strategies and policy options for upgrading home care employment are surveyed in Part IV. This concluding section of the book presents a number of practical recommendations for managers in the home care industry. Policy changes necessary for ensuring a sufficient and reliable supply of workers to meet the growing demand for home care are also outlined. Sixty-two tables, four figures, and a methodological appendix complement this valuable addition to home health care industry literature. Academics in the fields of gerontology, health policy, and health care management, as well as directors and managers of independent home care agencies and policy makers concerned with the supply of personnel and with the financing and delivery of long-term care and home care will find this groundbreaking study filled with important, timely, and useful information.

PENNY HOLLANDER FELDMAN is Lecturer in Political Science in the Department of Health Policy and Management, Harvard School of Public Health. Among her recent publications are Recruiting an Elite: Admission to Harvard College (1987) and, with Alice M. Sapienza, the chapter Strategic Management of Quality of Worklife in the Home Care Industry in Human Resource Management in the Health Care Sector: A Guide for Administrators and Professionals (Greenwood Press, 1989).

ALICE M. SAPIENZA is Assistant Professor of Management in the Department of Health Policy and Management, Harvard School of Public Health. In addition to her work in home care, she has published several recent articles on the management and diffusion of biotechnology in the United States and abroad.

NANCY M. KANE is Assistant Professor of Management in the Department of Health Policy and Management, Harvard School of Public Health. Her recent publications include Home Care Crisis of the Nineties, which appeared in The Gerontologist (1989).