Tina Fineberg/AP Photo
Ai-jen Poo in 2006
Nobody over the past 25 years has done more to uplift the historically downtrodden profession of care work in America than Ai-jen Poo. A MacArthur “genius” grant winner and senior adviser to Care in Action, Poo began organizing nannies, housekeepers, home care, and child care workers in 1996, winning real benefits at the local level for a workforce largely composed of immigrant women and women of color.
Last year, a coalition Poo co-directs—Caring Across Generations—developed the concept of Universal Family Care, a social-insurance program not unlike Social Security. Out of one fund financed by broad incremental taxation, families would be able to count on early-childhood care and education, paid family and medical leave, and long-term supports and services for elderly family members and people with disabilities. It would create a single access point for families to manage their ever-changing care options; and it would supply an expanded care workforce to handle those needs, making a living wage in a respected profession.
I talked to Poo about the basics of universal family care, the critical racial-equity component of the effort, and how to organize the vast constituencies of those who give and need care. She compared the effort to improve the standing of care workers today to the labor fights in manufacturing in the last century. And she centered the need to value caregiving as a central component of quality of life.
A transcript, edited for brevity and clarity, follows.
Can you lay out for us how a Universal Family Care program would work?
Ultimately, what we need is a big public investment in all of our caregiving systems. So child care should be universally accessible and affordable, and child care workers should earn living wages with benefits and union representation. Paid family leave should be universally affordable and accessible regardless of where and how you work. And then long-term supports and services should be universally affordable and accessible, and the entire workforce that holds up that system should earn living wages with benefits and representation. Those are the pillars. That’s the goal that we’re trying to get to.
The idea of Universal Family Care is to create a framework where those pillars of a care infrastructure will be fully funded in a durable way and integrated, unified, and interdependent. One financing mechanism that we’ve explored is social insurance. The reason why we like that idea is that, in the history of this country, social insurance has been a way that we’ve been able to sustain programs that become a fundamental part of our social contract.
I also believe that there are other ways of doing this. Ultimately, it’s a question of priorities and values. I think that Congress, today, could decide to fully fund our child care programs, expand Medicare to provide long-term services and supports, and expand Medicaid and rebalance it to [offer] support. I think, for example, the care economy plan that the Biden campaign has laid out is a really strong step forward in that direction. It also centers the needs of the care workforce in a way that is unprecedented. I think that’s a critical piece, especially when you look globally: There are other countries that have stronger child care infrastructure and even stronger long-term care infrastructure, but the piece about the workforce is always one that is sidelined.
Why did this concept appeal to your organization? We’ve seen elements of universal systems for one long-term support services program or one child care program, but could you explain why you felt a holistic, family care system was so important?
When you look at all of these programs, the user is essentially an intergenerational family unit. The need for paid leave is often connected to the need for long-term supports and services, which is not just for elders but also impacts children in a multigenerational household. And so having a holistic approach that’s unified and really understands the independent and interconnected needs of families that are intergenerational is really the future. Looking at the problem in silos doesn’t get to that root issue that care should be fundamentally supported across the lifespan in an economy where most adults in a household work outside the home.
Part of the devaluing and underfunding of these programs has meant that the public-policy approach to these programs is really one of scarcity. The wages of workers are pitted against access to services for families. So consumers and workers are pitted against each other. When in reality, the way that care functions is also interdependent and more in a teamlike setting. Take [for example] care for someone with Alzheimer’s. You actually need family caregivers involved, you need oftentimes home care support, you need paid leave. The workers and the families in the practice of providing care need to work together. And the fact that their interests are often pitted against each other is a huge problem.
Universality of access to these programs is not just a “nice to have,” but fundamental to any of these programs. As is a really strong care workforce. When we think about care, it really is infrastructure.
Yeah, it’s dependent on human infrastructure. And you wouldn’t build half a bridge.
Exactly.
“Having a holistic approach that’s unified and really understands the independent and interconnected needs of families that are intergenerational is really the future.”
How would universal family care specifically help minorities and promote racial equity?
Historically, this work has been associated with women in our families. Some of the first domestic workers in this country were enslaved Black women. And ever since then, this work has been disproportionately held by an underpaid and explicitly excluded workforce of Black women and other women of color.
There’s a deep history here. As the labor laws were being enacted in the 1930s as part of the New Deal reforms, there were debates in Congress. And Southern Dixiecrats refused to support a number of the labor laws if they included protections for farmworkers and domestic workers, who were Black workers at the time. That exclusion in the laws really did shape the treatment of this workforce in our labor policy. That, combined with our failure culturally to really invest in caregiving systems that would support working families, has led us to a time now where families don’t have an infrastructure of support to support their child care or elder care or support for people with disabilities.
And you have Black and Brown working-age adults disproportionately concentrated in low-wage service jobs where the numbers don’t add up, and they’re not able to afford the care that they need. Whether we’re looking at it from the lens of care consumers or from the lens of an underpaid care workforce, it’s disproportionately and overwhelmingly impacting Black and Brown families.
It’s one of the reasons why Black women have been on the forefront of organizing to improve the wages, improve the working conditions, address the exclusions in the labor laws. And there have been many generations of Black domestic workers who have fought and made real gains. Everyone from Black washerwomen in Atlanta in 1881, to the National Domestic Workers Union that Dorothy Bolden started in Atlanta, Georgia, to the work of Carolyn Reed in New York, to our work today at the National Domestic Workers Alliance.
Just recently in fact, the Black domestic workers within our movement have launched an agenda called the Unbossed Agenda. Which is really a vision for how we can value and care for Black women who are doing the work to hold up the care economy. And it includes support not only for the federal Domestic Workers Bill of Rights but also Universal Family Care within that vision.
With respect to the workers, if there’s large funding support, people will want to not only be in care work but stay in it. The quality of the workforce is going to improve as the standards of the workforce improve. Do you see these jobs in the same class in terms of size and value as the manufacturing economy was in the 1940s and ’50s?
Care jobs are a large share of the jobs of the future. They are jobs that cannot be outsourced, they’re not going to be automated, at least not anytime soon. They’re essential, as we found during this COVID crisis. And they’re job-enabling jobs. So when you raise the wages and you improve the conditions and make these jobs more sustainable, it not only benefits those workers and their families. These are jobs that enable other Americans to go to work more sustainably, knowing that their families actually have the care and supports that they need. And without a big public investment in our caregiving systems, we won’t get there.
Right now, we lose some of our most talented caregivers to other low-wage service professions like fast food and retail. They cannot survive on the wages they earn doing care work, and have been forced to supplement [income] with driving for Uber and Lyft, piecing together an income as opposed to understanding that this is a valued profession.
Those manufacturing jobs were at one time dangerous, precarious, low-wage jobs that were done by women of color and immigrant women, women of marginalized social status. And we transformed those jobs into living-wage jobs with real economic security and mobility, where one generation could do better than the next. And a sense of real pride and dignity in the work. That’s what we must do with the care workforce.
“Care jobs are a large share of the jobs of the future ... These are jobs that enable other Americans to go to work more sustainably.”
The first half of this issue of the Prospect is basically the stories of people who are stressed out because of the lack of support that they get. Do you think that more than anything, this is about liberty and peace of mind?
I absolutely think it’s about liberty, freedom, and in many ways democracy-enabling jobs. I don’t know if you’ve ever had someone in your life who has had a stroke, or has had a form of dementia, or even just dealt with raising children. It is emotionally and energetically challenging enough without the crushing pressures of affordability and navigation of eligibility for programs. The added stressors are definitely an inhibitor on our collective quality of life in this country.
Right now, the only way some families have to solve this crisis is through uncompensated care. Do you see as part of this proposal a mechanism to compensate family caregivers who choose to stay home and take care of loved ones?
Absolutely. I think that care in America, because of the huge need, especially on the part of a growing aging population, is an all-hands-on-deck situation. We’re going to need a really strong care workforce, we’re going to need supported family caregivers, and we’re going to need friends and family all providing care. And the government needs to play a role in supporting all of that.
It will have huge ripple effects across our economy, including supporting women’s labor force participation as a whole. We’re hearing so many stories of women who are dropping out of the workforce right now because they can’t navigate or get access to care they need during the pandemic. It’s undermining and rolling back decades of progress when it comes to gender equity. We should be thinking about all of that when we think about the payoff of investing in our family caregivers and our professional care workforce to really be part of the solution here.
You mentioned Joe Biden and the care piece of his Build Back Better agenda. We have seen more attention paid to this issue in recent years. What more is needed to make family care a top political priority? Do you think that outlining a definitive universal policy in the way that you have plays into that?
We need to have a concrete framework that candidates can really champion. I think we do need as voters to show up as care voters. And to have a public demand and to be able to see ourselves as a constituency. At Caring Across Generations, we very much see our work as about building the caring majority. The theory is that in this country there are at least 100 million people who are directly affected by the need for care. That is a huge and powerful force for change in our country. And if we would just recognize that identity that we all share and the need to really come together to demand more of our candidates and our elected leaders, I think you start to see the action comes in the reaction. That starts at the grassroots level in the community. Every level of office, from municipal city councils, to state legislatures, to Congress. I think that the political infrastructure needs to hear from us as care voters. That this should be a national priority for policy change.
You mention the potential size of this coalition, 100 million people. That is extremely powerful, but at the same time, getting ten people in America on the same page can sometimes be difficult. How do you direct a coalition like that, with different aims and goals?
I do think that the dignity of work and the importance of caring for families are pretty core values that are shared across communities in this country. The path to getting there? Certainly, there’s going to be lots of debates and different kinds of priorities within that. But I think having a foundation of core values that at least we aspire to in this country, if we’re not always good at reflecting back, are really key. At Caring Across Generations, we’ve always centered equity, in that we’ve looked to highlight the stories and experiences of caregivers and care workers who face multiple challenges when it comes to realizing health and well-being for their families.
One thing we do quite often is we begin our meetings by asking people to share a story about someone in their life who’s cared for them, and the value of that relationship. It really does speak to something that first lady Rosalynn Carter used to say quite often, that there are only four kinds of people in the world: people who are caregivers or will be caregivers, people who need care or will need care. Most of us occupy more than one of those identities at any given moment. And I think if we can anchor into that shared experience, and also put at the forefront people who are facing the greatest amount of pain and challenges when it comes to care, then I think you have a formula for building a kind of majoritarian movement.
