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One in six Americans is over age 65, and that number is only going to climb in the next few decades. So how can we collectively prepare for this elder boom? Ai-jen Poo is president of the National Domestic Workers Alliance, and she thinks this is our golden opportunity to finally give caregivers their due. We hear about why we need to expand Medicaid access, improve job conditions for care workers, and see aging as a gift, not a crisis. We also talk to professional home care worker Katrina Mouzon about the challenges facing care workers today.

Learn more about supporting professional care workers at The National Domestic Workers Alliance’s website, https://www.domesticworkers.org/. For more information on Washington’s public long-term care insurance program, visit https://wacaresfund.wa.gov/.

This season of Uncared For is presented by the Commonwealth Fund, a nonprofit foundation making grants to promote an equitable, high-performing health care system.

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To follow along with a transcript, go to lemonadamedia.com/show/ shortly after the air date.

Transcript

SPEAKERS

Ai-jen Poo, SuChin Pak, Katrina Mouzon

Ai-jen Poo  00:00

For as long as I can remember, people who have been talking about this aging demographic shift have compared it to natural disasters of different sorts, like the silver tsunami, the age wave.

 

SuChin Pak  01:43

There’s so many metaphors that I’ve read. I’m like, wow, this is someone’s had a lot of fun with, with the imagery of this doom, right? That’s coming.

 

Ai-jen Poo  01:54

And it’s always some kind of major natural disaster. And I think the only way that it’s a disaster is is actually man made. It’s unnatural. This is an opportunity, a massive opportunity, for a long overdue culture change.

 

SuChin Pak  02:13

This is Uncared For, I’m your host, SuChin Pak. As a country, we are older than we’ve ever been. One out of six Americans are over 65 and that number is only expected to increase over the next few decades. So how are we going to care for everyone, especially when family caregivers and professional care workers alike are already stretched thin. Our guests today believe we have to change the way we value caregiving to see it as the backbone of our country, the literal infrastructure holding everything up. And then we need to invest in it. We’ll hear from Katrina Muzon, a professional care worker. She knows firsthand how low wages and long hours take a toll on caregivers.

 

Katrina Mouzon  03:04

It’ll burn you out, because your clients need you, and more clients need you. So I’ll probably work like 70 hours a week.

 

SuChin Pak  03:13

But first we’ll turn the mic back to Ai-jen Poo who you heard from up top. Ai-jen Poo is the president of the National Domestic Workers Alliance, and author of The Age of Dignity, preparing for the elder boom in a changing America, she knows the ins and outs of the problems stacked against caregivers today and the long overdue policy solutions We need to support them. So can you give me a sense of of the scale around how much older we are becoming as a country, and what this means, like, what is at stake, because they’re not just numbers, right? That’s when you talk about that, yeah, the big picture there.

 

Ai-jen Poo  03:59

Basically, what has happened is we today, 10,000 people will turn 65 and 10,000 babies will be born, give or take, and we have experienced such advances in healthcare and technology that people are living longer than we ever could have imagined. We have more generations to care for and less care to offer, because most people, most adults, work outside of the home just to make ends meet. So we’ve got 53 million overstretched working family caregivers, more than 7 million underpaid professional care workers. This social worker, named Jessica Calarco, often says, other countries have a safety net, and the US has women. Because the overwhelming number of those family caregivers are women, and the overwhelming number of the professional care workers are also women, and majority women of color. So we are in a situation where we are a country that needs more care than ever before, and we have less of it. Women and women of color are filling the gaps, and it’s completely unsustainable.

 

SuChin Pak  05:30

Just take a moment and let that sink in. As a country, we are facing a massive aging population, and yet we are relying on unpaid family caregivers and underpaid care workers to simply handle it before we get deeper into all of that, I wanted to know how AI-Jen’s passion for this issue started like most of us. Her first introduction to care began in childhood. Now let’s talk about growing up, I know that you talk a lot about this care village that was around you with your grandparents. Tell me what did that early on experience teach you about caregiving?

 

Ai-jen Poo  06:15

Well, all of my grandparents played a really significant role in raising me, as did my parents and a village of aunties and uncles. I have no idea who was actually a blood relative who wasn’t, and I think it really normalized this idea that care really is this collective endeavor where there’s lots of people of different generations who are involved and should be involved, and that’s part of what makes it beautiful.

 

SuChin Pak  06:46

I feel like that’s such a more common experience outside of this country, living with your grandparents and where aging is just part of like there’s no separation, yeah, but.

 

Ai-jen Poo  06:59

No, it’s so true the siloing that we have, even the definition of what is a nuclear family is pretty recent in this country and in lots of immigrant communities, communities of color, rural communities. It is a very intergenerational model of living, and it’s so natural and normalized that we don’t even think of it as intergenerational. It’s just how we how we live. I mean, I just like the richness of growing up around my grandparents is something I would just never trade.

 

SuChin Pak  07:34

Yeah, tell me about that. Tell me about your grandparents and what your relationship with them was like. What? What did that look like? Life look like for you with them?

 

Ai-jen Poo  07:43

Well, they were revered as elders in the family, the wisdom, the authority, there’s enormous power with having walked this earth for many, many years and and so, you know, I, I just, I wanted to be just like my grandmother’s, you know, and I looked forward to when one day little ones would would revere me, you know, my my grandmother has so many sayings and mantras and that I still live with today, like a big one for her was about the importance of laughter and joy, and she believed deeply, like in her heart of hearts, that if you laugh like big belly laughs three times a day, you will live longer. You will have a different quality of life.

 

SuChin Pak  08:34

By the way, she’s right, you know, I think I read it was a maybe an interview that you did, or an article about this gendered work, right? And talk about who is doing this work today. And then number two, how does the devaluing, how does that practically show up when it comes to this demographic of people who are doing this work?

 

Ai-jen Poo  09:01

So when I think about caregiving, it’s a whole spectrum of paid and unpaid care that we’re reliant upon. So we have all of these family caregivers, about 70% of whom are women, and 11 million of them are sandwich generation. So they’re both parents of young children, and they’re caring for their parents. That Panini squeeze effect of pressures from both sides of the generational spectrum. Then you have the professional care workforce of early childhood educators, childcare workers, direct care workers of different types. And everyone in the professional care workforce is underpaid, and it’s vast majority women, over 80% women who. And majority women of color who do this work, and in fact, the care workforce is where the largest concentration of black women are in the in the entire economy. So the reality is, is that you’re almost punished for working in the care economy because you are supporting the dignity of our elders, and you’re making it possible for our loved ones with disabilities to live full whole lives in the community, and you’re paid less than $12 an hour. Oftentimes, the median annual income for a home care worker in America today is $23,000 per year. So the people that we are counting on to care for the people that we love as their profession, can’t care for themselves on on the income that they earn. And that is actually what is so powerful about the potential for change here is when we invest in care work and making care jobs good jobs, it has this incredible ripple effect across so many communities and throughout our economy that I think is just so powerful to think about.

 

SuChin Pak  11:23

Yeah, I think, I think I read somewhere where you were saying that this is the work that makes all other work possible, and you were equating it with infrastructure, right? And I was like, whoa, that, like, blew my mind. Can you, can you just like, make that connection for everybody else listening that hasn’t heard it framed in that way before?

 

Ai-jen Poo  11:47

The definition of infrastructure really is the systems and the workforce that enables everything in society and the economy to function. It’s the scaffolding that makes everything else possible, and so we often associate it with bridges and tunnels, but it’s also broadband. It’s also transportation systems, other utilities, if that is the definition of infrastructure, what could be more essential and fundamental than access to care. And Senator Casey actually said it really well. He had a floor speech one day where, when we were talking about the infrastructure bill, he said, the thing is, is that some people need a bridge or a tunnel to get to work, and other people need childcare, and other people need home care. We think about care somehow as like some soft, special interest issue, you know, like some nice to have, but it’s like, where would we be without care? We wouldn’t exist.

 

SuChin Pak  12:57

I mean, can you imagine if caregivers everywhere took the day off, we wouldn’t be able to function as a country. It’s that simple. Up next, we’ll learn what it’s like to be a care worker today from someone with first hand experience. Katrina Mouzon is a professional home care worker dedicated to her clients because she knows she’s sometimes all they have.

 

SuChin Pak  13:20

You just can’t be like, oh, I’m going to leave. Oh, I don’t want to do this. You know, you’re the only person that really cares. So what can you do? You know.

 

SuChin Pak  13:57

That’s when we come back.

 

SuChin Pak  14:35

For many professional care workers, their work is their calling. They dedicate their days to looking after other people’s loved ones. And this isn’t easy work. The days can be long, physically exhausting and emotionally demanding through her work. Ai Jen hears many stories from professional care workers.

 

Ai-jen Poo  15:26

I was just having dinner with a home care worker who told me that the family of the client that she cares for who has Alzheimer’s, they often forget that she doesn’t take her medicine unless it’s in applesauce, and there’s only a certain kind of flavored applesauce that she will accept her medicine inside of, and the family just is not paying attention to those details. So out of her $12 an hour paycheck, she buys blueberry flavored applesauce every single week to make sure that her client is able to take her meds. And that kind of thoughtfulness and love that is a part of is like mission critical to being a successful care worker is invaluable, and yet we are compensating people at poverty wages.

 

SuChin Pak  16:28

It’s blueberry applesauce, but it’s also making a client feel supported and seen. Care workers often go above and beyond, like this, and yet wages are abysmally low, like Ai-jen shared before the median annual income is just $23,000 per year. Ai-jen organization, the National Domestic Workers Alliance, is trying to change that by advocating for basic labor protections, including a domestic workers Bill of Rights to ensure fair wages. Ai-jen connected me to a care worker, Katrina Mouzon, based in Charlotte, North Carolina. I wanted to talk to Katrina to hear what her side of the care conversation looks like. You know, for those of us that aren’t caregivers or don’t have experience working with a caregiver, what does a caregiver do?

 

Katrina Mouzon  17:21

Being a caregiver to me, I feel like I’m more than a caregiver. I become like family. It’s a lot, it’s a lot of duties. So the main duties when you walk into someone’s house like, it’s like, okay, so you got to do bed, baths, showers, bench here, um, light housekeeping, laundry, you got to take them to the doctors, or, you know, just companionship, um, doing one on one with somebody. You get to know who they are. You get to know, um, like, how they feeling. You get to know, you get to know their whole family dynamic, like, what’s really going on in the house. You get to see how people actually are. You got to deal with the sadness of the client. You got to deal with the attitudes of the kids or the husband or whatever. You got to deal with a nasty house. You got to deal with the dog, the cat, you know, you become, you know, saying you become, you become the confident you become who they depend on.

 

SuChin Pak  18:31

Let’s talk about some of the kind of logistics of home care. And I want to talk about specifically your work with the agency. How many hours did you work a week? How much were you paid? Do you feel like you the pay was fair? Can we get into some of just like, the nitty gritty, the details of of caregiving?

 

Katrina Mouzon  18:55

Okay, so feel like I was paid what I was worth. No, as a caregiver, you will never get paid with your worth. Like, I think that’s on any job, you know. So just imagine working 70 hours a week coming home, still gotta cook, still gotta be a mother. Um, the pay was horrible like, you gotta clean somebody’s behind. You gotta get mentally abused, you know, I’m saying because some of them mad, um, you gotta, you gotta do so much things for people, and since you were purposely made for it, and feel like you can’t argue about it, you can’t really get mad about it. You just gotta do it.

 

SuChin Pak  19:34

Yeah, I mean, I think that it’s so shocking to me about how many hours that that you work for, how much pay? I think it. You don’t even understand it until you sit with a caregiver or even look over the statistics. Because it’s not just you, it’s across the board. I want to ask you know this work is, is some of. Uh, the hardest work out there. It’s demanding, it’s underpaid, it’s high stress. So how do you maintain boundaries? Or is that something that you’re working on? How do you, you know, separate work from from that you know, the person that you are.

 

Katrina Mouzon  20:22

So setting boundaries was something I had to work on. I have kids, but when my client calls or when they need me, I got to stop what I’m doing and go run to their aid, because I know they don’t have nobody, you know. And I got to tell my kids, like, listen, Christmas time come Christmas morning, I can’t some days I couldn’t have been there and watched them open up their Christmas presents because my client needed somebody to take them to the bathroom or change their diaper. So I had to learn to say no, and I had to learn to know that it’s okay for me to say no without feeling like, dang, I disappoint them, so that’s when I learned boundaries, when I figured out look my kids need me just as much as you need me.

 

SuChin Pak  21:09

This is what it means to be a caregiver. So often you feel pulled in multiple directions to look after others, not to mention even taking a minute to look after yourself. When I asked Katrina what keeps her going in this work, she didn’t hesitate with her answer. The reason her clients, one client in particular stands out. Before Katrina began working with him, she says he hadn’t been able to take a shower for years.

 

Katrina Mouzon  21:38

He had a good family, but his family couldn’t put him in the shower. And I love challenges, especially when it come down to the healthcare deal. So I gave him his first shower for two after two years, you know? And he was like, he was so thankful, and that put up all of my face that I’m able, that God gave me strength to be able to do things like this, you know? I’m saying just simple as a shower. You know? I’m saying we take so much things for granted, but being in the health still like that just humble me so much. Like this is, this is what you supposed to do.

 

SuChin Pak  22:12

Caregivers like Katrina put their whole heart and spirit into this work, and it’s about time we start valuing it. When we come back, we’ll hear from Ai-Jen about how we As a country can better care for the caregivers.

 

SuChin Pak  23:43

Care jobs are one of the fastest growing categories of work today. It makes sense, right? With the booming elder population, these are the jobs in demand. In my conversation with AI-Jen, she told me how we can ensure these are actually good jobs for the workers and their clients.

 

Ai-jen Poo  24:39

We’re gonna need a lot more care, and it’s already showing up in the kind of rates of job growth in the home care workforce. It’s consistently one of the fastest growing occupations. So we’ve got a workforce where the demand is increasing. They’re not going to be outsourced. They’re not going to be automated. These are, whether you like it or not, going to be a huge share of the jobs of the future, and we have to make them good jobs. And the thing about it, that is really powerful is that we could. It’s actually not that complicated. And what I mean by that is 70% of home care workers in America right now work through the Medicaid program. The Medicaid system currently is set up to support nursing home care, as opposed to home care. So we’ve got this need to really build out the home and community based care system, but we have it in a lot of places, and we have the seeds of it across the country. If we put more funding into the Medicaid program, we could actually build out that infrastructure and build out that workforce to have good pay, living wages, family sustaining wages, benefits, job security, and actually make this a profession that people aspire to enter into.

 

SuChin Pak  26:08

I want to linger a moment here on what AI-Jen shared about investing in Medicaid, more investment would mean better conditions for workers and the people they care for. We’ve talked before on this show about how Medicaid, not Medicare, does cover long term care for people over 65 with low incomes, but the reality is, many people just aren’t eligible. So we need more options. If we can find new ways to support long term care on a federal and state level, we can help people continue to live and age safely in their homes. One state, Washington is already on it. They have a new Long Term Care Insurance program available to the public.

 

Ai-jen Poo  26:54

Washington state, as of July of last year, became the first state to begin implementing a long term care benefit in the country, and.

 

SuChin Pak  27:05

Yeah, no, tell, tell everyone, like, what is this program? Because it is the only the first can you tell us a little bit briefly about how the state program works.

 

Ai-jen Poo  27:16

It’s called Washington Cares, walk cares, and there’s a website, you can look up more information about it, but basically it’s a social insurance program. It’s kind of like Social Security, where you pay into a fund and then eventually you’ll be eligible for a long term care benefit. And it’s not an unlimited amount of money, but it really does help. What this benefit does is it supports people who need long term care but are not eligible for Medicaid to be able to pay for it. And because it’s a fund, a pooled fund, the way so social insurance works, it’s it’s basically everybody contributes, and then everybody can have access. So it’s really exciting. I think if we had a long term care benefit in this country that helped family caregivers pay for helped all of us really pay for our long term care needs, that could be a total game changer. And so yes, everybody’s got to vote, and everybody’s got to let their candidates and elected officials know that you care about care, that you’re a care voter, and you expect them to support us, to take care of the people that we love.

 

SuChin Pak  28:27

Okay, good. We’ve got the assignment.

 

Ai-jen Poo  28:36

Yes, we are.

 

SuChin Pak  28:37

We are ready. We are ready and motivated after this conversation.

 

SuChin Pak  28:45

Like Ai-Jen said, there are other states following Washington’s lead to prioritize care. For example, New York and Pennsylvania are considering programs similar to WA Cares. Of course, policy changes are where we can have the greatest impact. But I also wanted to know what Ai-Jen thought we could do on an individual level to make caregiving easier. What advice do you have for those of us, myself included, who want to plan ahead for our own care?

 

Ai-jen Poo  29:15

Well, I believe that it’s really starts with having the conversation now, when you’re not in the midst of a crisis, and approach it with real curiosity, like, what would it look like to actually be cared for in the way that feels comfortable and the feels like home to me and have that conversation with increasing circles of loved ones, people that you trust, who you know in some way, are going to be a part of your care squad, your care team, your care network, and the more you start to create a and socialize a climate of having conversation. Conversations about care, then the more normalized it becomes in your life and in your planning. And I would say that the most important thing is to really resist the isolation of it all, to really be in it with the people that you love and trust, and to find safe spaces and expand those spaces to talk about what you need.

 

SuChin Pak  30:33

I love AI-Jen’s advice for these conversations, to approach them with curiosity, to keep these conversations ongoing with your care squad, the people that are there to support you despite all of the challenges facing caregivers today, I love the conversation with Ai-Jen feeling optimistic about the future, there’s joy and meaning in this work. And instead of looking at the elder boom as a crisis, we can look at it as an opportunity. That’s not to say policy changes will be easy, but it’s critical that we rethink how we value caregiving, that we see it not as an individual issue, but as a collective responsibility. It’s on us to make these jobs and family roles both dignified and sustainable when we look after caregivers, when we recognize the power of this work, we also ensure our older loved ones get the best possible care.

 

CREDITS  31:38

There’s more Uncared For with Lemonada Premium. Subscribers get exclusive access to bonus content, like unaired interview clips from caregivers across the country. Subscribe now in Apple podcasts. Uncared For is a production of Lemonada Media. I’m your host SuChin Pak, Muna Danish is our supervising producer, Lisa Phu and Hannah Boomershine our producers. Our mix is by Ivan Kuraev. Music is by Andrea Kristinsdóttir. Our associate producer is […]. Jackie Danziger is our VP of narrative content. Executive Producers are Jessica Cordova Kramer and Stephanie Whittles Wachs. This season of Uncared For is presented by the Commonwealth Fund, a nonprofit foundation making grants to promote an equitable, high performing health care system. Help others find our show by leaving us a rating and writing a review. You can follow me on Instagram at @SuChinPak and Lemonada @LemonadaMedia across all social platforms. Follow Uncared For wherever you get your podcasts and listen ad free on Amazon music with your Prime membership. Thanks so much for listening, see you next week.