Review of Elder Care in Crisis: How the Social Safety Net Fails Families By Emily K. Abel, New York: NYU Press. 2022. pp. 232.

Reviewed Book

Elder Care in Crisis: How the Social Safety Net Fails Families By Emily K. Abel, New York: NYU Press. 2022. pp. 232.

An elderly person on a wheelchair is being pushed by a uniformed caretaker inside a home
Cover of Elder Care in Crisis (2022)

Cati Coe

Carleton University

Emily Abel has long been interested in kin care. My first encounter with her body of work was the historical study Hearts of Wisdom: American Women Caring for Kin, 1850−1940 (2000), documenting the labor of women in caring for kin in the United States. Her most recent book, Elder Care in Crisis, also examines kin care, this time with a specific focus on those caring for spouses or parents with dementia, in the present day, including during the COVID epidemic, through examining online support groups for caregivers in the United States from 2011 to 2022. Through her historical knowledge, she puts contemporary family caregiving into longer perspective than most studies of care do.

Care has been a burgeoning field of study over the last two decades, across numerous disciplines and fields, including medical anthropology. Hard to define, it has come to take on a rather vague, capacious meaning but generally is associated with positive valences, of warmth and love, rather than more “negative” ones like conflict, hierarchy, and belonging. The pandemic has heightened our sense of the importance of care and demonstrated the failure of some forms of care, like long-term care homes’ inability to protect their frail and aging residents from contagion or the isolating effects of their efforts at protection. The increased risks of the vulnerable and elderly are weighed against the curtailment of freedom of the majority of the population and found less important in the balance, thus further marginalizing older people. Some of the popularity of care has to do with its potential for critique—of an uncaring capitalist society, of a neoliberal state, and of the social devaluation of those who care, who are mainly women and people of color in precarious positions (Thelen 2021). Elder Care in Crisis similarly uses its research on family caregivers to critique the importance of profit in care institutions and the reliance on family caregivers to reduce the costs of state care.

Overall, the book is fair and balanced, undercutting the sense of crisis suggested by the title. Abel notes that very little has changed in care since she began her research on this topic: most care is provided by family caregivers, women provide the bulk of care labor, and the government leaves family caregivers largely on their own to cope. The crisis is thus ongoing: while there were fewer elderly people with chronic conditions in the nineteenth century, women then were constantly tending to the sicknesses of infants, children, and neighbors, at a time when chronic diseases like tuberculosis and infections were rampant and swept through households, infecting member after member. Women attended neighbors’ births and provided care to sick and dying children. Thus, there was no golden age of family caregiving; or, rather, women’s burnout from care responsibilities is not new, although the word burnout was unknown in the nineteenth century.

Abel discusses how stress and burnout became vernacular terms by the 1980s, and these labels were quickly used to describe kin caregivers. Yet a focus on the stress and burden of caregiving ignores the joys of caregiving, she argues, in which people can become closer and more intimate as a result of synchronizing with one another through care. As she says, “Caregiving exacts serious, often calamitous costs, but it is also a profound human experience and cannot be neatly subsumed under the term ‘stress’” (9). This point is borne out by her data: the support group members in her study spoke of their partners with dementia in relational ways, and caregiving gave a special meaning to their lives, even as they found themselves overwhelmed with practical tasks and emotional responses. We must attend to the complexity and feelings of ambivalence about care as Abel does.

What I found most moving were the emotions expressed by family caregivers in the support groups, in particular, their sense of guilt when they felt that they could not do enough or when they felt that they had to put their spouses into institutional facilities. This guilt is a harsh indictment of our society, in which caregivers blame themselves for being unable to care for their spouses. Support group members assuaged others’ expressed sense of guilt through various methods, but these technologies of self did not always succeed in doing so. Although kin caregivers felt anger, Abel decides that they are unlikely to be a political force, even though some support groups on health issues have become so. Instead, Abel reveals the ways members of caregiving support groups direct their anger at individual actors, medical personnel, or specific nursing homes rather than the long-term care system as a whole. Thus, Abel shows why the elder care crisis will probably not turn into a revolution. Only infrequently did kin caregivers recognize their potential shared interests with paid care workers, from whom they often felt divided by race, class, and citizen/migrant distinctions.

Studying support groups opened certain doors for understanding caregiving, in which caregivers expressed their concerns emotionally to others in similar straits who responded supportively. But it also limited what was possible to study about caregiving, given the norms that developed within the support groups. Abel tries to be comprehensive by addressing the experiences of paid care workers employed by home nursing agencies and in nursing homes, who might be a source of relief for kin caregivers. Abel nods to the experiences of paid caregivers from others’ research to frame the more ambivalent narrations by kin caregivers about paid care workers, trying to be fair to both sides. Ultimately, however, her research cannot do justice to paid care workers, who tend not to participate in caregiving support groups. Building such solidarity has become important to many advocates working on care issues.

Composed of short chapters, with very clear language, Elder Care in Crisis is immensely easy and engaging to read, making it ideal for undergraduate classes. Chapters could be assigned independently of one another, or the whole book could be used to discuss longer histories of caregiving in America and demonstrate continuities in the care crisis.

Crisisprecarity, and vulnerability have become key words in anthropology, although perhaps less in medical anthropology than in studies of work and capitalism. However, Abel’s work suggests that it may make sense to think of the crisis in elder care as a long-term chronic condition, as with other crises of homelessness, poverty, and democracy. Cruddiness, Povinelli’s term to analyze the conditions that result from state abandonment, might be a better description of contemporary elder care than catastrophe or crisis (Badone 2021; Povinelli 2011). Somehow caregivers manage to be resilient, trudging along, adapting to the changing circumstances of their loved ones, averting disaster at great cost, using others to help find a way through, in a whirl of meaning and complex emotions. From the perspective of kin caregivers, Elder Care in Crisis documents the complexity and cruddiness of care today.


Abel, Emily K. 2000. Hearts of Wisdom: American Women Caring for Kin, 1850–1940. Cambridge, MA: Harvard University Press.

Badone, Ellen. 2021. “From Cruddiness to Catastrophe: COVID-19 and Long-Term Care in Ontario.” Medical Anthropology, 40(5): 389–403.

Povinelli, Elizabeth A. 2011. Economies of Abandonment: Social Belonging and Endurance in Late Liberalism. Durham, NC: Duke University Press.

Thelen, Tatjana. 2021. “Care as Belonging, Difference, and Inequality.” Oxford Research Encyclopedias of Anthropology.