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Nancy Kusmaul Published in Health & Social Work

Nancy Kusmaul, Associate Professor, and colleague Stephanie Wladkowski Published in Health & Social Work

Title: Direct Caregiving in Older Adults: How Systems of Care Perpetuate the Grand Challenges and What Social Workers Can Do about It


Abstract: Direct care workers (DCWs) provide personal care, emotional support, and companionship, helping older adults maintain quality lives. DCWs earn low wages, have little training, and experience high turnover rates. While the demand for DCWs grows, real wages continue to fall. Undervaluing DCWs threatens the continuity and quality of care that older adults receive. Through the social work grand challenges lens, this article discusses two qualitative studies, in home care (n = 24) and nursing homes (n = 23), that demonstrate that while DCWs help advance long and productive lives, they experience extreme economic inequality and lack equal opportunity and justice. The article concludes with a discussion of social work’s role in advancing opportunity and justice.


Kusmaul, N., Wladkowski, S. (2021). Direct Caregiving for Older Adults: How systems of care perpetuate the grand challenges and what social workers can do about it. Health and Social Work. Advance Online Publication. https://doi.org/10.1093/hsw/hlab017

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