Demographics and the Care Crisis

The Age of Dignity: Preparing for the Elder Boom in a Changing America
By Ai-jen Poo, 176 pp., The New Press, 2015

In this slim but engaging volume, Ai-jen Poo, executive director of the National Domestic Workers Alliance (NDWA), argues that an increasingly aging U.S. population requires a drastic shift in an already inadequate care economy. She contends that a sustainable system of care will entail not only accessible, affordable, high-quality care for all who need it but also fair wages and working conditions for the swelling work force providing that care. Public programs must be restructured and the cultural stigma that surrounds care work, aging, and disability in the United States removed. She urges people to work toward better systems of care on every level, from the national to local co-op living arrangements. 

Poo weaves together experiences of recipients of care, unpaid family caregivers, and paid caring professionals with statistical and historical information. She addresses the way that oppressive dynamics of gender, race, class, migration, and age structure the caring economy for both care workers and recipients of care. She also emphasizes how our society has consistently de-prioritized and undervalued care and care work.

Poo’s ability to make this demographic and policy issue come alive is no doubt a product of her 15 years of experience in grassroots organizing for domestic workers’ rights. Before heading the NDWA, she was the lead organizer for Domestic Workers United (DWU), a New York City-based organization that she and others started in 2000.

In 2010, after a decade of organizing, DWU and its allies succeeded in getting a “Domestic Workers’ Bill of Rights” passed in New York State. This legislation was the first in the U.S. to mandate a number of basic labor protections, including paid overtime and a working environment free from discrimination and harassment within the domestic work industry. Since then, domestic worker rights activists have won similar legislation in Hawaii, California, Massachusetts, Oregon, and Connecticut, and are currently pushing for a bill in Illinois.

DWU’s organizing success in New York centered largely on nannies and their employers. Because employers of nannies are generally affluent, organizers could win support by arguing that fair pay and good working conditions were ultimately good for both recipients and providers of care. Despite their successes, DWU and NDWA had to confront the limitations to this strategy. The majority of paid domestic workers in the United States are home care assistants and home health aides. They have been hired out of necessity, and their rate of reimbursement for care is often set by Medicare and Medicaid. Even if employers can pay out of pocket, they still may not be able to afford more than the bare minimum. In these cases, paying more would mean fewer hours for workers and less care for employers, when many people already receive less care than they need.

Therefore, DWU and NDWA brought together care worker, immigrant, senior, and disability rights advocates to form a national “Caring Across Generations” campaign in 2011.

Poo makes a strong case for drastic change in the system. Equally compelling is the idea, which runs throughout The Age of Dignity, that to meet the challenge we must stop thinking of care as a “social cost.” She prefers to speak of “social investment.” The challenge Poo does not pose, though, is whether these goals can be met without overturning the for-profit structure imposed on all economic activity in this country. If the care crisis is as pressing as she suggests, meeting it may entail an even greater paradigm shift, one that replaces a market-based notion of “social good” with one based on human welfare.

Elena Blanc is DSA’s membership coordinator.

This article originally appeared in the fall 2015 issue of the Democratic Left magazine.

Individually signed posts do not necessarily reflect the views of DSA as an organization or its leadership. Democratic Left blog post submission guidelines can be found here.

 

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