The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The privatized welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women–owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980. This study explains the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years. © 2018, © The Author(s) 2018.

long term care welfare state replacements Filipino women privatization mental health care services labor force conditions residential care facilities immigrant entrepreneurship U.S. deinstitutionalization

Deinstitutionalization Long-Term Care long term care mental health human middle aged privatization welfare reform financial management outsourcing United States Young Adult Humans migrant Adolescent Asian Americans Emigrants and Immigrants Asian American female institutional reform social welfare health services Outsourced Services organization and management health care Ownership adult subsidy system long-term change immigrant population