Caring for America is an important, difficult, and timely book. It is important because it recasts the history of the American welfare state. In their quest to understand the development of America's long-term care system and the vast, undervalued, and increasingly assertive labor force that now powers it, Eileen Boris and Jennifer Klein reveal a welfare state that is more complicated than we knew. Whereas previous scholarship has stressed division—boundaries between public and private, separate “tracks” for different types of recipients, clear demarcations between clients and workers—Boris and Klein emphasize interconnectedness. They show how the tropes of rehabilitation and independence have funneled “undeserving” poor mothers toward low-paid positions in the homes of “deserving” welfare state beneficiaries, blurring the line between those who give aid and those who take it. The cooperative federalism of the twentieth century, they demonstrate, ensured that nearly every needy American was the responsibility of multiple levels of government and that congressional alterations to existing funding structures would produce ripple effects at the state and local level. Perhaps most important, the authors amass a wealth of evidence that states’ desire to save on labor costs, paired with the consumer demands of the elderly and disabled, resulted over time in elaborate edifices of privatization: public monies funded in-home care, but through contracts with private vendors and clever payment arrangements, states avoided acknowledging care workers as their employees. Many poor immigrant and minority women—the predominant providers of home care—thus remained insulated from the reach of fair labor laws and other social welfare benefits, even as the state created a demand for their services. In short, the authors reveal a welfare state that has all the gaps and disparities that previous scholars have described, but is more dynamic and intricate than we imagined.

The book is difficult for some of the same reasons. To allow readers to see what previous accounts have neglected—and in particular, to make visible workers who have long been invisible—Boris and Klein must cover a tremendous amount of ground. Caring for America takes the reader from the New Deal through the Great Society and the “Reagan Revolution”; the epilogue reaches the healthcare reforms of 2010. Because the fate of home care workers did not rest on a single piece of legislation, but rather involved the interpretation and implementation of dozens of statutes and regulations, the authors must also chart incredibly complicated legal terrain. They must provide readers with working understandings of the Social Security Act of 1935 and its subsequent amendments, the Fair Labor Standards Act (1938), the Kerr-Mills Act (1960), the Economic Opportunity Act (1964), and the Omnibus Budget Reconciliation Act (1981), to name just a handful of the important federal laws. Because the interplay of these statutes and their effect on home care workers is often discernible only at the ground level, the authors must simultaneously familiarize the reader with the byzantine realm of state and local social welfare provision. There, in the shadow of the law, public agencies interacted with charities, private vendors, workers, labor unions, clients, experts, and elected officials. A final layer of complexity results from the authors’ admirable determination to showcase places and times (Chicago, Los Angeles, and New York, for example, in the 1980s and 1990s) in which home care workers made their voices heard. Through rich descriptions of local struggles, the authors demonstrate workers’ power and agency, as well the obstacles they had to surmount to achieve even modest gains. Inevitably, such a multilayered approach has a cost: the text may be challenging for those unfamiliar with the backdrop, namely, the political economy of the twentieth-century United States. However, the patient reader will emerge seeing both a forest (albeit a troubling one) and some exceptional trees.

This intervention could not be more timely. Home care workers comprise a vast and growing workforce—“much larger than that of the iconic auto and steel industries,” the authors note (5)—and their fate is bound up with that of many others, including hospital and restaurant workers, immigrants, public employees, the elderly, the disabled, and all those who might one day need to receive or procure intimate care. Scholars and policy makers have refused to acknowledge these connections, by denying that home care is “work” or by privileging the perspective of the recipient-consumer. Caring for America tears down the curtain, revealing the “social interdependence of care” (225) and insisting on the legitimacy and value of care work.

Boris and Klein hope that the book will foster constructive dialogue: about how to reconcile limited resources, neoliberal ideology, the demands of an aging population, and the rights of front-line service workers. Let us hope that it does. At a minimum, Caring for America will be a tremendous asset to legal historians, labor historians, and scholars of the United States welfare state.