Anthropology & Aging Anthropology & Aging, Vol 40, No 2 (2019), pp. 85-87 ISSN 2374-2267 (online) DOI 10.5195/aa.2019.236 This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. This journal is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. Book Review Review of Buch, Elana D. Inequalities of Aging: Paradoxes of Independence in American Home Care. New York University Press. 2018. Pp 263. $30 (Paperback). Erika Carrillo Purdue University http://www.library.pitt.edu/ http://www.library.pitt.edu/ http://www.pitt.edu/ http://www.pitt.edu/ http://www.library.pitt.edu/articles/digpubtype/index.html http://www.library.pitt.edu/articles/digpubtype/index.html http://www.upress.pitt.edu/upressIndex.aspx http://www.upress.pitt.edu/upressIndex.aspx http://creativecommons.org/licenses/by-nc-nd/3.0/us/ Carrillo | Book review | 85 Anthropology & Aging Vol 40, No 2 (2019) ISSN 2374-2267 (online) DOI 10.5195/aa.2019.236 http://anthro-age.pitt.edu Book Review Review of Buch, Elana D. Inequalities of Aging: Paradoxes of Independence in American Home Care. New York University Press. 2018. Pp 263. $30 (Paperback). Erika Carrillo Purdue University In her debut book, Inequalities of Aging: Paradoxes of Independence in American Home Care, sociocultural anthropologist Elana Buch provides an outstanding and timely critical examination of the sociopolitical realities of aging and care in the US. By engaging similarly with the intricacies of the lives of older adults, paid home care workers, and home care agencies in Chicago, Buch sheds new light on care exchanges in elderly home care. She argues that, while home care workers safeguard older adults’ independence, these care exchanges systematically generate inequalities and limitations for paid home care workers. Buch’s research scrutinizes these and other intrinsic paradoxes embedded in elderly care infrastructures and discourses in the US. By fleshing out contradictions between contemporary ideologies of “good” care for older adults and the ways paid home care is practiced, Inequalities of Aging calls for a reexamining of the ways care for older adults and care labor is valued and imagined in the US. The introduction sets the stage for this ethnographic analysis, with a critical examination of how the US care crisis has been framed in recent decades. Here, she introduces readers to the concept of “generative labor”: the social and biological practices that generate and extend life. By building on theories of reproductive labor from critical feminist scholars, Buch extends the concept beyond the scope of biological reproduction to the entire life course. This concept provides the means to analyze care labor as a life-giving, creative and dynamic process, that also generates and reproduces inequality in practice. In chapter one, “Generating Independence”, Buch uses ethnographic methods including participant observation, interviews, and life histories, to compose moving portraits of US older adults. She uses this collection of data to demonstrate how older adults’ practice both the cultural constructions of personhood and visions of US American independence and how it relates to control over one’s own home and personal property. For example, many older adults feel transitioning from private residence to assisted living to be particularly threatening to their independence and personhood. For this reason, many seniors opt to continue to live in their homes regardless of their need for home care assistance. Chapter two, “Inheriting Care”, shifts the lens, with a similar ethnographic sensitivity, to the lives of paid care workers. Like many paid care workers in the US, the employees at the two Chicago care agencies where Buch conducted her research are predominately low-income women of color and immigrants. They are often paid little over minimum wage, rarely have job stability or receive health insurance. Buch introduces a historical perspective to demonstrate how the overrepresentation of women and people of color in domestic, low-wage work, is linked to the long lasting legacies of discrimination and racism in the US work force. Carrillo | Book Review | 86 Anthropology & Aging Vol 40, No 2 (2019) ISSN 2374-2267 (online) DOI 10.5195/aa.2019.236 http://anthro-age.pitt.edu The third chapter, “Making Care Work”, provides a historical overview of how care work was conceptualized in the US. She investigates the various instruments that were developed to determine older adult’s vulnerability, as well as the code of ethics and professional standards that care agencies enforce upon the home care workers. These labor infrastructures frame care exchange as unidirectional: paid care workers are expected to maintain close, even loving relationships with clients while, at the same time, workers are prevented from sharing details from their own personal lives. Thus, the policies that seek to maintain autonomy and independence for older adults simultaneously disregard the well-being and the subjectivities of the paid care workers. These contradictions are deeply entangled with the standards for good care and, as Buch argues, consolidate a system that aggravates inequality between home care workers and their more affluent clients. Chapters five and six (“Embodying Inequality” and “Independent Living” respectively) demonstrate that despite care agencies’ established rules of professionalism and the condensing of care work into standardized activities, care relationships between care workers and elderly clients are complex and multifaceted. By examining specific cases of caregivers’ interactions with their clients, Buch shows how care workers utilize their expertise and moral imaginations to preserve each older adult with their own desired ways of living. Through embodied care practice, care workers practice “good” care when they put their clients’ needs before their own. Thus, they help older adults maintain a social status of independence and living at home, as before the onset of any physical frailty. This upkeep of homes and the sustaining of their client’s independence inevitably renders the labors of care workers invisible. The sixth chapter, “When Care Falls Apart”, is particularly poignant, as it foregrounds the effects of the physical and emotional demands placed on home care workers by their clients and the care agencies that employ them. Paid workers’ own familial responsibilities (eg. as mothers, daughters, and caregivers to other kin) are often trivialized in comparison to the needs of their clients. Without formal policies, like medical or family leave, workers often have difficulty juggling the needs of their clients with their own personal and familial needs. Buch effectively demonstrates how family or medical issues easily bring care workers in precarious positions, since they can be penalized by the care agencies who seek to maintain consistent schedules with their clients. Consequently, the demanding work and low wages contribute to the extremely high turnover rates in care agencies, which inevitably worsens the quality of care for older adults. In her conclusion, Buch argues that this system, which frames care work as low skill labor, is unsustainable if not destructive since it generates inequality and poverty among care workers. Additionally, it limits the care workers’ ability to provide qualitative and reciprocal care for their clients as for their own kin. Buch highlights the complex entanglement of poverty and care, and in doing so, urges policy makers and care agencies to develop solutions that address issues of poverty and care in tandem, rather than problematizing them as separate domains. The depth of Buch’s interviews with her participants is impressive. The book’s level of detail and knowledge of home care work demonstrate a great deal of trust and rapport Buch established with her participants. Her work focuses mainly on care workers who are American women of color, excluding the life histories of those who lived outside of the US. I find this particularly curious considering the high number of immigrant care workers in the US. Buch’s ethnography, though exceptional, may be enhanced by future research that examines the lives of other types of care workers, especially immigrants. Such research can enhance the anthropology of aging more Carrillo | Book Review | 87 Anthropology & Aging Vol 40, No 2 (2019) ISSN 2374-2267 (online) DOI 10.5195/aa.2019.236 http://anthro-age.pitt.edu broadly, as it will contribute to the growing research in diverse populations and draw more research attention to intragroup difference and diversity of care and aging experiences. Overall, the book is excellent and would make a valuable resource for those interested in the topics of old age and caregiving, and in feminist and gender studies. The book would be useful as a teaching resource for upper level undergraduates, graduate students or anyone working in the areas of medical anthropology, public health or gerontology.