Biting the Hands that Feed Us: Health Aides Suffer But Extend Much Love

Biting the Hands that Feed U

Home health care aides and nurses’ aides in institutional settings usually earn low wages and suffer from low job status. In many cases, overt racism or derision over their ethnicity is also a burden they carry. Often, however, they provide a kind of caring that goes above and beyond job descriptions.

A study by Celia Berdes, head of the Buehler Center on Aging at the McGaw Medical Center of Northwestern University, concluded that paid caregivers frequently use the word “love” to describe the quality of care they aspire to provide, and that they consider feelings of love as the natural result of a caregiver’s relationship with a patient. Using family metaphors, they see those for whom they care as their “children,” “babies,” “mother,” “father,” or “friend.”

Paid caregivers consider feelings of love to be the natural result of a caregiving relationship with a patient.

In Ireland, with its rapidly aging population, home careworkers struggle with the absence of value ascribed to their work in terms of respect and remuneration. Many home careworkers are immigrants. In addition to exhausting work schedules, frequent travel from place to place within tight time frames and without transportation money provided by their agency, they are also sometimes subjected to disrespectful comments about their origins. Sometimes the most grating remarks are from someone of the same ethnicity who has been in the country long enough to feel they have shed their own immigrant status.

In the United States, a 2014 Bureau of Labor Statistics report shows that although African Americans are only 11% of the general work force, they are 36% of the home health aide work force. Berdes’s study centered on thirty African American and immigrant nurses’ aides who work in nursing homes in the United States. In addition to the difficulties of their duties, most of the workers had experienced some form of racial abuse either from their patients, members of the patients’ families, or from fellow staff members.

The aides who were interviewed tended to interpret the racism expressed by their patients charitably. They understood how hard it was to be institutionalized and how invasive many personal care procedures are. They also took their patients’ mental and physical states into account, especially those of their dementia patients. Health aides also recognized that while certain terms were acceptable in times past, when their charges were growing up, these terms are now considered impolite.

Racist remarks by residents’ family members or fellow staff workers are harder to tolerate. Yet the caring aspect of their profession helps them maintain positive feelings about their work notwithstanding these and other drawbacks.

Researchers know that quality care work includes the caregiver’s emotional involvement as well as technical abilities. They and caregivers also know that there is often a tension between the requirements of the job and caring. Emotional or “affective” care sometimes goes head-to-head with the bureaucratic administration of an institution or the caregiving enterprise. This is particularly evident when healthcare workers experience grief upon the death of one of their charges, but because the work must go on, there is no allowance for their grief.

Researchers know that quality care work involves the caregiver’s emotional involvement, as well as their technical abilities.

In spite of this, health care aides say they see their charges as family members and are shocked that real family members are so often absent. In African American and other cultures from which the immigrants hail, putting an elder in an institution under the care of non-family members is viewed as being shockingly uncaring. It is partly a matter of money, but it is also an issue of culture. “In my country, never,” said an immigrant nurse’s aide said during Berdes’s study. “How could you do this to your mother or your father? We can’t do that, we don’t do that. I think they should keep them, you know. Just because they’ve gotten old, you don’t throw them away.” Berdes said health aides often experience a “caring culture shock, a sense of disbelief that elderly people could be so ill-treated.”

Health aides often experience a “caring culture shock, a sense of disbelief that elderly people could be so ill-treated.”

These sympathies undoubtedly add to health aides’ caring treatment of their patients. As we’ve seen, aides often refer to their charges in familial terms. It is not uncommon for them to refer to dementia patients as their babies or children. A young aide will project onto an elderly patient her feelings toward her own parents, giving them respect and veneration.

The aides who were interviewed reported having feelings of love toward their patients and expressing it in expected ways: giving patients a hug, a kiss, a hand to hold, a listening ear, and sometimes weeping along with patients when they were lonely or frightened.

Overcoming low pay, low status, racism and culture shock, health aides love their charges, grieve when they die, and see them as family and relatives. For this we owe them a vote of thanks–and much appreciation and respect.




Berdes, C., Eckert, J. M. (2007). The language of caring. Nurses’ aides use of family metaphors conveys affective care. The Gerontologist. Volume 47, Issue 3, pp. 340-349. Available online at

Berdes, C., & Eckert J. M. (2001). Race relations and caregiving relationships: A qualitative examination of perspectives from residents and nurse’s aides in three nursing homes. Research on Aging, 23 109-126.

Bureau of Labor Statistics Reports, U.S. Bureau of Labor Statistics, Labor Force Characteristics by Race and Ethnicity, 2013. Report 1050. August 2014. Available online at: