Americans are facing a looming, undeniable crisis. The number of elders who need sustained help with the tasks of everyday life is growing rapidly, but the availability of people who can care for them is lagging far behind.
At first blush, the problem seems to pertain only to the elderly and those about to cross that line into later life. Really, though, it is about everyone, regardless of age or financial status or any other personal or demographic characteristic. The Age of Dignity: Preparing for the Elder Boom in a Changing America, by Ai-jen Poo, with Ariane Conrad, spells it all out. Poo is a winner of a MacArthur genius award, and it takes true genius to describe with such optimism and warmth what is about to descend upon us all.
Americans are living longer, and that’s a good thing. But there are more and more seniors: Every day, more than ten thousand people turn sixty-five, and the fastest growing demographic is the group of people who are eighty-five and older. Of those who make it to sixty-five and beyond, Poo writes, a whopping seventy percent of them “need some form of long-term services and supports.” Already, she writes, we “have three times more families in need of care providers than our current workforce is able to support.”
That disconnect between the need for care and the availability of care workers is only going to grow. Without serious attention to solutions, we are all in trouble — our elders, those of us who want to become elders, and all the people who love other people who need care but can’t afford it, or can’t find it even if they can afford it.
For a long time, the care of our elders was a family affair. Even as “homes” for the elderly (sometimes called “old age homes”) became more commonplace, institutionalization never really warmed anyone’s heart — not the people who were left there, and not the people who made the (often heartbreaking) decision to bring their loved ones there. As they grow older, the vast majority of people (as many as ninety percent) want to live in their own homes; many, though, simply cannot manage on their own.
Family members feel most responsible. Many want to care for their elders, not just out of obligation but of love. But consider this: “According to one study,” Poo writes, “an estimated 1.2 million Americans over the age of sixty-five will have no living children, siblings, or spouses by 2020.” That means no immediate family members alive to even consider giving care.
The looming crisis of care, though, is not one that can be adequately addressed by individuals or families.
I’d add that even those who do have living relatives may find that those relatives live far away or have their own health challenges. And Poo argues that even if there are family members who are willing and able to provide long-term care for elders who need it, they should not assume those responsibilities on their own. They should welcome the help of professionals, and treat them with the respect and dignity they deserve, including decent pay and benefits and time off.
The looming crisis of care, though, is not one that can be adequately addressed by individuals or families. Instead, we need broad-based social change along three fronts: cultural (including more dignified representations of the elderly in the media), behavioral (for example, initiating the conversations we need to have in our families and our communities), and, of course, structural and policy changes.
For those who fear that the changes we need are all too daunting, Poo shares examples of successful initiatives from many different states and from other nations. In the U.S., for example, Naturally Occurring Retirement Communities, as well as the Village movement, have helped many elders stay in their own homes and out of institutions. Japan has a caregiving time bank, in which people can accumulate credit for care they provide to others, and then use those credits when they need help themselves, or transfer them to others.
Both Japan and Germany have universal social insurance programs that provide long-term care to everyone who needs it. Poo believes we need that — and much more — in the U.S., too.
What we don’t need is the anti-immigrant fervor sweeping the nation. As Poo points out, “two-thirds of nannies, housekeepers, and caregivers for the elderly are foreign-born, and about half of them are undocumented.”
Yes, universal long-term care insurance and all the rest will cost money, and that’s always a challenge, but Poo has some suggestions as to where funds could come from. For instance, she writes, “cuts to immigration enforcement as well as incarceration and defense spending and negotiation of lower prices for drugs purchased by Medicare and Medicaid” could help.
Poo is a tremendously accomplished person. She has achieved unlikely successes in organizing immigrant care workers and coaxing significant reforms from typically reluctant legislators. For example, she co-founded the Domestic Workers United, and had a hand in getting a Domestic Workers’ Bill of Rights passed in New York. In The Age of Dignity, she shows great sensitivity to the undignified ways that people such as the poor, immigrants, and women are treated, and relates personal and moving stories of the ways in which we tend to devalue their intimate and indispensable work.
In some ways, The Age of Dignity is a personal book. The stories the author tells are sometimes those of her own relatives. She offers a bit about herself, but I wanted more, especially about her experiences in organizing and advocating for social change. I was also disappointed that this inspiring person, who showed so much awareness and empathy toward so many marginalized groups, had nothing to say about the role of single people in caring for others. Surely she must know the research showing that single people often do a disproportionate share of the work of providing extensive care for those who need it. In families in which some grown kids are single and others are married, the singlist assumption is too often made that the singles should do the work because, according to the stereotypes, they don’t have anyone anyway and they don’t have a life.
Underscoring the significant financial costs to caregivers, Poo notes:
“In order to provide care, most family caregivers must rearrange their work schedules, reduce their hours, or take unpaid leaves of absence. Some find they must turn down opportunities for overtime or promotions or travel. Some use sick leave or vacation time.”
For single people, who have no spouse to fill in the financial gap if they have to take time off from work, these costs are even more consequential. The infringement on single people’s work also has worrying implications for their own old age, as their reduced hours and slower advancement undercuts the pensions and Social Security they will have available to them when they retire. Again, they won’t have a spouse’s benefits to draw from.
My reservations, though, do not spoil my bottom line. The Age of Dignity is a readable and deeply significant book. Poo’s cogent analyses, heartfelt storytelling, and wise recommendations will provide motivation and guidance as we create the caring infrastructure that will hopefully support us all for the rest of our lives.
The Age of Dignity: Preparing for the Elder Boom in a Changing America
The New Press, February 2015
Hardcover, 176 pages