Ai-jen Poo: Elders and Their Caregivers Deserve Dignity

By Miriam Zoila Pu00e9rez Feb 12, 2015

Ai-jen Poo–the labor organizer, MacArthur "Genius" Fellow and woman of color who rocks–just released her first book: The Age of Dignity." Co-authored by "book doula" Ariane Conrad, it provides an accessible and heartfelt look at a major problem looming for the United States–how we will care for baby boomer generation as it rapidly ages. "The Age of Dignity" also sheds light on the quickly growing, low-paid home-care industry, which is dominated by women of color.

Along with stories from the workers she has organized with as director of the National Domestic Workers Alliance (NDWA), Poo shares her own family’s elder-care experiences, both good and bad. She calls the death of her paternal grandfather in an institution "one of the biggest regrets of my life and my family," but her maternal grandmother is still living independently with the help of a home-care worker.

Poo ends "The Age of Dignity" with concrete policy recommendations, and even a really inspiring vision of what she hopes could be her own home-care setup at age 80. Here, an edited and condensed interview with the first-time author via e-mail.

You mention in the book that of the approximately 2 million in-home caregivers who exist, most are women. What do we know about the racial makeup of this group?

When you look at home care workers who are hired through agencies, in addition to workers who are hired directly by their employers, you’ll see that it’s a workforce that is predominantly black women and other women of color–many of whom are immigrants.

According to the NDWA report "Home Economics," two-thirds of nannies, housekeepers and caregivers for the elderly are foreign-born, and about half of them are undocumented. Caregiving is not only a women’s issue–it’s absolutely a racial justice issue and an issue that is intricately linked to immigration reform.

Does race impact professional caregiver relationships with those receiving care?

That’s a really interesting question, because we’re talking about a mostly women-of-color, immigrant workforce whose clients are often aging white Americans. I hear stories about challenging moments, but I also hear stories about the beautiful relationships that can develop. Through my work I’ve learned that caregiving relationships can be and often are wonderfully transformational, for both sides.

Can you say more about the links you make between the devaluation of home care workers and the legacy of slavery?

It’s been clear from the beginning that part of the reason why home-care and domestic workers have been excluded from basic labor protections for so long is the legacy of slavery. In fact, when the Fair Labor Standards Act and the National Labor Relations Act were passed in the late 1930s, they specifically excluded domestic workers and agricultural workers in order to secure the votes of Southerners in Congress who didn’t want these mostly Black workers to gain economic or political power. One of the key demands of the March on Washington in the ’60s was to reverse this. This exclusion meant that home-care workers weren’t covered under basic federal minimum wage and overtime protections, leaving people incredibly vulnerable.

In the book you seem pretty against institutions as the answer for elder care. Do you think it’s possible to transform them into more nurturing and cost-effective places?

There’s a reason why 90 percent of people don’t want to go to a nursing home — they’re often dehumanizing places that rob people of their dignity. I don’t think institutions need to be this way, though. There are several models that point the way towards institutions that are life-affirming and maintain a good quality of life. The Green House model is one. Ultimately though, I think we need to shift from the institutional model to a home-based model, and this means we need a strong, well-paid, well-trained home-care workforce.

How do we get there?

Our task is to call on our elected officials [to] improve the quality of institutional care for those who truly need it, and create the new infrastructure that would increase access to affordable, high quality home care while ensuring that these jobs are good jobs. We [should] create what I call the Care Grid — a system that, just like we brought water and electricity to every home in America, would bring quality care to every home in America.

Professional home care for the elderly seems like a luxury of the wealthy. How do we transform this to a standard practice for people of all classes?

There’s a reason that home care is the fastest-growing workforce in the country — our country is aging rapidly, with 10,000 people turning 65 every day. But these workers that we count on…are paid so little that they often can’t support their own families. The average wage is still around $9 an hour.

On the flip side, all but the wealthiest of us are finding it hard to afford the care we need. And you’re right, it shouldn’t be a luxury. But when the average cost of a private room in a nursing home is $87,000 a year, and when home care isn’t included as part of programs … like Medicare, most forms of care are out of reach for the vast majority of us. And the programs that do exist through Medicaid are underfunded and still overwhelmingly tilt towards putting people in institutions. … We desperately need [a] cultural shift in how we value aging and caregiving.

Female family members are so much more likely to take on the burden of elder and family care. Why?

Caregiving is and always has been associated with women, like many other kinds of unpaid work in the home. It’s just been assumed and expected that women will be the caregivers in our families–from caring for children to our elderly parents. And so we’ve done it, whether as unpaid and unacknowledged family caregivers or as low-paid professional caregivers like home care workers and domestic workers. Because it’s seen as "women’s work," that’s one of the main reasons caregiving has been devalued for so long. But with more and more women entering the workforce, this is becoming increasingly unsustainable. Working women of all walks of life face impossible choices right now, and these days are often juggling a full-time job, raising young children, and caring for an aging parent.

Your optimism about a really harrowing situation permeates so heavily throughout the book. How do you maintain such a hopeful outlook?

My hope is grounded in the work that so many of us around the country are already engaged in. Home-care workers and domestic workers are organizing, hand-in-hand with people with disabilities, aging Americans and their families to create solutions that guarantee dignity for workers and those they care for. … [This] will become an issue no one–including our elected officials–can ignore any longer.

And I know that this will happen. Because this movement is rooted in love and the belief in the dignity of all people, the love we feel for our families and the importance we place on caring for one another. We can win.