Summary

Long-term care can be vexing on a personal as well as social level, and it will only grow more so as individuals continue to live longer and the population of aged persons increases in the United States and around the world. This volume explores the ethical issues surrounding elder care from an ecological perspective to propose a new theory of global justice for long-term care.

Care work is organized not just nationally, as much current debate suggests, but also transnationally, through economic, labor, immigration, and health policies established by governments, international lending bodies, and for-profit entities. Taking an epistemological approach termed "ecological knowing," Lisa A. Eckenwiler examines this organizational structure to show how it creates and sustains injustice against the dependent elderly and those who care for them, including a growing number of migrant care workers, and how it weakens the capacities of so-called source countries and their health care systems. By focusing on the fact that a range of policies, people, and places are interrelated and mutually dependent, Eckenwiler is able not only to provide a holistic understanding of the way long-term care works to generate injustice but also to find ethical and practicable policy solutions for caring for aging populations in the United States and in less well-off parts of the world.

Deeply considered and empirically informed, this examination of the troubles in transnational long-term care is the first to probe the issue from a perspective that reckons with the interdependence of policies, people, and places, and the first to recommend ways policymakers, planners, and families can together develop cohesive, coherent long-term care policies around the ideal of justice.

Choice Review

Inspired by personal experience with her grandmother's care and Rachel Carson's writings, Eckenwiler (health administration and policy, philosophy, George Mason Univ.) argues for ethical and ecological thinking about transnational long-term care in this brief collection of her essays. She introduces global interdependence, privatization of social services, government-supported education and training of nurses for foreign markets, companies engaged in international recruitment, and health worker migration encouraged by economic, labor, and immigration policies. She makes important comparisons between the affluent global north and developing global south and warns that changing demographics and critical nursing shortages have increasingly driven the exporting of RNs, LPNs, and other direct-care workers from low- and middle-income countries (Philippines, India, etc.) to countries such as the UK and the US, which further exacerbates workforce inequalities. She also points out that the emphasis on self-care adds to the burden on unpaid and undervalued family caregivers and their dependent relatives. Although the author defines and explains the ecological approach, the text includes difficult phrasing throughout the five chapters. Notes and extensive references. Summing Up: Recommended. Graduate students, researchers/faculty, and professionals. E. R. Paterson emeritus, SUNY College at Cortland