The article analyzes the status of care work in capitalist societies. Care is a necessity in the context of human dependency and vulnerability. Here I understand care work as materialized and "thickly embodied" (Lanoix, 2013) rather than as affective labor (Hardt and Negri, 2000; Lanoix, 2013). On a very basic level, capitalist societies are founded upon unequal class relations as well as on the cultural and economic devaluation and externalization of relational embodied care. This can be seen, for instance, as certain elements of care work are relegated to the private sphere and remain largely unpaid and invisible. This great amount of unpaid labor is a basic condition of capitalism. I introduce the concept of value abjection (German: Wert-Abjektion) here to illustrate and analyze these structural tendencies and their effects on care workers and the elderly care recipients.

This paper examines the tension between macro level regulation and the rule breaking and rule following that happens at the workplace level. Using a comparative study of Canada, Norway, and Germany, the paper documents how long-term residential care work is regulated and organized differently depending on country, regional, and organizational contexts. We ask where each jurisdiction's staffing regulations fall on a prescription-interpretation continuum; we define prescription as a regulatory tendency to identify what to do and when and how to do it, and interpretation as a tendency to delineate what to do but not when and how to do it. In examining frontline care workers' strategies for accomplishing everyday social, health, and dining care tasks we explore how a policy-level prescriptive or interpretive regulatory approach affects the potential for promising practices to emerge on the frontlines of care work. Overall, we note the following associations: prescriptive regulatory environments tend to be accompanied by a lower ratio of professional to non-professional staff, a higher concentration of for-profit providers, a lower ratio of staff to residents and a sharper division of labour. Interpretive regulatory environments tend to have higher numbers of professionals relative to non-professionals, more limited for-profit provision, a higher ratio of staff to residents, and a more relational division of labour that enables the work to be more fluid and responsive. The implication of a prescriptive environment, such as is found in Ontario, Canada, is that frontline care workers possess less autonomy to be creative in meeting residents' needs, a tendency towards more task-oriented care and less job autonomy. The paper reveals that what matters is the type of regulation as well as the regulatory tendency towards controlling frontline care workers decision-making and decision-latitude.

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Nursing home (NH) residents are increasingly in need of timely and frequent medical care, presupposing not only available but perhaps also continual medical care provision in NHs. The provision of this medical care is organized differently both within and across countries, which may in turn profoundly affect the overall quality of care provided to NH residents. Data were collected from official legislations and regulations, academic publications, and statistical databases. Based on this set of data, we describe and compare the policies and practices guiding how medical care is provided across Canada (2 provinces), Germany, Norway, and the United States. Our findings disclose that there is a considerable difference to find among jurisdictions regarding specificity and scope of regulations regarding medical care in NHs. Based on our data, we construct 2 general models of medical care: (1) more regulations—fee-for-service payment—open staffing models and (2) less regulation—salaried positions—closed staffing models. Some evidence indicates that model 1 can lead to less available medical care provision and to medical care provision being less integrated into the overall care services. As such, we argue that the service models discussed can significantly influence continuity of medical care in NH.

The article delivers a contribution to theorise (the devaluation of ) care-work in patriarchal capitalism and to connect the theorization with the empirical analysis of the German ambulant care sector in neoliberal times. The central theorem of ‘value-abjection’ transforms Marxist value theory and conceptualizes the abjection of care work as constitutive mechanism of domination in patriarchal capitalism. Transferred to a concrete level of argumentation the theoretical perspective of value-abjection helps not only to analyse the structural tendency of abjection of care work. It also enables to identify empirically- concrete which specific aspects of care and for what reason are structured as abject.