LORI L. JERVIS Department of Psychiatry Division of American Indian and Alaska Native Programs University of Colorado Health Sciences Center The Pollution of Incontinence and the Dirty Work of Caregiving in a U.S. Nursing Home In U.S. nursing homes, it is the job of nursing assistants to tend to resi- dents ' basic bodily needs, including elimination and incontinence care. Given theirfrequent contact with pollutants, aides are very much at risk of becoming "pollutedpeople." In this article, I investigate how nursing as- sistants' continual contact with contaminating substances impacts their status within the workplace, their relationships with others, and their atti- tudes toward their work and themselves as workers. I also explore how aides manage their encounters with pollutants and their stigmatized role as "dirty workers." In doing so, I hope to explicate the meaning of elimi- nation and of incontinence caregiving in the United States, [nursing homes, caregiving, symbolic pollution, incontinence, American culture] N ursing assistant work is, in many ways, prototypical "dirty work." As pri- mary caregivers to the sick, the "crazy," and the dead in nursing homes, nursing assistants are constantly threatened with becoming symbolically polluted. 1 But of all the stigmata with which aides must contend, incontinence care poses one of the most serious threats to caregivers' sense of self and status on the job. This article investigates how nursing assistants' frequent contact with con- taminating substances impacts their position within the workplace, their relation- ships with others, and their self-conceptions. Since being enmeshed in the realm of the culturally taboo has its difficulties, I also explore how aides experience and manage their encounters with pollution. In doing so, I hope to demonstrate the sali- ence of symbolic pollution in a setting where such notions are seldom articulated but nevertheless play a major role in the structure of inequality. Method and Setting This article is based upon 21 months of ethnographic field work from 1993 to 1995 in an inner-city nursing home that I call Manchester Estates. Along with exten- sive participant-observation within the facility, I conducted audiotaped, semistruc- tured interviews with 14 residents and 16 staff members. I also reviewed residents' Medical Anthropology Quarterfy 15(l):84-99. Copyright© 2001, American Anthropological Association. 84