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How to Solve the Looming Care Deficit

Author Ai-Jen Poo says taking care of home care workers is a first step

By Liza Kaufman Hogan and SCAN Foundation

Editor's note: This article is part of a year-long project about aging well, planning for the changes aging brings and shaping how society thinks about aging.

The number of Americans needing at-home care will increase dramatically as baby boomers age. By the year 2035, there are expected to be 11.5 million people over age 85 in the U.S., compared to 5 million today.

A large number of people won't have the resources to pay for this care unless something changes. Add to this a shortage of home health care workers and underfunded social programs for the elderly, and a perfect storm is on the way.

Despite the challenging outlook, author Ai-Jen Poo says this collision of events presents an opportunity to address the needs of families, home care workers and taxpayers all at once.

Speaking Thursday at "The Future of Eldercare: What We Need for a Changing America," a Washington, D.C., panel hosted by New America, Poo offered a three-pronged approach to help close the coming gap in needs and services. First, improve the quality of care and access to quality care, she said. Second, make sure there are plenty of choices in terms of aging at home. And third, improve the quality of home health care jobs, making sure that the workforce is secure and can support their own families.

Not an Easy Job

Poo comes to the long-running, long-term care debate from an important vantage point, that of the workers who care for the frail elderly and disabled. As director of the National Domestic Workers Alliance, she has been fighting for better wages and benefits and policies for professional caregivers. Her book, "The Age of Dignity," argues that workers need better training and support, a decent wage and labor protections that will make these jobs worthwhile. A stable and better-trained workforce in turn will benefit those who rely on its services and allow more people to remain in their homes, avoiding costly and undesirable nursing homes.

"I think caregiving is a really important lens for that place where our interests come together," she said during the discussion. "Jobs and care ... affect all of us across race, class and generation."

(MORE: Finding Affordable Home Care for Your Parents)

According to Poo's book, domestic care workers earn less than $10 an hour and more than 40 percent work part-time. A 2012 survey of caregivers, nannies and housekeepers conducted by the National Domestic Workers Alliance and the University of Chicago found that few domestic workers receive benefits, like paid sick leave or disability insurance, for professions that have some the highest injury rates in the country.

Poo, a 2014 MacArthur fellow, and her allies have had some success convincing the Obama administration to extend the protection of the Fair Labor Standards Act to domestic workers. This is not without some controversy as was made clear Thursday when activists from ADAPT, a disability rights group concerned that these changes may affect the accessibility of home care for the disabled, interrupted Poo's talk.

Challenges for Immigrant Workers 

Beyond the wage and benefit issues, many workers face difficult work conditions in a climate of fear due to their immigration status. Two-thirds of domestic employees are foreign-born, according to the survey of 2,000 workers in 14 cities, and about half are undocumented.

Among the policy changes Poo supports is a clear path to citizenship for undocumented, domestic workers and a work-visa program for prospective immigrants.  In her book, she also calls for a reduction in deportations, which disproportionately affect domestic workers and their families. She'd also like to see Medicaid and Medicare reforms to shift more resources toward home health care services.

(MORE: Best and Worst States for Long-Term Care)

In the current political climate, where immigration reform and entitlement programs are among the most controversial issues, it's hard to see how some of Poo's ideas will gain traction. But the fact that caregiving needs cut across political lines gives Poo reason to be optimistic.

"I am very hopeful because everywhere I go, every single person has a care story." Many view it as a personal matter that they should be able to manage better on their own. Instead, she said these stories and struggles should be part of a "national, public conversation about our priorities as a nation." She is also heartened that caregiving issues are popping up as the 2016 campaign season warms up.


Public vs. Private Solutions

But government is only part of the answer to the nation's caregiving challenges. In her book, Poo describes several age-in-place movements and housing experiments happening on a local level. Among these are the village movement, where neighbors — usually over 50 — form a non-profit membership organization to provide volunteer or discount services that allow them to age in place.

A "time-banking" program in Japan allows people to accrue service hours for the services they provide. A person might deliver meals for an elderly neighbor so that their own parent might receive companionship services across the country. Poo also believes that Naturally Occurring Retirement Communities or (NORCS) can efficiently serve caregiving needs within communities.

(MORE: It Takes a Village to Raise a Centenarian)

On the experimental side, she describes "carepods." These are a form of communal living in which caregivers live with a person needing care in a special housing unit under a financial arrangement that allows the caregiver to purchase the home over time and their "guest" to receive care and housing at an affordable rate.

Howard Gleckman, a senior fellow at the Urban Institute, who spoke on the panel, said these types of local, private efforts are essential even as long-term care insurance and other policy issues are being sorted out. "I think a lot of solutions will come that way, not through policy," he said.

A Role for Boomers

Caitlin Connolly, Home Care Fair Pay Coordinator for National Employment Law Project, who attended the event, said, "We need to see baby boomers taking some charge here and saying, 'If I want to remain at home' — and 90 percent say they do — 'I really need to make sure this workforce is valued.' "

"The good news is that the boomers have a lot of gas left in the tank ... and frankly, a lot of money," said Paul Taylor, author of The Next America: Boomers, Millennials, and the Looming Generational Showdown, who joined Poo on the panel.

"Someone who is 65, 75 or 80 is often in a position to be giving rather than receiving aid," he said. "It tends to be at the very last stage of life when all these challenging issues come." Taylor added that the boomers who pride themselves on having brought about big social change in their younger years can be the ones to figure out long-term care.

"I absolutely think the generation who brought us rock and roll can change how we think about aging and help us prepare for it," Poo agreed.

Liza Kaufman Hogan is a freelance writer. Read More
By SCAN Foundation
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