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Description

The pandemic forced us to confront many previously unacknowledged societal issues, including the lack of infrastructure we have to support those who need care and those who give it. As COVID-19 deaths near one million in America, the time has come to address the caregiving crisis in this country. There are nearly 50 million unpaid family caregivers and 4.5 million paid home care aides in America, yet they remain largely invisible. Andy explores that dichotomy with Ai-jen Poo, Executive Director of the National Domestic Workers Alliance and Caring Across Generations, and Randy Klein, CEO of Vesta Healthcare. They discuss why this work is historically undervalued and what we can all do to help change that. Plus, how to plan for the care you will likely need or give in your life, and what Build Back Better could do to support caregivers.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Ai-jen on Twitter @aijenpoo.

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Check out these resources from today’s episode: 

• Read more about what Build Back Better would do to improve caregiving in America: https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/12/fact-sheet-build-back-better-investments-in-care-will-boost-economic-growth-and-help-businesses-thrive/
• Learn more about the advocacy organization Caring Across Generations: ​​https://caringacross.org/
• Check out the Care Can’t Wait summit on Facebook: https://www.facebook.com/events/263157082636004
• Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
• Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Randy Klein, Ai-jen Poo

Andy Slavitt  01:06

Welcome to IN THE BUBBLE, this your host, Andy Slavitt, February 23, 2022. So how do we lose nearly a million people in America? There’s a lot of places to start answering that question. And some of us might start by pointing at politicians and some of us may started pointing at one another. And some of us may start by just pointing at the pandemic and saying there’s something we can do. I think there’s a lot of answers and all them have truth to them. But I think there’s another answer to this question, which is we have underlying problems in this country that are revealed by the pandemic, where we have very weak safety nets. And when they get damaged when they get afraid, as a pandemic did, we see all kinds of loss and probably the place in America that I would argue we saw the most loss during the course of the pandemic, nearly 1 million lives so far, is our afraid system for caring for people who are frail and dependent. We undoubtedly lost a disproportionate number of those, and we need to ask ourselves, if that system were working right? Would we have lost nearly a million people? Or could many of those lives have been saved if we had a functioning caregiving system, if you will, a system where people could be at home, they can age, they don’t have to be subjected to infection control issues. And people who are 75, 80, 85 years old did not have to fear the virus coming into where they lived. Would we have saved more lives. And furthermore, would fixing that system, save more lives every day in America? Every day, outside of the pandemic, we lose people unnecessarily or people lead lives in, which lacked dignity, which seeped amid poverty, and ill health and loneliness, and all these kinds of issues.

Andy Slavitt  02:57

Those are the questions that this pandemic forces us to ask, and we have to ask them, and that’s what we’re gonna do on the show, we’re gonna go into what I think, is one of the biggest questions raised by this pandemic, which is our system for caring for people when they age and are affirmed, and maybe it will help us answer the question of how do we not lose a million lives next time. So I’ve been very eager to have this show, I brought on two great people. We have a piece of legislation in front of the Senate, it’s very, very moment called Build Back Better that has in it a tremendous investment in the infrastructure that we don’t have in this country that other countries do, around being able to provide care for people in this country when it’s needed. So with that, I’m going to tell you who our guests are, it’s Ai-jen Poo, who is a phenomenal woman, you’re going to love her. She is the executive director of something called the National Domestic Workers Alliance, and carry across generations. Its coalition of lots of advocacy organizations working to transform our long-term care system in the US, she is dynamite. Along with her, I’ve got Randy Klein, who have just gotten to know in the last few weeks, Randy is the CEO of something called Vesta Healthcare, which is a clinical provider in digital health platform that is to basically provide to take care of the highest needs people in our society, when being take care of at home and for their caregivers. So who are these caregivers like they’re us. Some of them are paid, and they’re not paid very well. That’s the problem. Some of them are us and we’re not paid at all. That’s not very well, that’s zero. We’re doing these vital things and taking care of all the people who are aging in our country. So big problem, one we’re situated to either ignore or solve in the very, very near future. And if we choose to solve it, we’ve got legislation right in front of us, called Build Back Better, it’s still in front of the Senate. It still has a chance people have believing it and want, I do. I think it is to us what bridges and roads and other kinds of infrastructure represent. Without further ado, let me bring on Ai-jen Poo and Randy Klein, here we go.

Andy Slavitt  05:19

Thank you both for being here. I think this is gonna be a lot of fun. We’re gonna try to take people from the very high level of understanding the challenges in the country, to their own situations to what it is from both a policy standpoint and an individual standpoint to do about them. And I think we’ll have a lot of people listen to this; this is a really hot issue for people. I want to start with a quote from Rosalyn Carter, former first lady who once said, and you both may be familiar with this quote, she said, I’d like to say that there are only four kinds of people in the world, those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers. If this is true, this has got to be the most one of the most universal issues. Why is it not more talked about, and better understood, Ai-jen?

Ai-jen Poo  06:14

That is actually one of my favorite quotes of all time. First Lady, Rosalyn Carter is such a genius and such an incredible advocate, and really laid the foundation for so much good work in this area. I would say that the reason why we don’t, why this issue hasn’t come into focus as a policy priority. And with a clear majoritarian political constituency behind it is because it is so pervasive. And culturally, I think we have this idea that caregiving is really an individual responsibility to be kind of shouldered by the women in our households. And if for some reason, we can’t figure it out, it’s a personal failure, it’s we don’t have the right job, or we haven’t saved or we did something wrong, as opposed to a collective failure on the part of a society that hasn’t invested in caregiving and caregivers in the way that it actually should, and must. And I think that that’s shifting now, because of both the demographic changes, the demand, and the advocates and the way advocates have come together and the pandemic and everybody kind of dealing with their own version of a care crisis in real time over the course of the last two years. All of that I think has created a different awareness about how shared and experienced this is and how essential collective kind of public policy interventions and solutions really are here.

Andy Slavitt 

Randy, if you want to jump in on there?

Randy Klein 

Should we think of caregivers as a workforce, or should we think about it as a responsibility that people have, in addition to the many other responsibilities that they have? How do you classify it, Ai-jen?

Randy Klein

I think echoing everything that Ai-jen just said, in addition to that, which I would describe as there’s gravity elements of this, people just sort of expect it to be this way. So they’ve got a low expectation of the entire system that that needs to be shifted. I think the other part of it is structurally, there are a number of things that make it difficult to effectively engage as a caregiver with the rest of the system. It’s very hard, it’s complicated, requires inside knowledge. And I think that one of the things that’s happening in the dialogue right now, is a recognition that caregivers are an incredibly important part of the solution. And that we as a country, need to put structures in place to link caregiving to the rest of the system, that it is not an isolated individual thing. It’s actually a huge part of the infrastructure that’s not being tapped into.

Ai-jen Poo 

Well, this is where I think the framework of infrastructure can actually be helpful here, because it is a system of policies, programs, and also a workforce that supports caregiving in this country. And each of us participate in it as well. It’s kind of an all-hands-on deck situation that requires supports a workforce and policies, in order to support us and so it is about a workforce. There are millions of people working inside of our care economy as professionals, but there are also 49 million working family caregivers who provide you know, 20 hours or more of care a week in addition to working a full-time job in some other sector of the economy.

Andy Slavitt  10:05

And those 49 million would be unpaid?

Ai-jen Poo 

Yes, family caregivers.

Andy Slavitt 

So, 49 million unpaid caregivers. And then what’s the size roughly of the paid caregiving workforce?

Ai-jen Poo 

Hmm, let’s see. So you have, I would say 6 million direct care workers, Randy may have better numbers, 6 million direct care workers. So that includes workers who are working inside of institutions like nursing homes or other congregate settings and a home and community-based care workforce, that specifically supporting the elderly and people with disabilities. So that’s not including the early childhood educators, the women, people who work in childcare centers, the pre-K teachers. That’s a whole other group.

Randy Klein 

There’s about four and a half million paid aides in the country that do homecare. So when you think about it from a labor force perspective, that dwarfs any other than that’s paid, right? These are professional caregivers that are doing health care work, it dwarfs any other field that’s out there. There’s a shortage of them right now. Right? So we need more. It’s a very difficult job with tremendously high turnover. And, you know, as Ai-jen was mentioning, it’s actually the tip of the iceberg, right? So roughly 50 million unpaid family caregivers that are doing work, at least equivalent to what the paid workers are, without any type of compensation, and without any type of support. So I think it’s a pretty staggering number. When you think about it’s basically one in five Americans.

Ai-jen Poo

Andy, I think it’s important to note in this context, that these are workers that can’t be outsourced. These are jobs that won’t be automated, at least anytime soon, until they design an algorithm for empathy. I think we still need human beings doing this work and so you have this workforce that we know for sure, will be a huge share of the jobs of the future. But we’ve made them poverty wage jobs that are completely unsustainable. The average homecare worker earns $18,200 per year. And I’ve heard, I have so many members who struggle every day because homecare is a calling for them. They believe that they were put here on this earth, to provide dignity and a quality of life for our elders and people with disabilities. But they cannot pay for the gas that is required to get from client to client on the wages that they earn. They leave they’re calling to take jobs and fast food and retail. Meanwhile, we have a labor shortage. So there’s an opportunity here, I think I paint a grim picture. But I think there’s an opportunity here of a transformation of jobs that we know we need, that we know are here to stay into good ones that will create dignity all around.

Andy Slavitt 

Yeah, I’m trying to wrap my mind around $18,000 a year in this country in 2022.

Randy Klein 

If you think about it, it’s basically one episode of care, right? Starting from when somebody has an event all the way through to post-acute, the entire cost of a year of an aid is offset by reducing one avoidable event. The amount of value that these people can create is second to none. That’s why I think that there’s a pay for here as well.

Andy Slavitt 

Yeah, so this will get into the policy questions, we’ll get to in a moment, which is why is the country, what’s the case for investing. It’s a question Why do you invest in early childhood education? Why do you invest in things that have paybacks that are difficult to measure as a country sometimes but you know, they’re there and then this is a case where I think Randy as you point out, it’s actually quite a bit easier because we can really see the benefit not only in people’s lives but in the costs saved.

Andy Slavitt  14:37

I want to just a more vivid picture first, though, of what it is like to be a caregiver, and you can bounce back and forth between the paid and the unpaid because I think that this affects so many of us, you’re in the situation. Generally speaking, you know, who are you looking after? Providing care, what are you doing? What are the most important things that you have to do? What is the work like and all about? And then importantly, who’s doing the work? You said earlier, you alluded to perhaps Ai-jen that, that there’s a lot, mostly women, which causes me to wonder, you know, whether or not the lack of focus here on policy solutions has something to do with that. But can you give us a vivid picture and then Randy, you’ve been focusing on how to provide the professional resources and connectivity and so forth to add dignity to this job as well. So I’d love to hear your reflections after that.

Ai-jen Poo 

So I was just thinking about a meeting where I accompanied a group of homecare workers into the White House to meet with representatives of the White House to discuss the importance of the investments in home and community-based care to homecare workers. And one of the women from Minneapolis, a Black woman, middle aged, she told a story of a new client that she had just taken on the week before coming to the meeting, coming to Washington to march with us for Build Back Better. And her story was about a woman who had very little mobility, who hadn’t had access to services throughout the entire pandemic, and therefore, was not able to clean her apartment had very little food, she was getting food occasionally from neighbors who, out of the kindness of their hearts would come and help. But she had no consistent care support. So her entire apartment, this new clients apartment was infested with rodents. And there was not any healthy food to be found. And the worker described having a phobia of rodents, and praying to God to give her the strength to face down her phobia, to help this person who was in dire straits. And she did. She came in, she cleaned the apartment, she signed the client up for food stamps, she got her a walker. So she had her first walk in the sun in two years, and filled her refrigerator with food. And this is just the beginning of this journey now that this worker is going to have with this client but has completely revolutionized the quality of her life and her dignity on a day-to-day basis. And that is the kind of work that I think is so underestimated so on, on not understood for its complexity, for its difficulty and for its value in people’s lives.

Andy Slavitt  18:03

Oversimplification don’t mean this in itself that when they say that these people are doing the dirty work. I mean, it’s the things that have to happen to make people just allow people to live a life of basic dignity. But the nobody talks about is unseen, unsexy and poorly paid.

Ai-jen Poo 

That’s right. It’s not. It’s not even referred to as a profession, oftentimes, we still call it help when it’s actually a profession for millions of people. And it is skilled work, it requires skill, capacity, resilience, agility, and it is producing something that is almost so valuable, that we can’t quantify it, which is dignity, human dignity.

Andy Slavitt 

Randy, what else could you tell us about this?

Randy Klein 

So, by virtue of what my company does, I have the ability to see what caregivers see. I get to watch what they observe in the home, I get to see what they’re experiencing. I get to see them saying somebody is refusing their meds, somebody’s showing signs of depression. Somebody is anxious, somebody fell, somebody is confused, somebody has something new and I don’t know what to do about it. Right? So the caregivers that are in the home, they’re seeing what’s happening in real time, they are truly the frontlines on this stuff. And as a result, they have the ability to make significant improvements in the lives, you know, the dignity piece comes from Ai-jen talking about the skill of recognizing that the skill of doing something with that, but the limited resources that they have to act on that to make this person’s life better. That’s actually literally what they do all day long. And for the most part, they do it with virtually no training and virtually no support. If you look at, you know, paid caregivers, many of them that are coming through, you know, consumer directed or fiscal intermediary Medicaid type programs, their training may in fact just be limited to how to build for the hours, they may have no training about what they’re supporting. If you look at the higher levels of training, you’re still talking about hours of training for people that are going to spend, you know, every day many hours a week with these folks.

Randy Klein  20:33

So caregivers, think of it this way, they stare at the abyss of what could go wrong all the time, right? And what they’re doing is trying to block and protect to prevent things from going wrong, because that’s their job that is their calling. I think that there actually are ways to quantify this because you can look at the impact that a caregiver can achieve. And you can look at what happens when somebody reaches caregiver level needs. And you can say, alright, what can these folks do if we think of them? And by the way, they’re us like the other part of this is we say they, but it’s actually like the Rosalyn Carter quote, most of us will be a caregiver at some point in time, we’re going to have a caregiver, they are us. If you think of us out there in the real world, as part of the solution to make things better, and you reframe us, as part of that answer, you start to, you know, want to professionalize it, want to make sure people have the right training, want to make sure people have the right incentives. And I believe there’s an economical way to do that as well.

Ai-jen Poo 

I agree with you, Randy, I absolutely agree that there’s a huge economic ROI. It’s actually such a win win win. You know, you’re on the one hand investing in a workforce who obviously plays a critical role in their own families and in their own communities and them being healthy, well cared for and earning a living wage has ripple effects across their communities, but then they’re doing a form of work. That is, is it’s an economic enabler, because it’s enabling the working family caregivers of their clients to go to work in all these different sectors of the economy, with the peace of mind of knowing that their loved one is in good hands, and and then you have the actual economic benefits of when people are getting better care. There’s no better prevention than good caregiving, right? In terms of preventing unnecessary hospitalizations, or falls, or all kinds of things that cost the healthcare system huge amounts of money. And so there’s just it’s just such a win win win, to be investing in this part of the economy. And this group of workers in particular, such a high leverage investment.

Randy Klein  22:55

I could not agree with that more.

Andy Slavitt 

Randy, let’s talk a little bit about what it for someone who’s listening, and may find themselves in a situation or approaching the situation where they’ve got someone in their family who is increasingly needing care, they’re aging, maybe it’s a disability, perhaps it’s a parent, perhaps it’s a child, perhaps it’s someone who’s losing mental acuity, perhaps someone who’s losing the ability to be physically independent. What should they start to think about? Like, what’s available to them? What are the resources available to them? How should they begin to process this event so that they can really take it on with as much support as possible?

Randy Klein 

So the first thing that I would say is that, you know, realism and preparation are the most important parts of this. When somebody starts developing needs, those needs exist 24/7, 365, they’re not 9 to 5, right? So you have to make sure that you have a plan for how you’re going to cover that person, that whole person and take a critical look at the folks that are around that person. Does your primary care have the resources that you need? Do you have a connection with homecare? Do you have a plan for what to do when things start to inevitably go awry? The vast majority of people are acting in a reactive manner, right, something happens, or what do I do to solve this problem right now? What I’ve seen be successful, and I don’t think there’s anything that’s particularly insightful about what I’m about to say. It’s why care plans exist, right, why people do wellness, why people focus on getting ahead of those problems. If you can pick up somebody having, you know, a small variant and change which again, going back to what caregivers are uniquely good at. They pick up small variance and change, right? They’re the best monitoring that’s out there and act on that quickly, which again, is where the system has to meet. These people where they are, you can avoid having, you know, worse things occur down the road. I would suggest that when somebody finds themselves, I’m a new caregiver, right? I’m now responsible for mom, to think about it from the perspective of how do I assure that mom remains stable long term? How do I make sure that I know what to do when things are wrong? How do I make sure that I understand what my community of people around me are? Because it’s a team effort. So who’s my backup? Who’s there for me? When I go to work, right? How am I going to do this and do that planful effort, that’s a really, really big ask, by the way, that’s not an easy thing to do. And, you know, going back to, I think infrastructure, things that can be done, it’s enabling programs making their, you know, the access to programs and funding that allow for those types of activities to occur.

Andy Slavitt 

So maybe we’ll do is, if there’s places to start resources, like places to get a creative care plan and people to call or services that people can call to get professional caregivers, we’ll put those as links into our show notes. Any advice that you’d give on top of that agenda before, we talk a little bit about what we need to do as a country.

Ai-jen Poo  26:13

I think at home having a conversation, making conversations about caregiving, a part of the conversations you’re having at home on a regular basis, because ultimately, the best time to plan as Randy said, is when you’re not in a time of crisis, and to be able to be thoughtful about and listen to what each other wants and needs, what one another’s vision, and hopes or aspirations would be when it comes to caregiving and being able to start wrapping your head around what might be coming down the road when you’re not in a moment of crisis. So I think, to the extent that we can make conversations about care in our homes, and in our dining room tables, normal, I think that’ll help us as a society really understand and prepare for the different kinds of caregiving struggles that we may be facing.

Andy Slavitt 

I think I know what’s happening around the corner, as a country, every eight seconds, another American turn, 65 years old. Nursing homes are a place that I think are historically inaccessible to some Americans. But also, over the course of COVID. We’ve seen how they’re not always the safest place to be. We do know that many Americans have a preference for aging in home, and having activities and social life things but isn’t the most comfortable setting possible, not in an institutional setting for as long as possible. All of that feels like a tremendous amount of pressure building. Now, if I told you that we had a society that of course, had amazing paid family medical leave, and a great long term care system, affordable childcare and universal health benefits, you’d say, well, that’s exactly logical. Those are the things you should have, with a society aging like that with a support system that’s needed like that. Not to mention with an infectious disease going around, which would cause people to want to be not have to go to work to get paid when they’re sick. So I’m sure I bet, don’t we? I mean, we have a crack paid family medical leave system in this country, don’t we?

Ai-jen Poo  29:07

We don’t.

Andy Slavitt 

We have a great long term care system, right?

Ai-jen Poo 

No, no, there’s no long-term care system in this country.

Andy Slavitt 

Okay. Okay. Wait a minute. I’m really confused. What about affordable childcare? We’ve got to have affordable childcare for everybody, right?

Ai-jen Poo 

No, no.

Andy Slavitt 

But we have universal coverage at least, we got that. Wait a minute. This is, but you’re just telling me that we don’t have any of the basic infrastructure in place as a country to solve these problems. I thought at least you’d say what Americans are going through some tough stuff, but at least the country has got their back, what’s going on here?

Ai-jen Poo

Well, we are so close to making a giant step forward on this front. With the President’s Build Back Better agenda. It is literally lays out big investments in home and community-based care for the aging and people with disabilities, big investments in affordable childcare, and paid family and medical leave. And that framework has passed through the House of Representatives, and is now waiting for the Senate to act. So I’m not gonna throw in the towel, because I actually think that in the next few months, massive change is actually possible. It’s within reach. It’s not like we have to start from scratch. But there’s actually a whole bunch that’s been in motion, where we’ve been making progress, we’ve been kind of marching towards the finish line on a bunch of this stuff. And that’s why we need people to stay engaged and reach out to their senators and let them know how important this stuff is. But it is true, we are so far behind, it is embarrassing.

Andy Slavitt  30:59

Now, Randy, if that happens, all this investment, that’ll be a big giant waste of money, right? Because there’s no economic rationale for keeping people at home and saving to the hospital and keeping people taking care of their families, right? Keeping people out of poverty. Or did you say something different?

Randy Klein 

Yeah, I think that the data might suggest a different conclusion to what would happen from investments like that. And that it may actually turn out to be something that saves the system a tremendous amount of money, while also putting pay in the pockets of folks that could do it improving overall productivity. And that would be kind of my conclusion looking at it, but you know, not everybody’s gonna agree with me.

Andy Slavitt 

So it’s the right thing and the smart thing. And it affects all of us?

Randy Klein 

It’s literally every one of us, should be pretty straightforward.

Andy Slavitt 

You’ve been fighting this battle for a long time, I’ve been watching, I see how this issue which affects so many people, generally speaking, I would say, with the very notable exception of you and a few others that don’t have people that are a real loud, effective voice for them. And so you’ve got this 10 to 10 to millions of people in these situations. Yet it is felt like Congress has always had other priorities. And even when we talk about infrastructure, when people talk about making sure that we’ve got our bridges that aren’t collapsing and making sure that we have highways that aren’t cracking, isn’t this a form of infrastructure to?

Ai-jen Poo  32:41

Absolutely, if infrastructure is the set of investments that we make, that allow for society, in the economy to function, like roads, bridges, transportation systems, then it absolutely is infrastructure. I mean, even the men who are repairing our bridges and tunnels, thanks to the bipartisan infrastructure, legislation, need care, they have someone in their lives who needs care. I mean, it’s almost the form of infrastructure before infrastructure. And it includes the workforce, they are a part of this infrastructure that enables us to go to work enables us to ensure the safety and well-being of people across age and ability that actually has to come first before anything else can happen in our economy.

Andy Slavitt 

Is this important to Americans? I mean, is this the kind of thing that Americans care about it, other polls or other things which indicate to you that this is a topic on people’s minds? Is there a political divide, the people who identify as one party believe it is more friendly than others? And what are the politics of the issue?

Ai-jen Poo 

I mean, it was interesting about this is every poll really comes back to us demonstrating high levels of support among Democrats, Republicans and independent voters. And so I think from the grassroots level, across partisan lines, there’s huge levels of support for these policies. We’ve been pulling specifically on home and community-based services in the build back better agenda. And that’s one of the most popular parts of the build back better agenda, because I think everybody is aware or has someone in their life who needs care. And the idea that there would be more support for care in the home and in the community is something that really resonates right now. So I don’t know Randy, what your thoughts are on this, but from what I can tell it is a very politically smart thing to do for any candidate for office or elected official to be a champion of care.

Randy Klein  34:59

I mean, I think of us as basically an apolitical organization. Right? So, we are a business that focuses on literally making caregivers part of the delivery system. So you know, if you think about infrastructure is a visiting nurse infrastructure is an ambulance infrastructure, you know, is a home visiting Dr. Infrastructure, I don’t think those are controversial statements. Of course, they’re infrastructure, right, that’s part of how care is delivered. Care is delivered through caregivers, it’s actually literally in the name. So it to me from a thought experiment standpoint, it could only be infrastructure, it’s just not well-connected infrastructure. So, you know, the idea that it’s not infrastructure kind of makes my head work.

Andy Slavitt 

Let’s try to close on a note that can help paint the picture that I think is an optimistic positive one. One of the things that I believe is that everything worth achieving is worth working for. And oftentimes, that work is hard. Oftentimes, if you look through history, it’s taken several generations of fighting to get the result that’s been needed. And I think it seems like that will be the case here, not just, I mean, we’ve just made the point in the last few minutes that it’s not just economically smart. It’s politically smart. It’s practical. It’s demographically smart. So what to talk about what the world could look like, or what the world would look like, with not just with this particular set of legislation passing. But in a world where you as an individual felt like when it came time to be in that situation. Everything worked, as it should, it worked perfectly. The resources were there. To your point, Randy, they were connected into a larger system and infrastructure. People were paid appropriately at access. And it was a way of life that people respected as a profession. So I’m wondering if either of you, and you could say to go for it just, just if you could paint a picture for it as it closes out, like, what would the what would it look like? How should the system be working, if things are working as they should?

Ai-jen Poo  37:21

If we had what I like to call universal family care, the idea that each of us would contribute the way that we contribute to social security, for example, to a fund that allows us to afford child care, paid family and medical leave, and long-term care or long term supports and services, in the context of our choice, at the time that we need it, it would mean that if I have a child, I could know that that child would have care when I returned to work. And I could know that I could take time away from work to be with a newborn at a critical time without having to either permanently leave my job or lose the income that I would be getting, if I were at work. And if I were to develop a disability, I would not have to worry about being segregated into a nursing home or a congregate facility, I would have a real option and supports an infrastructure to live with my family in the community and have a full whole life, work, contribute, learn. In then, as I grow older and more frail, I could count on the fact that there would be a trained professional workforce that I could draw upon to support me, as I have more and more complex needs. And they might even have training in the specialized chronic illness that I have. And they would be accompanying me on my journey. And they would also have the peace of mind that their income was going to allow them to take care of their own health and well-being and that of their families. And that whole picture of everyone feeling like care, dignity, and safety and well-being is within reach. No matter what age you are, no matter what your ability is, no matter what job you have. That feels like what we deserve.

Andy Slavitt  39:45

Yeah, you paint this really vivid image of people who are taking care of someone else’s parents, but not being able to take care of their own or taking care of someone else’s kids, but not being able to take care of their own in order to make an income. Randy, how do you see it?

Randy Klein  40:00

I love that vision. And what I would say is that, within that vision, that it would be a guided journey, right when I find out that I’m now a caregiver, or I’ve made a decision to become a professional caregiver, in either case, that I’m not in it on my own, and that I can seamlessly go to sleep at night and go to my job, leave my shift and know that the responsibilities that I have, have transferred to that next person, and that the people that are caring for me that I’m actually not a burden to them. And that it’s connected back to the rest of my care that I’m not going to be fearful because I know that this is a coordinated journey. And it’s something that I’ve got a team around me helping me both as the patient or clients and as the caregiver.

Ai-jen Poo 

I love that.

Andy Slavitt 

Well, look, I think you’ve both articulated why, but also how and what, in a powerful way. And, you know, if people are listening to this, and they can relate to it, I think it’s something that, you know, frankly, as I’ve learned over the last number of years, if we want it, we’re the ones that have to make it possible and make it happen. So supporting Ai-Jen Poo at that, you know, who is the Director of the National Domestic Workers Alliance. Thank you so much for coming on the show Randy Klein, from Vesta Health Care, supporting caregivers in very complementary ways. Thanks for educating us. Thanks for fighting for this. It’s a topic that doesn’t get talked about enough and hopefully we did it a little bit of justice today. And thank you.

Randy Klein 

Thank you so much.

Ai-jen Poo 

Thank you so much, Andy.

Andy Slavitt 

Okay, thank you, Ai-jen and Randy. Ai-jen and Randy were great guests. They did not, however, leave me with a dad joke to deliver at the end of this episode. And I didn’t like any of the dad jokes came across this week. So I need your help. Because I will not be dumbed down the dad jokes. no, no, no, no, no. We’re about the highbrow dad jokes. If you have any highbrow dad jokes, put them in the Twitter feed for at @inthebubblepod. We need your best dad jokes. I will read them at the end of these episodes when they have good ones. But I will not read a bad dad joke. At least. At least that one that I think is a bad dad joke. Let me tell you what’s coming up. Next week on the show Monday, Jesse Bloom. We’re gonna be talking about the evolution of the viruses known as SARS-CoV-2. To what happens to it next. Very cool conversation. Wednesday, the latest on what’s happening in Ukraine post the movement we’ve seen starting this week from Russia with David Frum, great friend of the show, brilliant conversation with David. And then the following Monday, Congressman Ro Khanna from California, who is someone who is at the epicenter of I would say the Progressive Caucus and technology and where things are going. He’s a young Congress person. He’s a veteran, very interesting. He wrote a fascinating book called dignity in a digital age. And he really explores the transition of technology on the dignity of work. I really look forward to that. Okay, enjoy the rest of your week. I will see you back here on Monday. Please be on time.

CREDITS

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, please tell your friends and please stay safe, share some joy and we will definitely get through this together.