Ai-jen Poo, a labor organizer and president of the National Domestic Workers Alliance, has been shining the spotlight on the crisis of care in the United States for almost three decades. She advocates for some of the nation’s lowest paid workers — those who tend to our children, the elderly and the disabled.
Last year, her efforts to shore up the country’s fragmented and underfunded care infrastructure nearly resulted in a multibillion-dollar federal investment. The infrastructure proposal President Joe Biden presented to Congress included universal pre-kindergarten, home health care for seniors and child care tax credits. But the Build Back Better Act did not make it through a closely divided Senate after having passed the House of Representatives.
Capital & Main spoke to Poo via Zoom about that fight and her ongoing efforts to bring more dignity to the working lives of caregivers and those who depend on them. Poo, who also directs Caring Across Generations, a national movement of caregivers and care recipients, conveyed a steady optimism about the prospects for large-scale federal investment in care work. “We are ascendant,” she said. State-level initiatives and grassroots campaigns led by home care workers are key to driving federal policy change, Poo said.
This interview has been edited for brevity and clarity.
Capital & Main: Nearly everyone is affected by caregiving, regardless of who you are or your political beliefs. Have you been able to make this an issue that transcends politics?
Ai-jen Poo: There isn’t a room that I go into where people don’t have very immediate, very emotional stories about caring for a parent with dementia or a child with a disability, or just all the mom rage that’s out there. This is such a widely and a deeply felt issue across so many different segments of our population, and our electorate.
Republican voters support these issues. The [issue] polls through the roof. They support having higher taxes or having a bigger role for government, because across partisan lines, despite distrust in government, people really feel like this is a place where we need societal systems to support us.
“Access to care is the difference between a person with a disability being able to live a full life in the community and potentially even work, and not. It’s life or death.”
What are the benefits of investing in care work?
There’s an economist at Harvard named Larry Katz who calls [improving care jobs] “triple dignity investments.” It is not only investing in her ability to support herself and her family. Those are job-enabling jobs that make it possible for working parents and working family caregivers to get to work.
Then, there are the people [receiving] care: the children, the people with disabilities and the older adults [who are] able to have the kind of quality of life that only comes through having care available.
What are the consequences for the U.S. of having an inadequate care infrastructure?
I think it’s the biggest driver of inequality that nobody talks about. We live in an aging society, where 10,000 people turn 65 every day and people are living longer, and chronic illnesses associated with aging like dementia and Alzheimer’s are exploding to epidemic levels. The only way that people can get access to long-term care is to completely impoverish themselves to be eligible for Medicaid.
The workforce in this industry is 87% women, majority women of color, who are also caregivers for family members. That means that all the ways in which inequity shows up along the lines of race and gender in our economy are compounded by the lack of any kind of assistance or investment in care.
It’s a huge obstacle to women’s participation in the workforce, to wealth building and economic mobility for working class people and working poor people, and there’s a huge toll in terms of our mental health, our physical health, health outcomes for our aging loved ones and our loved ones with disabilities. Access to care is the difference between a person with a disability being able to live a full life in the community and potentially even work, and not. It’s life or death.
The Inflation Reduction Act got over the finish line in part by stripping the elements that address the crisis in care. What does that say about how the issue is being prioritized by the Democratic Party?
We almost won an unprecedented, transformational investment in care that no one would’ve expected would even be on the table. [The U.S. House of Representatives passed]-Build Back Better bill included a new paid family medical leave program, hundreds of billions of dollars for child care and for aging and disability care in the home. Three-quarters of a trillion dollars on the table, and two years previous: Zero dollars on the table. We almost won a generational, transformational investment.
We’re still ascendant. President Biden signed the most sweeping executive order in history on care on April 18 of this year, signaling that this was going to stay a priority. It included over 50 directives to every federal agency to do whatever is within their power, short of the funding that only Congress can offer, to expand access to care, to support family caregivers, to improve wages and conditions for the workforce.
And we’re seeing a huge demand from states. Washington launched its long-term care benefit. In November 2022, New Mexico passed a ballot initiative to permanently fund child care in its state budget. There is undeniable momentum. Every day, I feel like I’m hearing from new corners of the movement how we’re growing. The fact that we didn’t make it into the Inflation Reduction Act shouldn’t have surprised anyone because we were never supposed to be in it to begin with. But we pushed our way in, and I think we’re next. There’s no question.
“President Biden signed the most sweeping executive order in history on care on April 18 of this year, signaling that this was going to stay a priority.”
What role have care workers played in addressing this issue?
It’s huge. That’s what’s driven a lot of the success that we’ve had in the care movement is care worker organizing. In New York, care workers and consumers are organizing together in the Fair Pay for Home Care campaign that won a $3-an-hour wage increase for home care workers in the state. In North Carolina, our home care worker members have been organizing for years to raise the wages and the reimbursement rates in the Medicaid home care system and have finally started to make some headway in the pandemic.
But that’s years of organizing, and it’s all being driven by workers, mostly Black women in the South. In New Mexico, our members, who are a mix of Latina, Indigenous and white women care workers, were successful in passing a measure that would set the stage for an increased amount of the reimbursement rates to go to wages. These are mechanisms that are so challenging and hard to navigate at the legislative level, budget level, funding level, and workers are organizing and passing laws to try to, step by step, make it possible for these jobs to become jobs that are better paid.
Why isn’t this work more highly valued?
I think it has a lot to do with who this work is associated with. Mostly women, women of color. And it also has to do with a deeply held cultural belief that care is a responsibility that we should shoulder on our own as families and individuals. And if for some reason we can’t figure it out on our own, we can’t afford it, or we can’t manage it, or we can’t find it, we consider it a personal failure. So, it’s often experienced as a crisis of personal failures as opposed to a system failure.
Is there another country besides the U.S. that has a strong care infrastructure?
Everything is imperfect. [But] if you think of the pillars of the care economy as paid family medical leave, child care, aging and disability care, and good care jobs for workers who work in the care economy, those four pillars, if you look at almost every developed nation — in Europe, Japan, Canada — everybody’s ahead of us.
In Latin America, Uruguay has universal access to these programs … It’s not just in wealthy countries.
