Photo credit: Michele Asselin, courtesy of The New Press.
Named one of TIME magazine’s 100 most influential people in the world in 2012, activist Ai-jen Poo is hoping to change the way we care for elders in our country. Ai-jen Poo is the director of the National Domestic Workers Alliance, co-director of Caring Across Generations, a MacArthur Fellow and author of The Age of Dignity, a recently-released book on elder care in America.
Someone in the U.S. turns 65 every eight seconds, resulting in 10,000 individuals a day and four million a year in greater need of elder care, she points out in the book. Yet there’s a lack of homecare workers who can provide the needed support for families.
Born and raised in Pittsburgh, PA, Poo spent her early childhood and summers in Taiwan with her grandparents who later moved to the U.S. for retirement. Her grandparents remained a steady and loving force in her life and served as inspiration for her activist spirit as she moved around the country with her parents, who later divorced.
I chatted with Ai-jen Poo on the phone about her upbringing and her recommendations for how to address the major challenges facing our country around elderly care.
Growing up, did you think you’d be championing social causes and advocating for domestic workers, women, mothers and the elderly?
Noooo. (Laughs). I actually wanted to be a writer when I was younger. Science and medicine, which are what my parents do, were never my strong suits.
My mother believes my activism started in the first grade. I think my activism and strong sense of equity and fairness have a lot to do with my parents’ values and the role that my grandparents played in my life.
What did you do in first grade?
[My mother] tells the story much better, but it was when I saw a television program about the famine in Ethiopia and decided to organize a cookie sale to raise funds for famine relief. So I baked some chocolate chip cookies and set up a little table in front of a supermarket to sell them.
Early in your book, you talk about your paternal grandfather. Can you talk a little about how he influenced you and your fight for better elder care?
My grandfather came to live with us when he retired. He was a really, really amazing man. He taught tai chi and built a whole following of tai chi practitioners among the Chinese immigrant community in Connecticut. My sister and I used to watch him in the mornings when he taught his classes.
Another ritual we had was to hurry through dinner so we could go into his room and watch his favorite show Wheel of Fortune. I’ve just got lots and lots of wonderful memories of laughing with him.
Eventually, he had a stroke. My father was unable to take care of him at home, so my grandfather ended up in a nursing home. As I visited him, he became just a shadow of the person he once was. His spirit really diminished. He was afraid, he felt completely alone and the conditions were so dehumanizing. It was just really painful for me to see someone who had such a vibrant life, and connected so many people, including my sister and I, to our culture through tai chi, and yet, was going to spend the last days of his life fearfully living alone in such dehumanizing conditions. I will never forget the smell, the sound, the lighting of that nursing home. I do wish he would have been able to stay at home, because that’s what he would have wanted.
My grandmother also played a huge role in my life. She’s one of my personal heroines. She lives independently still in her apartment in Southern California in Alhambra. It’s not far from her church, her church friends live in the neighborhood and she knows all her neighbors. She can just walk across the street to get her Chinese groceries. At 88, after working so hard her whole life and surviving poverty, migration and war and raising three kids and grandkids, she’s finally living life on her own terms.
She’s able to do that because she’s supported by a homecare worker, Mrs. Sun. If something happens, Mrs. Sun knows she can call my mom or uncle. Everyone’s connected, we have a strong circle of care around my grandmother, as it should be. That gives me the inspiration that it’s possible to create this circle of care in this country that gives everyone the choices we need to live well as we get older. It’s only going to happen if we work as a country to make it a priority, because there are so many huge gaps.
Ai-jen Poo (L) with her maternal grandmother and sister in Taiwan. Photo credit: Ai-jen Poo.
What needs to be done to address the elderly population boom?
Basically, we need to have a conversation within our families, starting with two simple questions. One: How do we plan as a family for our future caregiving needs? And two: What joys do we anticipate in caring for each other in the future? When we actually turn towards this challenge of caregiving needs, there’s so much possibility and potential and opportunity to strengthen our relationships and our families
But in addition to our families, our entire country really needs a plan. So the other thing I’m asking people to do, is to call their local legislator, or local senator or congressperson, and ask them what they are planning to support family caregiving needs in the future.
We need solutions at the individual level, at the family level and at the public policy and institutional level. We also need economic solutions in the marketplace. And when we turn toward this challenge as a country, I have no doubt that we will create the kinds of solutions that not only strengthen families, but actually strengthen us economically as a society.
There will be 27 million people who will need homecare by 2050, and the entire direct care workforce is only 3 million people. So there’s a huge need for a stronger and larger workforce. And yet the workers that we currently have, we can hardly sustain because we don’t pay them well enough and we don’t value their work. So these two simple solutions of making these jobs better jobs, really investing in these jobs being treated with dignity and respect—valuing them for their true worth in society and in our families—can not only strengthen the caregiving infrastructure for tomorrow, but it will attract more people to this work and in fact create millions of good jobs in this country, which is desperately needed. We need to create 11 million jobs to deal with the jobs crisis that we’ve been dealing with since the economic depression. This is a really clear place where there’s going to be job growth. We have a complete win-win solution here.
How can we create job growth for elder caregivers?
Well, right now people find caregiving jobs in all different kinds of ways. A lot of homecare workers are working through federally funded programs like Medicaid. And there are many who work for individual households all over the country and they’re not registered anywhere. And then you have companies like care.com who are matching people with jobs. So there are all kinds of jobs being created, some through government programs, some in the private marketplace, some through individuals and word of mouth.
I think job creation is going to happen in all those areas. What we have to do is to make sure that wages and working conditions across the board are fair and sustainable and we support and lift up the companies that are really creating good jobs; and we actually support programs that are creating good jobs through publicly-funded programs, that we protect and expand programs like Medicaid that are currently funding a lot of homecare jobs in states like California, so we really secure those programs, as opposed to constantly putting them on the chopping blocks for cuts, which is what the trend has been.
What are some other ways people can ensure fair working conditions for homecare workers?
That’s a great question. In my book’s appendix, I provide resources for people interested in hiring caregivers. I also include helpful information for domestic workers, like standard contract guidelines and tips on navigating these complicated public programs.
One great resource for employers is the Hand-in-Hand Domestic Employers website (http://domesticemployers.org). One of the things I really like is that they have something called the Fair Care Pledge, which is something that you can take to basically say, I pledge to bring fairness to my caregiving relationship. That means fair pay, time off and a written contract so there’s good clarity and communication on what’s involved in the job.
There’s also lots of public policy that we should encourage people to support, like paid family leave, paid sick days and caregiver tax credits.
Rosalynn Carter once said, “There are only four kinds of people in the world: those who are caregivers, those who will be caregivers, those who need caregivers and those who will need caregivers.” And usually, we’re more than one of those identities at any given time, and that’s a beautiful thing. It connects us all.
Can you talk a little about the role immigration plays in the caregiving field?
It’s hard to say the exact numbers, but I would say that half of our caregiving workforce is foreign born, and at least half are undocumented. Those are really just rough estimates. I would say that given the tremendous needs for caregiving that American families are facing, that there is very little way to imagine us meeting that need without a strong immigrant workforce that’s stabilized.
Right now, a lot of people are relying on immigrant care workers. My friend, whose mother has Alzheimer’s and lives in Staten Island, has an undocumented caregiver who’s been with her for a long time. Having a lot of changeover in caregivers aggravates Alzheimer’s symptoms. Having that consistent care is really important. The whole family worries that one day their undocumented caregiver will be deported or detained for some reason that is outside of their control, and then what will happen? Of course, they’re concerned about the caregiver’s wellbeing, but they also worry about the potential impact on their mother.
Millions of families are counting on undocumented immigrant caregivers, but those relationships are always vulnerable and trapped in the shadows because of workers’ undocumented status. And so if we could offer a pathway to legal status and citizenship for the undocumented immigrant care workforce, it would really serve to bring caregivers and a lot of the families who count on them out of the shadows, which will strengthen and increase opportunities for training, which would in turn improve the quality of elderly care. There are enough jobs to go around in this sector, and I think that immigrants will and must be a large part of the solution, and we should embrace that.
This interview has been edited for length and clarity.