Abstract

The significant protections afforded the elderly in this country through Social Security and Medicare end when older adults become disabled and in need of long-term care services. We have no coherent system of care for frail elders; instead we have multiple and fragmented programs, each with their own attending funding streams and eligibility requirements. In spite of significant public resources allocated to long-term care, many frail elders are unable to pay for needed services, go without needed services, or receive services they neither need nor want in their attempts to patch together a plan of care. Poor quality of care pervades the delivery of long-term care services. Care-givers, both paid and unpaid, bear heavy emotional and financial burdens that threaten to unravel the fabric of responsibilities that we hold dear to loved ones and to society. These problems with long-term care are complex and deeply entrenched in cultural values and norms that define the need for care as a commodity or as a private trouble, that construct old age as a medical problem, that holds out self-determining and independent adults as the norm for human experience, and that perceives women as natural care-givers. ;A public ethic of care provides a possible antidote to the problems of long-term care. Addressing several key research questions develops this argument. First, what are the constitutive elements of a public ethic of care? Second, how do current long-term care policies stand up when analyzed through the lens of an ethic of care? Third, what contributions can an ethic of care make to thinking about the social and political issues of long-term care policy and what kinds of possibilities are opened up by reasoning with an ethic of care? Finally, what does care look like as a political idea? More specifically, what would long-term care policy look like if care were a central moral focus in our liberal, democratic, pluralistic society? The methodology used is both normative and empirical. Arguing that a public ethic of care should have a more central moral focus in our society is a normative exercise. Describing and analyzing current policies in long-term care, and the extent to which they realize an ethic of care is empirical work. ;Part One reviews the philosophical and historical traditions from which a public ethic of care emerges. Part Two is a detailed problem statement of long-term care policy, evaluated through the analytic lens of a public ethic of care. Part Three works toward reconceptualizing long-term care through the lens of an ethic of care, considering how long-term care might be re-visioned if grounded in the assumptions of a public ethic of care. The conclusion brings the discussion of a public ethic of care back specifically to the profession and practice of social work, where the argument is made that a public ethic of care can inform and shape the historical commitments of the profession, and the knowledge and skiffs of the profession can further the implementation of a public ethic of care