TRANSFORMATIONS IN WORK 273
One positive result of this privatization of the care of the elderly has
been the professionalization of nursing care. Even among those working
in “basic care,” almost all of whom were women, almost two-thirds (65
percent) have completed formal vocational training (mostly as nurses or
nursing aides). The other eff ects of this have been more ambivalent. Like
all markets, the market for nursing care is driven by competition. Yet the
prices have been set by a pseudo-monopoly, namely the health and nurs-
ing care insurance companies, which have a lot of clout over the service
providers, most of whom are small companies. Thus, the great negoti-
ating power of the insurance companies has resulted, according to Wil-
fried Kunstmann, in “agreements to subjugation” that set the tone for the
way work is done in this business. Personnel scheduling and workfl ow
organization are no longer being optimized to meet “patients’ needs,”
but rather to maximize profi ts. This trend has intensifi ed the work that
needs to be done and limited the fl exibility of the nursing staff. Many
of these often-underpaid nurses and aides are overworked, prompting
them to switch jobs or even professions. About 30 percent of them have
been diagnosed with burn-out syndrome at least once. Meanwhile, the
comparatively expensive cost of employing registered nurses is becom-
ing a fi nancial burden for many companies; the larger the nursing care
provider, the lower the percentage of registered nurses they employ. As a
result, there has been talk of a “gradual deprofessionalization of nursing
care for the elderly” since the end of the 1990s.^80
Tighter state and municipal budgets and the pressure to cut costs
“from above” have only served to further strengthen the business side
of care management and the focus on profi ts. On a completely diff er-
ent note, however, digitalization and the networking of information and
communications structures has made it easier for nursing staff and care
managers to keep up with the ever-growing mandate to maintain proper
records. Time budgets (specifying the allotted time per patient) and in-
creasing standardization have also led to a successive Taylorization of
patient care. The stimulating and communicative aspects of care that
are particularly benefi cial for the elderly and help keep them active have
mostly been deemed to be irrelevant in terms of profi ts, meaning that
they are considered to be unnecessary in nursing care structured along
Taylorist lines.
The Americanization of Paid Work?“(Neo) Taylorization,” “fl exibility,” and “insecurity” are diff erent aspects
of an all-encompassing process that has fundamentally transformed work
in the service sector, industry, and agriculture, expressing itself ideologi-