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“The Age of Dignity” Argues Compellingly for a Stronger Eldercare System

February 5, 2015

Ai-jen Poo‘s book The Age of Dignity: Preparing for the Elder Boom in a Changing America argues that the U.S. has a moral and economic responsibility to more substantively address the needs of elders, a population that will surge in the coming decades.

Poo, the director of the National Domestic Workers Alliance and co-director of the Caring Across Generations campaign, places home care workers at the center of her argument. These workers are what she calls “the caring professionals” — the 2 million paid, in-home caregivers who allow elders to live with dignity and independence every day. These workers, she writes,

are most consistently in contact with the most costly clients of our nation’s health care system. They substantially cut health care costs by helping to manage chronic illnesses and by supporting people so that they can stay in their homes and out of radically more expensive institutions.

Yet the home care workforce, Poo argues, is systematically undervalued by both the U.S. economy and the public at large — which, when it thinks of home care workers at all, tends to regard them as merely those people who come to Grandma’s house to clean her toilet.

“When you are a caregiver,” says Erlinda, a direct-care worker from Chicago whom Poo quotes at length in her book, “you do clean the toilet, but you also cook, give [consumers] their medicines, talk to them, entertain them, heal them…. We are not just caregivers; we are one of the most important members of a household.”

The first two chapters of The Age of Dignity provide context for home care workers’ growing importance. “We have more senior citizens in America today than we’ve had at any time in our history,” Poo writes, adding that Americans aged 85 and older constitute the country’s fastest-growing demographic group.

And elders increasingly want to remain in their own homes. Unfortunately, this puts immense emotional, physical, and financial pressure on a generation of men and women raising children in double-income households. They simply don’t have time to care for their parents as well — which is where home care workers come in. Citing PHI statistics, Poo explains that demand for home care workers will skyrocket over this decade.

Yet despite their growing importance, home care workers remain, as Erlinda puts it, “the most unappreciated workers on this planet.” Their labor, Poo writes, is often not seen as authentic work: “Providing love, care, and companionship are considered women’s ‘natural’ skills and therefore not monetizable.” This perception, compounded by home care workers’ low wages, nonexistent benefits, erratic work schedules, and low social standing (there are very few white male home care workers) contributes to the workforce’s vulnerability. In one of many anecdotes from the book, Poo recalls a Nepalese caregiver she met named Diki, whose employer kept her passport away from her as leverage.

The second half of The Age of Dignity outlines what Poo calls the “Care Grid,” a series of policy initiatives and cultural reforms designed to prepare America to care for the coming “elder boom.” Among the changes Poo suggests are a minimum wage of at least $15 an hour for home care workers to go along with stronger universal training standards. She also cites Cooperative Home Care Associates, a worker-owned home care agency (and PHI affiliate) in the Bronx, as a model employer. Additionally, she writes, the U.S. government should spend less money enforcing the country’s harsh deportation policies — which disproportionately affect the home care workforce — and steer more money toward Social Security and Medicare to strengthen elders’ ability to pay for the home care they want.

The resources are available to create quality care through quality home care jobs, Poo writes: “We could create millions of good jobs caring and supporting one another, jobs that you can truly take pride in and that pay a wage to support your family.” Americans just need to work together to make it happen.

— by Matthew Ozga

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