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Under the above atrocity is yet another huge complex mess.
I worked as an attendent for about two years back in the late 60s. It is a remarkably difficult job with a terrible job hazard---back pain. This pain is due to the stress on lower back muscles, caused by heavy lifting. It can deteriorate into a disabling disk injury and require surgery to fuse the lower back.
The hours are terrible and the work load is tremendous, especially in institutions. Wages are below minimum. There are no health benefits of course, and most of the workers are at the very bottom of the labor market, mostly composed of minority women and men.
The basic industry is nursing home operators. There are also giant corporations who own these as national chains. They collect the retirement checks, social security payments to feed and house their residents---the profits come directly out of worker exploitation.
In last few years of work, I had many of these nursing homes on my delivery schedule. It was what you would expect. The rich go to spa like vacation resort places, while the poor go to nightmares, literally nightmares as shown in One Flew Over the Cuckoo's Nest, i.e. Laguna Honda in SF where the film was shot on location. The reality of Laguna Honda is both much worse and much better than seen in the film.
The real nightmares are mostly over in the East Bay in its poorer sections like Richmond.
So that's industrial side. Home care and attendent care for people in independent living situations is another gross exploitation scene. I was very lucky. I worked for highly educated guys, most of whom had personal attendents they valued highly. I had no idea that was very far from the norm.
The true norm is appallingly bad. For one thing you can not live on the wage and you can be fired at any moment. The work is a maxium of degrating and humiliating. The potential for abuse works on both sides of the employment relation.
The only solution to the mirad of problems with this service industry is to nationalize it under the state, county, and city public health departments, and in effect make these workers state employees subject to all sorts of regulations, monitoring, and oversight, along with training and placement. Not to keep bringing up my old fed program, one of the units was devoted to working out such an attendent training and referral system on the ground.
Another thing that is needed is to re-conceptualize what this work is. It is in effect nursing care at a low level. Now this medical model is highly controversial with the disabled community. However, in terms of actual work done, to support independent living, it is a combination of maid and nurse. Social roles have to be worked out, socially negotiated...
This role is so complex it can only be de-constructed by likes of Judith Butler, in the master-slave dialectic.
CG