The Care Bureaucracy

41 Pages Posted: 22 Mar 2023 Last revised: 18 Aug 2023

Date Written: August 18, 2023


The state plays an increasingly crucial role in providing home care as an aging population leads to mounting care needs. The public care system in the United States delivers home care and compensation for care work through an increasingly bureaucratic mode of governance featuring task-list enumeration, documentation, professional supervision, and exacting surveillance. The process adopts a rigid functional approach to define, measure, and regulate care, one that creates tension with the home care’s relational, fluid, and person-centered dimensions. Through the concept of “care bureaucracy,” this Article describes the status quo disciplinary bureaucracy governing public home care, analyzes its political economy context, including its connection with distrust and fragmentation in the public care system, and lays out its benefits and profound costs. The care bureaucracy not only burdens families needing care and care workers with unpaid and privacy-invading bureaucratic work, but also deters participation and stiffens the provision of home care, threatening the state’s capacity to adequately deliver the promised quality care. The Article also proposes an alternative way to govern public home care by drawing from the Department of Veterans Affairs’ caregiver programs for veterans with service-related disabilities.
This Article makes two contributions to legal scholarship on care and the state. First, this Article explores the tension between public responsibility and family and worker autonomy in a mundane form of family regulation—a disciplinary bureaucracy—in the public home care system. The care bureaucracy imposes a not-so-punitive and yet highly omnipresent regulation of the users’ family, workplace, and bodily autonomy by micro-managing their physical movements inside homes. Second, it establishes the political-economy connection between the bureaucratization and fragmentation of public home care. In analyzing the status quo political economy of the care bureaucracy, this Article provides a roadmap to reform the public care system into one more responsive to the growing care needs.

Keywords: Home Care, Bureaucracy, Medicaid, Political Economy

Suggested Citation

Zhang, Yiran, The Care Bureaucracy (August 18, 2023). Indiana Law Journal, Forthcoming, Available at SSRN: or

Yiran Zhang (Contact Author)

Cornell ILR School ( email )

New York
United States

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