A 1908 report analyzing correlations between grade size and school performance, printed in volume II of The Psychological Clinic.

LEONARD P. AYRES was director at the Division of Education of the Russell Sage Foundation,  former general superintendent of schools for Puerto Rico, co-author of “Medical Inspection of Schools,” and author of “Laggards in Our Schools.”

A 1909 report on the effect of irregular school attendance on children's grade progress, printed in volume III of The Psychological Clinic.

LEONARD P. AYRES was director at the Division of Education of the Russell Sage Foundation,  former general superintendent of schools for Puerto Rico, co-author of “Medical Inspection of Schools;” and author of “Laggards in Our Schools.”

Winner of the 2020 Robert E. Park Award for Best Book from the Community and Urban Sociology Section of the American Sociological Association

A Volume in the American Sociological Association’s Rose Series in Sociology

“Sites Unseen is perhaps the most important contribution made in this century to our understanding of the distribution of environmental hazards in U.S. urban areas. Scott Frickel and James R. Elliott, two masterful sociologists, present their innovative and insightful research in this accessible but deeply scholarly work about how the history of cities affects the well-being of contemporary urban residents. This is a seminal work that is likely to spawn a wide variety of new research as well as aid and encourage social and environmental activists.”

—RICHARD YORK, professor of sociology and director and professor of environmental studies, University of Oregon

“This is a work of exceptional quality and profundity, the result of painstaking and systematic investigation of the largely hidden yet massive and ‘relentless accumulation’ of industrial hazards that exists throughout urban America. Scott Frickel and James R. Elliott present a twenty-first century theory and method of human ecology that requires us to expand our sensory capacities, and they give us a bonus: an innovative and empowering DIY Guide for those who seek to apply these tools to their own cities and neighborhoods. Sites Unseen will change forever the way we think about cities. I fervently hope that it also changes the way we live in and (re)make them.”

—DAVID N. PELLOW, Dehlsen Chair and professor of environmental studies, University of California, Santa Barbara

“Sites Unseen is an innovative and important book. Scott Frickel and James R. Elliott document in laser-like fashion how the poor and people of color are disproportionately burdened by exposure to a heretofore largely invisible landscape of industrial-era environmental hazards in American cities. By adroitly exposing the hazards and demonstrating how our regulatory apparatus seems capable of only handling the most extreme risks, Frickel and Elliott’s creative use of public data, methods, and findings lay the foundation for renewed research interest in environmental sociology and geography.”

—JAMES H. JOHNSON JR., William R. Kenan Jr. Distinguished Professor of Strategy and Entrepreneurship and director of the Urban Investment Strategies Center, University of North Carolina Kenan-Flager Business School

From a dive bar in New Orleans to a leafy residential street in Minneapolis, many establishments and homes in cities across the nation share a troubling and largely invisible past: they were once sites of industrial manufacturers, such as plastics factories or machine shops, that likely left behind carcinogens and other hazardous industrial byproducts. In Sites Unseen, sociologists Scott Frickel and James R. Elliott uncover the hidden histories of these sites to show how they are regularly produced and reincorporated into urban landscapes with limited or no regulatory oversight. By revealing this legacy of our industrial past, Sites Unseen spotlights how city-making has become an ongoing process of social and environmental transformation and risk containment.

To demonstrate these dynamics, Frickel and Elliott investigate four very different cities—New Orleans, Minneapolis, Philadelphia, and Portland, Oregon. Using original data assembled and mapped for thousands of former manufacturers’ locations dating back to the 1950s, they find that more than 90 percent of such sites have now been converted to urban amenities such as parks, homes, and storefronts with almost no environmental review. And because manufacturers tend to open plants on new, non-industrial lots rather than on lots previously occupied by other manufacturers, associated hazards continue to spread relatively unabated. As they do, residential turnover driven by gentrification and the rising costs of urban living further obscure these sites from residents and regulatory agencies alike.

Frickel and Elliott show that these hidden processes have serious consequences for city-dwellers. While minority and working class neighborhoods are still more likely to attract hazardous manufacturers, rapid turnover in cities means that whites and middle-income groups also face increased risk. Since government agencies prioritize managing polluted sites that are highly visible or politically expedient, many former manufacturing sites that now have other uses remain invisible. To address these oversights, the authors advocate creating new municipal databases that identify previously undocumented manufacturing sites as potential environmental hazards. They also suggest that legislation limiting urban sprawl might reduce the flow of hazardous materials beyond certain boundaries.

A wide-ranging synthesis of urban and environmental scholarship, Sites Unseen shows that creating sustainable cities requires deep engagement with industrial history as well as with the social and regulatory processes that continue to remake urban areas through time.

SCOTT FRICKEL is professor of sociology and environment and society at Brown University.

JAMES R. ELLIOTT is professor of sociology at Rice University.

Winner of the 2019 Don T. Nakanishi Award for Distinguished Scholarship and Service from the Western Political Science Association Committee on the Status of Asian Pacific Americans

“Immigrants are not necessarily liberals, and religion is a large factor in predicting immigrant conservatism. These points are often overlooked by scholars and policymakers alike, and Janelle Wong’s path-breaking work shines much needed light on the ways in which religion—particularly evangelical Christianity—shapes immigrants’ politics, with considerable implications for the future of American party coalitions.”

—Michael Jones-Correa, professor of political science, University of Pennsylvania

“This is the perfect time for this important book. With evangelicals again in the bright political spotlight over their role in electing Donald Trump, it is essential to understand Janelle Wong’s exploration of evangelical religion, interests, and identities. Evangelical is clearly not a synonym for white Republican. But the steady diversification of evangelicalism will not necessarily entail a moderation of white evangelical politics either. There is fascinating work to be done on how people wrestle with competing racial and religious identities and Wong’s Immigrants, Evangelicals, and Politics in an Era of Demographic Change paves the way.”

—Paul A. Djupe, associate professor of political science, Denison University

As immigration from Asia and Latin America reshapes the demographic composition of the U.S., some analysts have anticipated the decline of conservative white evangelicals’ influence in politics. Yet, Donald Trump captured a larger share of the white evangelical vote in the 2016 election than any candidate in the previous four presidential elections. Why has the political clout of white evangelicals persisted at a time of increased racial and ethnic diversity? In Immigrants, Evangelicals, and Politics in an Era of Demographic Change, political scientist Janelle Wong examines a new generation of Asian American and Latino evangelicals and offers an account of why demographic change has not contributed to a political realignment.

Asian Americans and Latinos currently constitute more than one in every seven evangelicals, and their churches are among the largest, fastest growing organizations in their communities. While evangelical identity is associated with conservative politics, Wong draws from national surveys and interviews to show that non-white evangelicals express political attitudes that are significantly less conservative than those of their white counterparts. Black, Asian American, and Latino evangelicals are much more likely to support policies such as expanded immigration rights, increased taxation of the wealthy, and government interventions to slow climate change. As Wong argues, non-white evangelicals’ experiences as members of racial or ethnic minority groups often lead them to adopt more progressive political views compared to their white counterparts.

However, despite their growth in numbers, non-white evangelicals—particularly Asian Americans and Latinos—are concentrated outside of swing states, have lower levels of political participation than white evangelicals, and are less likely to be targeted by political campaigns. As a result, white evangelicals dominate the evangelical policy agenda and are overrepresented at the polls. Also, many white evangelicals have adopted even more conservative political views in response to rapid demographic change, perceiving, for example, that discrimination against Christians now rivals discrimination against racial and ethnic minorities.

Wong demonstrates that immigrant evangelicals are neither “natural” Republicans nor “natural” Democrats. By examining the changing demographics of the evangelical movement, Immigrants, Evangelicals, and Politics in an Era of Demographic Change sheds light on an understudied constituency that has yet to find its political home.

JANELLE S. WONG is professor of American Studies at the University of Maryland.

Winner of the 2019 Alexander George Book Award from the International Society of Political Psychology (ISPP)

"Why do so many Americans both depend on public programs and express distrust and opposition to the federal government that provides them? Suzanne Mettler, one of the most original political scientists working today, offers crucial answers to this puzzle. Her important new book, The Government-Citizen Disconnect, will engage citizens and scholars alike at a juncture of crisis, controversy, and revitalization for American democracy."

—Theda Skocpol, director, Scholars Strategy Network, and Victor S. Thomas Professor of Government and Sociology, Harvard University

"Americans hate government. They also depend on it more and more. In this compelling and deeply researched book, Suzanne Mettler shows that this paradox is at the heart of our current political crisis. Anyone who cares about the future of the country should read The Government-Citizen Disconnect."

—Jacob S. Hacker, Stanley B. Resor Professor of Political Science, Yale University

Americans’ relationship to the federal government is paradoxical. Polls show that public opinion regarding the government has plummeted to all-time lows, with only one in five saying they trust the government or believe that it operates in their interest. Yet, at the same time, more Americans than ever benefit from some form of government social provision. Political scientist Suzanne Mettler calls this growing gulf between people’s perceptions of government and the actual role it plays in their lives the "government-citizen disconnect." In The Government-Citizen Disconnect, she explores the rise of this phenomenon and its implications for policymaking and politics.

Drawing from original survey data which probed Americans’ experiences of 21 federal social policies -- such as food stamps, Social Security, Medicaid, and the home mortgage interest deduction -- Mettler shows that 96 percent of adults have received benefits from at least one of them, and that the average person has utilized five. Overall usage rates transcend social, economic, and political divisions, and most Americans report positive experiences of their policy experiences. However, the fact that they have benefited from these policies bears little positive effect on people’s attitudes towards government. Mettler finds that shared identities and group affiliations are more powerful and consistent influences. In particular, those who oppose welfare tend to extrapolate their unfavorable views of it to government in general. Deep antipathy toward the government has emerged as a conservative movement waged a war on social welfare policies for over forty years, even as economic inequality and benefit use increased.

Mettler finds that patterns of political participation exacerbate the government-citizen disconnect, as those holding positive views of federal programs and supporting expanded benefits have lower rates of involvement than those holding more hostile views of the government. As a result, the loudest political voice belongs to those who have benefited from policies but who give government little credit for their economic well-being, seeing their success more as a matter of their own deservingness. This contributes to the election of politicians who advocate cutting federal social programs. According to Mettler, the government-citizen disconnect frays the bonds of representative government and democracy.

The Government-Citizen Disconnect illuminates a paradox that increasingly shapes American politics. Mettler's examination of hostility toward government at a time when most Americans will at some point rely on the social benefits it provides helps us better understand the roots of today's fractious political climate.

SUZANNE METTLER is the Clinton Rossiter Chair of American Institutions at Cornell University.

Winner of the 2019 Outstanding Book Award from the Inequality, Poverty, and Mobility Section of the American Sociological Association

2018 Choice Outstanding Academic Title 

“Bruce Western, our foremost authority on mass incarceration, has filled in a yawning gap in the research on one of the great banes of our era. Homeward is a thorough and deeply illuminating study on the end-point of mass incarceration—the effort to reintegrate ex-offenders into our society. The challenges outlined in the book should not simply inform our reentry efforts, but should also make us question the American policy of handing down sentences, which, in some profound way, never really end.”

—Ta-Nehisi Coates, National Correspondent, The Atlantic

“In Homeward, Bruce Western probes in rich detail the lives of ex-prisoners in their first year of life back on the streets of Boston. He looks unflinchingly at the correlated web of adversities that men and women face in the transition out of prison, especially how violence, drug and alcohol addiction, mental illness, and family chaos exacerbate the stigma of a prison record in the reentry to society.  Beautifully written and deeply researched, this book provides an important framework on social and criminal justice.  The implications for policy are profound.”

—Robert J.  Sampson, Henry Ford II Professor of the Social Sciences, Harvard University

In the era of mass incarceration, over 600,000 people are released from federal or state prison each year, with many returning to chaotic living environments rife with violence. In these circumstances, how do former prisoners navigate reentering society? In Homeward, sociologist Bruce Western examines the tumultuous first year after release from prison. Drawing from in-depth interviews with over one hundred individuals, he describes the lives of the formerly incarcerated and demonstrates how poverty, racial inequality, and failures of social support trap many in a cycle of vulnerability despite their efforts to rejoin society.

Western and his research team conducted comprehensive interviews with men and women released from the Massachusetts state prison system who returned to neighborhoods around Boston. Western finds that for most, leaving prison is associated with acute material hardship. In the first year after prison, most respondents could not afford their own housing and relied on family support and government programs, with half living in deep poverty. Many struggled with chronic pain, mental illnesses, or addiction—the most important predictor of recidivism. Most respondents were also unemployed. Some older white men found union jobs in the construction industry through their social networks, but many others, particularly those who were black or Latino, were unable to obtain full-time work due to few social connections to good jobs, discrimination, and lack of credentials. Violence was common in their lives, and often preceded their incarceration. In contrast to the stereotype of tough criminals preying upon helpless citizens, Western shows that many former prisoners were themselves subject to lifetimes of violence and abuse and encountered more violence after leaving prison, blurring the line between victims and perpetrators.

Western concludes that boosting the social integration of former prisoners is key to both ameliorating deep disadvantage and strengthening public safety. He advocates policies that increase assistance to those in their first year after prison, including guaranteed housing and health care, drug treatment, and transitional employment. By foregrounding the stories of people struggling against the odds to exit the criminal justice system, Homeward shows how overhauling the process of prisoner reentry and rethinking the foundations of justice policy could address the harms of mass incarceration.

BRUCE WESTERN is the Daniel and Florence Guggenheim Professor of Criminal Justice Policy and Professor of Sociology at Harvard University, and Co-Director of the Justice Lab at Columbia University.

Winner of the 2019 Otis Dudley Duncan Book Award from the Sociology of Population Section of the American Sociological Association

Winner of the 2018 Oliver Cromwell Cox Book Award from the Section on Racial and Ethnic Minorities of the American Sociological Association

Winner of the 2018 Robert E. Park Award for Best Book from the Community and Urban Sociology Section of the American Sociological Association

Honorable Mention for the 2018 Outstanding Contribution to Scholarship Book Award from the Race, Gender, and Class Section of the American Sociological Association

“In The Cycle of Segregation, Maria Krysan and Kyle Crowder offer a major breakthrough in understanding of the roots of residential segregation in U.S. society today. Their social-structural sorting perspective elegantly and convincingly explains how black and Hispanic segregation can persist even as minority incomes rise and discrimination and prejudice in housing markets decline. It is a remarkable achievement.”

—Douglas S. Massey, Henry G. Bryant Professor of Sociology and Public Affairs, Princeton University

“I highly recommend this book. Maria Krysan and Kyle Crowder's social structural sorting perspective provides new theoretical lens for recognizing and understanding the self-reinforcing processes of residential segregation. Their original analysis of the drivers of segregation and thoughtful policy prescriptions for dismantling it make Cycle of Segregation a must-read.”

—William Julius Wilson, Lewis P. and Linda L. Geyser University Professor, Harvard University

“It is rare that a book written on a problem so fundamental to social life—segregation—is able to make a truly unique contribution and to set the stage for a new, more refined research agenda. Cycle of Segregation does so. Maria Krysan and Kyle Crowder have synthesized insights from a wide range of empirical studies, and put them together to develop a theory of how the structure of urban inequality constrains and shapes individuals’ residential choices, giving segregation its own self-perpetuating momentum. This book changed how I think about segregation, and it should be read by anyone who cares about America’s urban neighborhoods.”

—Patrick T. Sharkey, Professor and Chair of Sociology, New York University

The Fair Housing Act of 1968 outlawed housing discrimination by race and provided an important tool for dismantling legal segregation. But almost fifty years later, residential segregation remains virtually unchanged in many metropolitan areas, particularly where large groups of racial and ethnic minorities live. Why does segregation persist at such high rates and what makes it so difficult to combat? In Cycle of Segregation, sociologists Maria Krysan and Kyle Crowder examine how everyday social processes shape residential stratification. Past neighborhood experiences, social networks, and daily activities all affect the mobility patterns of different racial groups in ways that have cemented segregation as a self-perpetuating cycle in the twenty-first century.

Through original analyses of national-level surveys and in-depth interviews with residents of Chicago, Krysan and Crowder find that residential stratification is reinforced through the biases and blind spots that individuals exhibit in their searches for housing. People rely heavily on information from friends, family, and coworkers when choosing where to live. Because these social networks tend to be racially homogenous, people are likely to receive information primarily from members of their own racial group and move to neighborhoods that are also dominated by their group. Similarly, home-seekers who report wanting to stay close to family members can end up in segregated destinations because their relatives live in those neighborhoods. The authors suggest that even absent of family ties, people gravitate toward neighborhoods that are familiar to them through their past experiences, including where they have previously lived and where they work, shop, and spend time. Because historical segregation has shaped so many of these experiences, even these seemingly race-neutral decisions help reinforce the cycle of residential stratification. As a result, segregation has declined much more slowly than many socialscientists have expected.

To overcome this cycle, Krysan and Crowder advocate multilevel policy solutions that pair inclusionary zoning and affordable housing with education and public relations campaigns that emphasize neighborhood diversity and high-opportunity areas. They argue that together, such programs can expand the number of destinations available to low-income residents and help offset the negative images many people hold about certain neighborhoods or help introduce them to places they had never considered. Cycle of Segregation demonstrates why a nuanced understanding of everyday social processes is critical for interrupting entrenched patterns of residential segregation.

MARIA KRYSAN is professor of sociology at the University of Illinois at Chicago.

KYLE CROWDER is Blumstein-Jordon Professor of Sociology at the University of Washington.

Winner of the 2019 Distinguished Scholarly Monograph Award Presented by the Labor and Labor Movements Section of the American Sociological Association

Winner of the 2018 William G. Bowen Award Presented by the Industrial and Labor Relations Section of Princeton University

“If you think declining job quality is an inevitable outcome of globalization, computerization, or financialization, think again. Where Bad Jobs Are Better systematically dismantles doom and gloom arguments to offer an empirically-based account of how reasonable reforms to U.S. employment and labor law could help ensure that hourly retail jobs are at least pretty darn good. Françoise Carré and Chris Tilly show how institutional structures, social norms, and worker voice combine to create meaningful variation in the quality of seemingly similar retail jobs. No book on the retail sector approaches either the insights or the comprehensiveness as that offered by Where Bad Jobs Are Better.”

—Susan Lambert, associate professor, School of Social Service Administration and codirector, Employment Instability Researchers Network, University of Chicago

“This richly comparative book decisively punctures the myth that retail jobs are inherently bad jobs. By comparing two retail sectors in the United States and retail jobs in seven countries, Françoise Carré and Chris Tilly show how institutions shape the quality of retail jobs and point to ways that bad jobs in retail and other service sectors can be upgraded.”

—Arne L. Kalleberg, Kenan Distinguished Professor of Sociology, University of North Carolina at Chapel Hill

“Retail is the largest employment sector in the United States—and Françoise Carré and Chris Tilly offer the most comprehensive and thorough analysis of the management and employment practices in retail that we have. Based on ten years of careful field studies coupled with national data, they explain how the industry has evolved, why so many retail jobs are ‘bad,’ and why this is not inevitable. Their rich descriptions of working conditions across many retail sectors and countries show the negative effects of bad jobs on working families, and show that employers have a choice in their business and labor strategies. By tracing Wal-Mart across several countries, they show how the same employer can behave differently in different environments. Timely, accessible, engaging, important—Carré and Tilly speak to a broad audience of academics, practitioners, and policymakers—providing key insights on how to turn bad jobs into good ones.”

—Rosemary Batt, Alice Hanson Cook Professor of Women and Work and chair, Department of Human Resource Studies, ILR School, Cornell University

Retail is now the largest employer in the United States. For the most part, retail jobs are “bad jobs” characterized by low wages, unpredictable work schedules, and few opportunities for advancement. However, labor experts Françoise Carré and Chris Tilly show that these conditions are not inevitable. In Where Bad Jobs Are Better, they investigate retail work across different industries and seven countries to demonstrate that better retail jobs are not just possible but already exist. By carefully analyzing the factors that lead to more desirable retail jobs, Where Bad Jobs Are Better charts a path to improving job quality for all low-wage jobs.

In surveying retail work across the U.S., Carré and Tilly find that the majority of retail workers receive low pay and nearly half work part-time, which contributes to high turnover and low productivity. Jobs staffed predominantly by women, such as grocery store cashiers, pay even less than retail jobs in male-dominated fields, such as consumer electronics. Yet, when comparing these jobs to similar positions in other countries, Carré and Tilly find surprising differences. In France, though supermarket cashiers perform essentially the same work as cashiers in the U.S., they receive higher pay, are mostly full-time, and experience lower turnover and higher productivity. In Germany, retailers are required by law to provide their employees notice of work schedules six months in advance. And as the authors show in a chapter on Wal-Mart around the world, while the company is notorious for its low-quality jobs in the U.S., in many countries including China and Mexico, Wal-Mart is unionized, pays more than its competitors, or both. 

The authors show that disparities in job quality are largely the result of differing social norms and national institutions. For instance, weak labor regulations and the decline of unions in the U.S. have enabled retailers to cut labor costs aggressively in ways that depress wages and discourage full-time work. On the other hand, higher minimum wages, greater government regulation of work schedules, and stronger collective bargaining through unions and works councils have improved the quality of retail jobs in Europe.

As retail and service work continue to expand, American employers and policymakers will have to decide the extent to which these jobs will be good or bad. Where Bad Jobs Are Better shows how stronger rules and regulations can improve the lives of retail workers and boost the quality of low-wage jobs across the board.

FRANÇOISE CARRÉ is research director at the Center for Social Policy at the University of Massachusetts, Boston.

CHRIS TILLY is professor of urban planning at the University of California, Los Angeles.

“Community colleges have long been the neglected stepchild of higher education in America. They are the institutions that absorb millions of less affluent students, who enter college with high ambitions but poor preparation. Bridging the Gaps analyzes the many obstacles to realizing the worthy goals of millions of American students who are tripped up by institutional reliance on test scores, discouraging forms of remedial education, and advising systems that fail to reach the students who need them most. The authors tell us why this is the case and, more importantly, what we have to do to remedy the situation for the good of our young people, mature students, the labor market, and employers who need a skilled workforce. It is a critically important read.”
—Katherine S. Newman, provost, senior vice chancellor for academic affairs, and Torrey Little Professor of Sociology, University of Massachusetts, Amherst

“Bridging the Gaps explodes two myths. The first is that the baccalaureate degree is the only postsecondary degree worth having. The second is that students fail in community colleges primarily for lack of ability or motivation to succeed. Through a series of well-designed studies, the authors show that sub-baccalaureate credentials are valuable in the labor market and for life and work satisfaction. They show that confusing and ineffective placement tests, unclear pathways to degrees, poor advising, and weak career services contribute to the shockingly low completion rates at community colleges. They demonstrate that the correction of these deficiencies is not expensive and would allow community colleges to contribute much more than they currently do to students’ aspirations for upward mobility.”
—Steven Brint, Distinguished Professor of Sociology and Public Policy, University of California, Riverside

College-for-all has become the new American dream. Most high school students today express a desire to attend college, and 90 percent of on-time high school graduates enroll in higher education in the eight years following high school. Yet, degree completion rates remain low for nontraditional students—students who are older, low-income, or have poor academic achievement—even at community colleges that endeavor to serve them. What can colleges do to reduce dropouts? In Bridging the Gaps, education scholars James Rosenbaum, Caitlin Ahearn, and Janet Rosenbaum argue that when institutions focus only on bachelor’s degrees and traditional college procedures, they ignore other pathways to educational and career success. Using multiple longitudinal studies, the authors evaluate the shortcomings and successes of community colleges and investigate how these institutions can promote alternatives to BAs and traditional college procedures to increase graduation rates and improve job payoffs.

The authors find that sub-baccalaureate credentials—associate degrees and college certificates—can improve employment outcomes. Young adults who complete these credentials have higher employment rates, earnings, autonomy, career opportunities, and job satisfaction than those who enroll but do not complete credentials. Sub-BA credentials can be completed at community college in less time than bachelor’s degrees, making them an affordable option for many low-income students.

Bridging the Gaps shows that when community colleges overemphasize bachelor’s degrees, they tend to funnel resources into remedial programs and try to get low-performing students on track for a BA. Yet, remedial programs have inconsistent success rates and can create unrealistic expectations, leading struggling students to drop out before completing any degree. The authors show that colleges can devise procedures that reduce remedial placements and help students discover unseen abilities, attain valued credentials, get good jobs, and progress on degree ladders to higher credentials.

To turn college-for-all into a reality, community college students must be aware of their multiple credential and career options. Bridging the Gaps shows how colleges can create new pathways for nontraditional students to achieve success in their schooling and careers.

JAMES E. ROSENBAUM is professor of sociology, education, and social policy, and research fellow at the Institute for Policy Research at Northwestern University.

CAITLIN AHEARN is a Ph.D. student in sociology at UCLA.

JANET E. ROSENBAUM is assistant professor in the Department of Epidemiology and Biostatistics at the School of Public Health at SUNY Downstate Medical Center in Brooklyn, NY.

“Who Will Care for Us? is a comprehensive and probing work on the challenges and opportunities of building a labor force to do some of the most consequential and sensitive work in our society: providing long-term care for others. Paul Osterman analyzes this complicated landscape with clarity and offers new, creative, and tractable approaches to policy.”

—David Weil, dean, Heller School for Social Policy and Management, Brandeis University, and former Wage and Hour Administrator, U.S. Department of Labor

“In Who Will Care for Us?, Paul Osterman provides important insights into the chall- enges and opportunities for the most important members of the long-term care workforce—the certified nursing assistants and home care aides who provide the lion’s share of services to very vulnerable populations. He combines the best of storytelling and robust scholarship to highlight the systemic factors that explain why this profession is so undervalued. As important, he offers a thoughtful range of policy and practice solutions to elevate this workforce and ultimately deliver better services to a diverse and growing long-term care population.”

—Robyn I. Stone, executive director and senior vice president for research, LeadingAge Center for Applied Research

“With the aging baby boom generation, long-term care will be one of the great policy challenges in the coming decades. In Who Will Care for Us?, Paul Osterman identifies one of the key barriers to achieving high-value long-term care: our underinvestment in how we pay and train the direct care workforce. He makes the compelling case that continuing with the status quo is not the answer. He argues for transforming the direct caregiver job to encompass a much wider set of roles. In order for this to occur, we need to not only retrain our workforce, but also reform many of the policies that have led us to neglect our caregivers.”

—David Grabowski, professor of health care policy, Harvard Medical School

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 wellbeing 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.

PAUL OSTERMAN is Nanyang Technological University (NTU) Professor of Human Resources and Management at the M.I.T. Sloan School of Management.