The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The public-private welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women-owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980.
[Photo: Dr. Jennifer Nazareno]
This study, conducted Dr. by Jennifer Nazareno, Brown University Presidential Diversity Postdoctoral Fellow in Public Health and the Jonathan M. Nelson Center for Entrepreneurship, sought to explain the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years.
Results indicated that immigrant Filipino women have strategically extracted and agentically benefited from their health care professional backgrounds as well as their group’s social class. Historical and structural forces, such as the Americanized nursing training and education programs that began when the Philippines was colonized by the U.S., have also considerably impacted the development of this form of immigrant enterprise around health and long-term care services. At the same time, many of the Filipino immigrant women became entrepreneurs by becoming private owners and operators of government-subsidized businesses located in the peripheral market sector, which highlights their constraints as business owners and underscores salient structural inequalities in general. Furthermore, the experiences of immigrant Filipino women reflected the challenges and limits of their social, political, and economic mobility as immigrant entrepreneurs and their role as welfare state replacements.
Dr. Nazareno utilizes transnational feminist and intersectionality frameworks to illuminate the complexities related to the immigrant women laborers in the U.S. health and long-term care sectors and the subsequent emergence of immigrant nurse entrepreneurship. Oversimplification of this global phenomenon through a cost/benefit and/or supply/demand analyses has overlooked the gendered and racialized aspects of the health and long term care workforce. Typically, this type of labor has been viewed as women’s labor and historically, has been underpaid and undervalued. This article is particularly salient given increasing demand for health and long-term care workers in middle to higher income countries like the United States because of the combination of increased medical spending, the recent passage of the Affordable Care Act, and demographic changes related to the aging of the population.
This article was published in: The International Journal of Health Services.