In response to an expanding need for at home care, the state has established a highly bureaucratic system for delivering and compensating such assistance. This rigid approach to valuing care, in which needs are fragmented into easily quantifiable units, imposes under-recognized yet significant costs on workers and recipients alike.

U.S. childcare policy increasingly drives resources into large, formal centers under the banner of "quality assurance." This trend has devastating impacts on home-based providers and the working families they serve.