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Caring as Social Change: An Interview with Ai-jen Poo

Sarah Stevenson
By Sarah StevensonApril 15, 2015

Ai-jen Poo, author of a recent book on aging and elder care, brings her experience with domestic workers to bear on the challenges facing our growing population of seniors.

With the growing tide of baby boomers retiring and reaching older age, discussions of the looming “silver tsunami” seem to be everywhere we look — and yet we still have not fully resolved critical questions such as where all of these seniors are going to live, how they will be cared for in situations of illness and end-of-life, and who is going to pay for it all. One of the often-repeated hopes is that the more socially activist baby boomer generation will help usher in some much-needed changes to the way our society handles elder care. But where should the changes start? Ai-jen Poo, author of the recently-released book “The Age of Dignity,” is spreading the message that America’s caregiving infrastructure needs an overhaul, and so do our attitudes about aging.

The Way We View Aging in America

Ai-jen Poo comes at this issue from the unique perspective of her longtime work with immigrant women workers, many of whom are employed for surprisingly low wages as domestic caregivers for the ill and aging. In addition to her positions as director of the National Domestic Workers Alliance and the co-director of Caring Across Generations, an organization committed to improving long-term care in the U.S., Poo is a 2014 MacArthur Foundation fellow who is committed to across-the-board change in the increasingly important field of caring for the elderly.

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“As a society, we tend to view aging as a crisis, as a loss of vitality,” she says. “But I think that people getting older is not a crisis; it’s a blessing. It’s a chance to live longer, connect longer, teach longer, and love longer. There are so many ways our elders can lead vibrant lives and continue to make meaningful contributions to society even after they have retired.”

The problem, Poo says, is in the way we as a society view aging, illness, disability and death: with fear and anxiety, which we instinctively react to by “putting older people somewhere we can’t see them: in institutions. The truth is most of us don’t want to go to a nursing home — they’re often dehumanizing places that rob people of their dignity. The medicalization of aging, though, has driven policies and cultural expectations that are biased toward an institutional model of care, even though 90% of people prefer to age at home. There’s a huge disconnect there.”

Preserving Dignity in Elder Care

In recent decades a shift has begun, with more and more seniors choosing to age in place, surrounded by family, friends and the community. Poo sees this as a vital part of the solution to the problems with our current elder care system:

“Ultimately, I think we need to shift away from the institutional model of care to more of a home-based model that honors our humanity and sense of connection,” she says. “This will not only bridge the gap between what the vast majority of people want and the choices that are currently most available — it should have a positive impact on people’s health, too.”

Poo’s authority on the topic stems not only from her position as a spokesperson for care reform, but also as a granddaughter who witnessed firsthand some of the problems with the traditional care system when her grandfather went into a nursing home. “He had had a series of strokes, and my father couldn’t care for him anymore. He died at the nursing home, three months after he went.” She and her family found themselves wishing they had been able to keep him at home, but they hadn’t realized it was a feasible option.

She acknowledges that plenty of nursing homes have a positive impact for those who need the additional support. But, Poo says, “there are alternative models that point the way towards long-term care that is life-affirming and focused on maintaining a good quality of life.” As a contrast, she relates a dramatically different story of care.

“My 89-year-old grandmother, for example, is still living at home and on her own terms, all thanks to an amazing home care worker named Mrs. Sun. Mrs. Sun makes it possible for my mom to keep working and gives her peace of mind that my grandmother is still receiving the care she needs.” Poo believes that family caregivers need this type of support, and those needs are only going to grow; it’s potentially a positive opportunity for the economy as well, creating much-needed jobs.

Updating the Aging Care System

Unfortunately, we aren’t there yet. “Our policies and priorities as a nation haven’t caught up with our rapidly changing demographics, or the realities of today’s American families, where millions of us are caring for aging relatives,” says Poo.

“Our current system is a holdover from another time, when life expectancy was around 60 years and dementia was rare. It’s from a time when society relied on the uncompensated work of women who didn’t hold jobs outside the home.”

Poo sees a solution, but it would require fundamental changes to our elder care infrastructure. She outlines a concept called the Care Grid, which is critical to bringing to everyone the opportunity for quality care at home. The Care Grid isn’t simply about making physical infrastructure changes, though: it’s also about tackling deeply entrenched policies and improving social supports — “investing in home care, solutions that make care affordable and accessible — that would support all of us to live and age with dignity.”

Holistic Change and the Benefits for Families and Caregivers

Making it affordable for families to have quality care is one major step in the right direction. Also, Poo says, “we need to shift away from a funding model that prioritizes nursing homes over home and community-based care.” A third and essential piece of the puzzle is investing in our home care workforce. “As it stands now, because our society places such a low value on this work, the industry has high turnover and little opportunity for advancement. This has a real impact on the quality of care families can expect to receive.”

This is where Poo’s expertise in the area of domestic worker advocacy comes in. “Home care workers make on average less than $10/hour, with few benefits,” she says. “Ensuring fair wages and benefits along with professional training would go a long way towards creating the quality workforce we need to meet the growing demand for quality home care.”

Home care referral services like A Place for Mom can, and should, be a part of the solution, Poo says. “These services need to have the best interests of seniors and their families at heart, as well as the individuals who are providing care.

“The scope of the elder boom means that the solutions we need will come from both the public and private sectors. Businesses that connect families to the appropriate care options and are sensitive to the needs of those they are serving… play an important role.”

Have you read Ai-jen Poo’s book: “The Age of Dignity?”What do you think are the most pressing issues facing our current system of care? Share your thoughts with us in the comments below.

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Sarah Stevenson
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