The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us?  economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care.
 
Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers  are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the well-being of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops.
 
Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers.
 
As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.
 
 

A person’s skin color affects their life experiences including income, educational attainment, health outcomes, exposure to discrimination, interactions with the criminal justice system and one’s sense of ethnoracial group belonging. But, do these disparate experiences affect the relationship between skin color and political views? In Skin Color, Power, and Politics in America, political scientists Mara Ostfeld and Nicole Yadon explore the relationship between skin color and political views in the U.S. among Latino, Black, and White Americans. They examine how skin color influences an individual’s politics and whether a person’s political views influence how they assess their own skin color.
 
Ostfeld and Yadon surveyed over 1,300 people about their political views, including party affiliation, their opinions on welfare, and the importance of speaking English in the U.S. The authors created a matrix grounded in their “Roots of Race” framework, which predicts the relationship between skin color and political attitudes for each ethnoracial group based on the blurriness of the group’s boundaries and historical levels of privilege. They draw upon three distinct measures of skin color to conceptualize the relationship between skin color and political views: “Machine-Rated Skin Color,” measured with a light-reflectance meter; “Self-Assessed Skin Color,” using the Yadon-Ostfeld Skin Color Scale; and “Skin Color Discrepancy,” the difference between one’s Machine-Rated and Self-Assessed Skin Color. 
 
Ostfeld and Yadon examine patterns that emerge among these measures, and their relationships with life experiences and political stances. Among Latinos, a group with relatively blurry group boundaries and low levels of historical privilege, the authors find a robust relationship between political views and Self-Assessed Skin Color. Latinos who overestimate the lightness of their skin color are more likely to hold conservative views on current racialized political issues, such as policing. Latinos who overestimate the darkness of their skin color, on the other hand, are more likely to hold liberal political views. As America’s major political parties remain divided on issues of race, this suggests that for Latinos, self-reported skin color is used as a means of aligning oneself with valued political coalitions. 
 
African Americans, another group with low levels of historical privilege but with more clearly defined group boundaries, demonstrated no significant relationship between skin color and political attitudes. Thus, the lived experiences associated with being African American appeared to supersede the differences in life experiences due to skin color.
 
Whites, a group with more historical privilege and increasingly blurry group boundaries, showed a clear relationship between machine-assessed skin color and attitudes on political issues. Those with darker Machine-Rated Skin Color are more likely to hold conservative views, suggesting that they are responding to the threat of losing their privilege in a multicultural society.
 
At a time when the U.S. is both more diverse and politically divided, Skin Color, Power, and Politics in Americais a timely account of the ways in which skin color and politics are intertwined.