"The human experience has a crisis": MacArthur genius Ai-Jen Poo on America's "elder boom" and the labor of dealing with death

There's a sense of urgency people feel at a personal, familial level. Here's how to take that into the public arena

Published February 9, 2015 8:45PM (EST)

Ai-Jen Poo         (Michele Asselin)
Ai-Jen Poo (Michele Asselin)

Every eight seconds, another American turns 65. By 2030, the percentage of our population that is 65 or older will be 20 percent. We are on the verge of what analysts are calling "elder boom," with an aging population that will have needs -- medical, financial and emotional -- that our current system is ill-equipped to meet.

In her new book "The Age of Dignity: Preparing for the Elder Boom in a Changing America," author, MacArthur Fellow and National Domestic Workers Alliance director Ai-jen Poo offers a personal, cultural and political perspective on how our failing and flawed system can, and must, change to address these changes head on.

"I think the aging of the baby boom generation and the changes that that's starting to bring about in terms of relationships between millennials and boomers, millennials and their grandparents, family caregivers and paid caregivers and seniors ... There's a whole bunch of relationships that are changing and that are creating major openings in how people understand our interconnectedness and how people understand the urgency with which we have to start dealing with these issues," Poo told me when we spoke last month. "I think there's a sense of urgency that people are experiencing at a very personal, familial level. Our task is to really take that into the public arena and start a different kind of public conversation about it."

I talked to Poo about her work with the National Domestic Workers Alliance, the policy agenda she sees as essential to meeting the needs of our aging population, what climate change and the "elder boom" have in common and what she calls "building a culture of care." Our conversation has been condensed and lightly edited for clarity.

The book is structured around the personal stories of care workers, and one thing that becomes clear very quickly is how complicated their jobs are. The responsibilities range from medical to emotional to very exacting physical labor, and yet, as one of the women told you, they are often reduced in the public to being women who “wipe ass.”

I think what we found was that because domestic workers, even though their work is devalued or undervalued in society, actually take a tremendous amount of pride in the work they do. It's just very difficult to be a caregiver if you don't love caring for people and if you don't, in a deeply authentic way, care for the people who are in your charge. There's just a tremendous amount of emotional energy that goes into this work for them every day, and it's something they feel proud of. I think hearing domestic workers talk about how much dignity there is in this work is something that moves people and it also resonates.

Rosalynn Carter says this so beautifully. She says there's only four kinds of people in the world: people who are caregivers, will be caregivers, are in need of caregiving, or will be in need of caregiving. Oftentimes, we're more than one of those categories. I think that when the domestic workers stood up and said, this work is dignified work and I believe in it, I care about it, and I think it should be recognized and valued, it actually just really resonated with millions of family caregivers who know how difficult and how important this work is to the quality of life of people they love. More so, even, for the consumers, the people with disabilities and the seniors, the people who count on the care of women, whether their own family members or the paid workforce. I think it just resonated that deeper message around the meaning and the value of caregiving.

Historically, one of the challenges of the women's movement is that there's always been this race and class divide. One of the things that's so powerful about what has happened with the domestic workers' movement is that there has been a way to talk about valuing domestic work that really brings in women of all races and classes to understand their own interest in a transformation of caregiving. Not erasing the race and class differences by any means or any stretch of the imagination, but understanding that if we lift up the voices of paid caregivers -- who are doing this work for poverty wage and therefore cannot even support their own families -- if those workers and that voice is lifted up, it creates more space for all of our struggle and for solutions that address all of our needs. I think that there has been a way that we've created kind of a vision that feels inclusive of our varying challenges around this issue, which really does touch everyone.

You mention in the book a comment then-Gov. David Paterson made, after he said he would sign the Domestic Workers Bill of Rights in New York, that he viewed the exclusion of domestic workers from other labor victories as part of a long legacy of racism. You also talk about the dynamics of immigration in this country as being another element of why this work is grossly undervalued.

Well, the history of this workforce is one of generation after generation of overcoming adversity and exclusion. It teaches us so much about how far we've come and how far we still have to go as a nation. In the 1930s, when the New Deal was passed, it was tasked with basically establishing our framework for labor protection and labor laws in this country. It included the Fair Labor Standards Act and the National Labor Relations Act, among other policies, which are cornerstone labor laws. Southern members of Congress refused to sign on to the New Deal labor protection that would include farm workers and domestic workers -- who were largely African American at the time -- and in a concession to those members of Congress those two groups of workers were booted from the New Deal laws.

Those exclusions remain to this day. Generation after generation of advocacy and organizing on the part of domestic workers has meant that different aspects of those exclusions have been addressed, so that we now enjoy some protection. Most domestic workers and home care workers now are protected under the Fair Labor Standards Act, but that has been a really long fight and to this day we're still working to move forward a regulatory change that the Department of Labor finalized just last year. The states are struggling to implement a home-care rule change that will bring the remaining two million home care workers under the protection of the Fair Labor Standards Act.

It was a really significant victory for low-wage workers in this country that the Department of Labor moved forward on that, and it was something that has been in the works for about 20 years. There are lawsuits, as we speak, where home-care agencies and industry lobbies are trying to stop this rule change from moving forward, so we still haven't gotten to a point where people understand that this is real work that deserves protection, just like any other work in this country. It's ongoing, and yet we've made incredible progress and had significant victories in recent years.

Given the legislative deadlock on immigration in the last Congress, what do you think the new Republican majority will mean for the kinds of reforms that would bring so many of these domestic and home care workers under protection? Is there hope for more progress at the state level?

Since Gov. Paterson signed the New York Bill of Rights into law in 2010, three other states have passed domestic worker bills, including California, Hawaii and, this year, Massachusetts. The Massachusetts bill is a really strong bill that we're really proud of. It includes maternity leave for domestic workers and caregivers, which we've never been able to achieve before. We're going to continue to move forward in states, and this year there's a really strong bill pending in Connecticut, which we're really excited about. We're going to continue working in Illinois, and there are many other states in the roster for the following year. So there's kind of a wave of momentum happening at the state level, so we're hoping that will continue.

It does set the stage for federal-level policy that, once and for all, can not only address the exclusion but actually put into place the kind of protections that reflect the needs of 21st-century America and the ways in which the structures of the economy and of caregiving have shifted. We're looking at developing a vision for that in the coming year, and we're looking at this immigration issue as a central component of it. We really believe that there is a strong argument to be made that all caregivers who are working as caregivers now -- even if they're undocumented but have the intention to continue working in this sector -- because of the tremendous need for this workforce and the fact that the need for caregivers is going to grow so exponentially, we should offer a pathway to citizenship for the undocumented caregiving workforce here. Signing up for training, allowing you a work authorization through your training program, and then, eventually, being able to apply for Permanent Resident status.

That is a proposal, that we're going to be developing a pathway to citizenship through training to really strengthen the caregiving workforce we have here, and bring the workers who are already doing this work out of the shadows, offer them access to the kind of training and support they'll need to really leverage their work as a part of the broader strategy to strengthen quality of life for our older generation, and also be able to elevate the quality of these jobs. Until we bring folks out of the shadows, it will be really difficult to professionalize and strengthen this workforce in the ways that we need as the demand grows.

The elder boom is similar to climate change, in a way. It’s an issue with real, material consequences that will require cultural and policy shifts that our elected officials are resistant to making. But the current system is not sustainable as our population ages, and we ignore that at our own peril.

Totally. It's so interesting, if you talk to any mega-trend analyst they will always name many different trends but always within the top five will be the age wave or the changing generational demographic and climate change. Those two major mega-trends are going to change everything about the way we live and work and play, and yet there's still large cross-sections of our society who have not turned towards them in that way.

Twenty years ago, Gloria Steinem wrote this article called "Revaluing Economics" in her book “Moving Beyond Words” and one of the things she says in that essay -- which is one of my favorites of hers -- is that the two invisible resource upon which everything else in our economy and society is built are the planet's natural resources -- water, air, land, earth -- and the work that goes into caring for and supporting and nurturing families. Those two resources are so invaluable and yet have been made invisible, taken for granted, and, in many cases, exploited. She argues that any vision for our future, and economy where we can all thrive has to fundamentally revalue those two natural resources as incredibly critical pillars that need to be protected.

There's something very deep about the ways in which our culture has assumed patterns and practices and has adopted a way of being that takes those two aspects of life for granted. That really has to shift.

Do you see that shift happening?

Thankfully, I think among young people it is shifting. When you think about the caregiving roles that more and more young men are playing within families or you think about young people who assume that dealing with climate change is going to be a part of their future, I think that is a source of a tremendous amount of opportunity on both fronts and the result of many people who have really called our attention to these issues over many decades.

Part of it is that we have to keep pushing for change on all fronts and pushing for change with this notion underneath it, as Gloria says, of really revaluing those fundamental elements that are so crucial to human life and society. If we keep pushing on all fronts, there will be these openings for major breakthroughs. I think the aging of the baby boom generation and the changes that that's starting to bring about in terms of relationships between millennials and boomers, millennials and their grandparents, family caregivers and paid caregivers and seniors... There's a whole bunch of relationships that are changing and that are creating major openings in how people understand our interconnectedness and how people understand the urgency with which we have to start dealing with these issues.

I think there's a sense of urgency that people are experiencing at a very personal, familial level. Our task is to really take that into the public arena and start a different kind of public conversation about it -- which I think has started to happen in climate change, but in a different way.

Immigration reform is a big part of the book, but you also talk about Social Security and other structural changes. It feels like this is a challenging political moment, perhaps, to advance some of those progressive policies.

It's kind of like a gemstone, depending on the entry point of where you looks at it. It can always be refracted in lots of different ways. For us, as domestic worker organizers and advocates on this issue, it's always been a difficult time. People have always told us that it would be impossible, and I think that now, more than ever, the demographics and the social means and the human experience has a crisis. It's such that it will become an issue that rises to a national priority, and the question is: what does it look like when it does emerge? Are the solutions going to be inclusive enough? Are they going to be bold enough? That is what we're trying to set the stage for, the boldest and most thoughtful and comprehensive set of solutions that really does address the many different sides of this issue.

Sometimes people have advocacy agendas that mainly focus on the quality of care for consumers or mainly focus on affordability for consumers but really neglect to think about the well-being and sustainability of the workforce. You just get a partial solution at best, so what we're trying to do is really work from the bottom up in terms of public policy, really support at the municipal and state level policies that both lift up the means and the quality of care for consumers and for families, creating more really choices for families while, at the same time, improving the quality of these jobs. Some of the policy ideas we have are things like creating a federal innovation fund that would support state and local innovations that actually improve both the quality of jobs and the quality of care and actually create more choices for families.

There are going to be states -- for example, Ohio is aging incredibly quickly as a state, and they're going to have to face this issue sooner than other states. Maine, the oldest state in the country, is way ahead on this issue. The Speaker of the House has created a whole aging-in-place agenda that does include workforce support.

I think that if we, from a federal level, really support and nurture and learn from the innovations that are happening at the state level, we will see the seeds of the kind of thoughtful solutions we need for the future. I don't think that any of the existing federal frameworks have really addressed all of the different dimensions of this issue, so we're going to have to see what emerges and what we learn. Really, what we need is something that thoughtfully takes into account all the different aspects of this issue from the perspective of workers, families, caregivers, and consumers.

One of the approaches you address in the book is this idea of a “care pod,” which, it seems, could exist absent of broader policy and structural changes. There are actually a number of successful community-based approaches to care that are already happening across the country and seem like they could be brought to scale.

There's everything from a village movement to naturally occurring retirement communities to some of the more social-enterprise ideas that are actually about people in communities finding and creating solutions. They're taking care of each other, they're sharing resources and caregivers, they're actually pooling resources to receive services as a community, they're really figuring out creative ways of building upon the natural resources that exist within a community to get some of these new needs met as we grow older.

The care pod is just one example of that, where you're actually saying, OK, what do workers need? And what do seniors need? Well, seniors want a comfortable home environment, they want independence. Caregivers also want a comfortable home environment, they want to be around their families, and they also want economic stability. If seniors were able to live with caregivers instead of the other way around, could that work? Could we create a housing framework where we offer homeowners who are caregivers the opportunity to open up their homes to seniors? It's similar to the village movement and the naturally occurring retirement movements. It's a similar kind of idea, where you're taking the kinds of communities people naturally want and naturally build and figuring out how to get the different kinds of needs met by the community.

You can actually build those without massive changes in public policy, and then you can actually create public policy to support those models to scale and to really promote those models to develop. I think that that should also be a huge part of the solutions for the future, because the scope and scale of how the aging of America is going to change our relationships and our needs as Americans... it just really does require solutions and creativity on all levels. I think that the more we can be moving this forward on all fronts and then thinking creatively about how we can connect the dots between public policy and local innovative ideas, whether they're in the marketplace or the community in a non-profit context... the more we can connect all these things, the more they can be leveraged and supported to grow.

These approaches allow people to age in their homes, which, as you say in the book, is what they want. The holistic care models are also less costly, and minimize hospital visits. So why do you think we're stuck in the not-very-efficient and very, very expensive healthcare system we have now?

I think there are entrenched institutional interests and habits that have been created over the last few decades. The institutional model of nursing home care is incredibly entrenched and it is not the future. We are moving away from institution-based care and towards home- and community-based services and care, and that is a good thing, but we're not making that shift quick enough.

I think the historic undervaluing of the role of the caregiver just means that we miss opportunities to really train and integrate both family caregivers and paid caregivers into the health care delivery system. If home care workers who are with patients hour upon hour during the day and through the night could really be valued and seen as trusted eyes and ears for physicians and nurses to draw from as resources, I think we could actually make huge advancements in the management of chronic illnesses, prevent unnecessary emergency room visits... there's so much that could be done if we really invested in the role of the home care worker as a critical part of the care team.

It's both that these institution-based systems are much less effective and costly -- and unnecessarily so -- but it's also that there's so much human potential that could be really helpful in the treatment and management of good health for older people that we're not taking advantage of. I think it's a win-win to really invest in the workforce and in this notion that we need to embrace a more home- and community-based model and that it is the future. It's just a question of breaking out of some of the institutional norms and entrenchment we've been living with for a long time.

We are very uncomfortable talking about caregiving as waged work and dealing with the financial aspect of something that is also so personal. And yet those conversations are also so essential to negotiating even the basics of fair pay and fair work.

For sure, it's a job and it's also an incredibly deep relationship. It's both. We need a public policy framework and a social values and cultural norms framework that accounts for the fact that it's both, not one or the other.

There's an existential level here, too. It seems like part of our reluctance to engage with the rights and dignity of care workers and domestic workers in this country might be our reluctance to confront the nature of their work. It’s about death. And we don’t want to talk about death.

It is a really powerful cultural current that we're up against that sees aging and dying as this thing to be afraid of and to avoid. There's actually a number of cultural currents that are working against us here: on the one hand, the fear of aging and dying, on the other hand, there's the lack of value that we've placed on caregiving, and then there's this whole other piece that's about the state of multi-generational relationships in our country and how separated we've become from one another and how much we've failed to value the multi-generational relationships in our lives.

There are all these cultural currents that we're up against, and I think the most powerful antidote to those has been the story of millennials who are really engaged in the care of their grandparents and were raised, in some part, by their grandparents and have a tremendous special bond with them. That's why we're really invested in the celebration of Grandparents' Day, because it ends up being this moment where you can just tell amazing stories about how much and why you love your grandparents. The fact that there are increasingly more and more examples of how people are aging in incredibly active... they're not just aging, they're really living longer; living vibrant, active lives for longer and seeing that as a good thing, as an opportunity to love longer, learn longer, work, contribute, all these things.

I don't want to sound naive and say that there aren't incredible complexities that come with aging, but I think the more models and stories we have of people really trying to find solutions and people really living life on their own terms at all kinds of stages of life and in connected ways, connected to their caregivers, connected to their grandchildren... that is a powerful counter-current to the long-standing cultural norms that we're up against and the existential question of are we really going to deal with this, ever. I think so, I think that the more powerful current is the one towards the powerful story of how we connect as human beings and how we ultimately find ways of living in strong relationships and connections to one another.

By Katie McDonough

Katie McDonough is Salon's politics writer, focusing on gender, sexuality and reproductive justice. Follow her on Twitter @kmcdonovgh or email her at kmcdonough@salon.com.

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