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This chapter explores variation in direct care workers’ health risks within institutional and home-based settings, according to the demographic composition of workers and the gendered, raced, and citizenship-based expressions of their work roles.

This quantitative intersectional study draws on two nationwide datasets from the US National Center for Long-term Care Statistics, a division of the Centers for Disease Control and Prevention, the National Nursing Assistant Study (NNAS), and National Home Health Aide Survey (NHHAS).

Workplace context was the strongest predictor of workers’ health risks and working conditions. Physical injuries affected more than half of facility-based workers annually compared to less than 10% of home-based workers. Facility-based workers are more likely to report insufficient time for tasks, lower job satisfaction, and less respect and appreciation from patients. Home-based workers may be more likely to experience emotional distress, be offered fewer benefits, but experience fewer injuries, due to the better relative health of their patients and having more time for client care. Women reported more injuries and more time pressure than men across racial and citizenship groups within the same work setting.

There are limitations to the NHHAS and NNAS public-release data file data. We are unable to fully capture citizenship, some racial/ethnic categories, workers over age 65, supervisory workers, facilities with fewer than three residents, and facilities not certified with Medicare or Medicaid. The exclusion of these questions, workers, and contexts is a weakness of the present study.

Analyses draw on data from the first nationally representative sample surveys of home health aides and nursing assistants in the United States. Direct care workers are an important population to capture through intersectional research since care work is done predominantly by multiracial women and immigrants. This research also underscores the importance of workplace contexts in shaping the labor performed and the workers’ experiences.

As the population ages in the United States and globally, health-care demands are rising and varied, including the growth of home health care. Small, regional, qualitative studies indicate both satisfaction and exploitation in home health-care work. These intimate, caring relationships with clients may be especially challenging for minorities due to client prejudice and structural marginalization. This study broadens the scope of current research by addressing issues facing home health-care workers using large-scale, nationwide data.

Using nationally representative data of home health aides in the US, the National Home Health Aide Survey (NHHAS), we evaluate which features of work are related to overall satisfaction. The prevalence and sources of discrimination and working conditions are examined according to workers’ intersectional gender, race, ethnicity, and class identities.

Satisfaction was highest for those who were extremely satisfied with challenging work, learning new skills, and were most supported in their caring labor. Salary was the area with the most frequent dissatisfaction. Support for reproductive and caring labor was often inadequate. Black women and men reported the highest levels of discrimination (about 28.0%), followed by Hispanic women and men (16.5% and 10%, respectively). The largest source of discrimination was patients (80.4%). There were differences in job outcomes according to intersectional identities of race, class, and gender.

Discrimination, low wages, and not having enough support for both reproductive and caring labor are problems for home health aides. Improving home health aide work is also likely to improve patient outcomes.

To determine healthcare utilization issues for low-income Hispanic immigrants who have both excess weight and chronic pain.

Community health workers conducted at-home interviews with 101 middle-aged and older Mexican Americans (aged 40-79 years, M=52.1±8.8) associated with a community agency in southern California to evaluate healthcare underutilization and reported reasons for not using medical or pharmaceutical care.

Almost all participants (91 percent) reported having received at least some medical care in the year preceding the study interview. However, at some point during the prior year, 62 percent had not seen a doctor when it was needed and 45 percent had not taken a prescribed medication. While the primary reason for underutilization was financial, communication, and trust reasons were also reported.

Although cross-sectional and geographically restricted, this study lays the foundation for additional research on reasons for underutilization of recommended healthcare and lack of pain management in low-income Hispanic immigrants who are overweight and have chronic pain.

Policy implications include the urgent need for health insurance.

Implications for providers include the need for accurate pain assessment and better communication about medication to prevent non-adherence in this population.

The current study highlights the existence of healthcare underutilization among overweight and obese Mexican Americans with chronic pain and identifies specific barriers to care, care seeking, and pain management.

This chapter will initially review some health care system issues with a focus on the US health care system. It will then review some of the sociological literature about race/ethnicity, immigration, socioeconomic status (SES) and gender and how these factors link to health and health care. In addition, the chapter will serve as an introduction to the volume and will briefly review the contents of the other sections and chapters in this volume.

The authors bring diverse feminist perspectives to bear on social entrepreneurship research and practice to challenge existing assumptions and approaches while providing new directions for research at the intersections of gender, social and commercial entrepreneurship.

The authors apply liberal feminist, socialist feminist and transnational/post-colonial feminist perspectives to critically examine issues of gender in the field of social entrepreneurship.

By way of three distinct feminist lenses, the analyses suggest that the social entrepreneurship field does not recognize gender as an organizing principle in society. Further to this, a focus on women within this field replicates problematic gendered assumptions underlying the field of women’s entrepreneurship research.

The arguments and suggestions provide a critical gender perspective to inform the strategies and programmes adopted by practitioners and the types of research questions entrepreneurship scholars ask.

The authors redirect the conversation away from limited status quo approaches towards the explicit and implicit aim of social entrepreneurship and women’s entrepreneurship: that is, economic and social equality for women across the globe.

The authors explicitly adopt a cultural, institutional and transnational analysis to interrogate the intersection of gender and social entrepreneurship.

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.