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The Outsourced State: The Retraction of Public Caregiving in America


To date, the United States (U.S.) has no universal, long-term care insurance model. Instead, formal long-term care services are mostly provided through a privatized industry that mirrors the growing social inequalities and wealth disparities that characterize the U.S. population. Namely, a two-tiered, two-class industry has formed that consists of a minority of the population that can completely afford to pay privately for services. In contrast, the majority of those populations in need of formal long-term care services must rely on government-subsidized private enterprises and an insecure welfare state system that undergoes pertinent defunding threats, despite the growing demand for services. This dissertation is focused on the organizational structure of the long-term care industry and the role of immigrants. One central research question is: “How does the U.S. long term care industry’s organizational structure lead to an entry point for Filipino immigrant women entrepreneurs? My study is a predominantly qualitative study and I utilized archival materials, snowball sampling, semi-structured interviews and participant observation methods.

In my study, I found that Filipino immigrant women, particularly nurses, have become entrepreneurs through owning peripheral government-subsidized businesses located in the secondary market of the long-term care industry. Many of these businesses are predicated on providing care to some of the most impoverished, mentally and physically disabled younger and older adult populations. Due to privatization and state austerity policies that have accelerated the bifurcation of the U.S. long term care industry, Filipino women immigrants have created an entrepreneurial market niche by accepting lower, fixed reimbursements and decreased profit margins that have led to (inadvertently) assisting the U.S. government in continuing to absolve itself of having primary responsibility for providing health and social services to its own citizens. This research builds upon sociological literature, specifically theories on the political economy of the U.S. long term care industry and aging, gendered labor migration, care work, ethnic entrepreneurship and intersectionality.

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