'The Work That Makes All Other Work Possible': Ai-jen Poo on Why Home Care Workers Are Infrastructure Workers

The COVID-19 pandemic put a spotlight on the importance of child care, in-home care and support for the elderly as well as for members of the disability community across the nation. Now, one of the most contentious parts of negotiations with Republicans over President Biden's infrastructure plan has to do with the administration's inclusion of $400 billion in spending for at-home care for the elderly and people with disabilities, with the administration arguing that such domestic work is as essential to a functioning economy as roads and bridges.

KQED’s Mina Kim spoke with Ai-jen Poo, director of the National Domestic Workers Alliance, about domestic workers and what it means to include this work in the infrastructure plan.

The following interview has been edited for length and clarity.

Why Care Work Is Best Described as Infrastructure

Ai-jen Poo: We've always talked about how domestic work, the work that happens inside of our homes to take care of our family members, our children, our loved ones with disabilities, our aging loved ones, really is the work that makes all other work possible. Having access to care makes it possible for all of us to go out into the world and do what we do every single day.

If you think about the definition of infrastructure, it's really that which enables society and the economy to function. And what could be more fundamental than having the ability to take care of your loved ones as you prepare to work and participate in our workforce and economy?

Even if you think about the traditional definition of infrastructure, roads, bridges, tunnels, all of the people who are rebuilding our bridges and fixing our tunnels, they need care, too. So maybe it's the first form of infrastructure before anything else.

'Single Greatest Opportunity in Generations'

What do you think about the fact that care work is now in a presidential infrastructure bill?

Ai-jen Poo: I think it's the single greatest opportunity we've had in generations to establish the kind of policies and programs we need to support our ability to care for our families as we work. It's necessary.

Even before the pandemic, many of us were simmering in a care crisis. We have a situation where the baby boom generation is aging into retirement at a rate of 10,000 people per day, turning 65 every 8 seconds. We've basically added an entire generation onto our lifespan and we haven't adopted any of our systems or policy to support a quality of life and the care we need as we live longer. On both ends of the generational spectrum, we need more care than ever before at a time when we have less of it. Our default care infrastructure in previous generations was just expecting that women will stay home and be full-time family caregivers.

We need programs, policies, systems and a strong care workforce to support us. There are over 2.5 million [care workers], and they're overwhelmingly women — 92% women and majority women of color, including many immigrant women. This is actually the part of the economy with the highest concentration of undocumented immigrants of any workforce. They are also majority primary income earners for their families and majority mothers of small children.

We have a workforce who is essential not only to the families they support, but their own families and communities. And it's also a workforce that has always been majority women of color. Some of the first domestic workers in the U.S. were enslaved Black women. And the fact that the work as a profession has always been associated with women of color has profoundly shaped the way that we've treated this work in law, policy and in culture.

Starting in the 1930s, when we were putting our foundational labor laws into place, this workforce was excluded intentionally as a result of racism and the legacy of slavery in our country. And it created a situation of extreme insecurity when domestic workers entered a crisis like a pandemic — it just became incredibly exacerbated.

Structural Problems in Pay and Working Conditions

Could you talk a little bit more about some of the more common structural problems that you see regarding pay and working conditions?

Ai-jen Poo: Eighty-two percent of domestic workers didn't have a single paid sick day. When the second stay-at-home orders came down, you saw dramatic losses in jobs and income because there's no job security, there's no contract or work agreement. The wages are essentially poverty wages.

So most domestic workers didn't have the savings to be able to fall back on. I remember in March of 2020, in the first weeks of the pandemic, we held a meeting on Zoom with some of our members and one of them held her phone up to the Zoom screen to show us that she literally had 1 cent left in her bank account.

What Investing in the Care Economy Looks Like

When you say investment in care workers and the care economy, what does it look like?

Ai-jen Poo: The Biden American Jobs Plan proposed a $400 billion investment in Medicaid, home and community-based care. What that money would do is expand access to home and community-based services and care for the elderly, and people with disabilities. And it would support raising wages and access to benefits for the workforce.

Right now, the average annual income of a home care worker is $17,000 per year. I don't know a single community where that is sustainable, let alone enough to raise a family on.

What we end up seeing is high rates of turnover because people simply cannot survive and sustain themselves doing this work ... because the wages are so poor and the conditions are so tough, we have huge parts of this country that we call home care deserts or direct care deserts because people can't get the support that they need in order to live in their communities. They end up either having to go into a nursing home or having to rely on overstretched family caregivers who have to make impossible choices about whether or not they can work. The money to Medicaid would specifically raise wages for the home care workforce and strengthen that workforce so that they can stay and sustain themselves doing this work.

It would expand access to the services for over 800,000 people who are on waiting lists and the millions more who don't even know there's a waiting list to wait on.

A Cultural Shift

What evidence do you have that there is a tangible cultural shift happening here?

Ai-jen Poo: I do feel this incredible rage, we call it the "mom's rage," that incredible frustration that moms are feeling and have felt throughout the pandemic.

If you're a parent or you're a primary caregiver for a family member who needs assistance with activities of daily life, you know that it's an impossible choice between work and family members who need you for their basic human needs.

The kind of rage that I'm feeling, especially from women who disproportionately bear the brunt of caregiving responsibilities in our country, and especially women of color who've been pushed out of the workforce by the millions, almost 5 million women pushed out of the workforce in the pandemic because of caregiving challenges. That is an indicator that something is very broken.

If we are to pull ourselves back from the regression to 1988 women's workforce participation levels, we're going to have to rebuild and build something really different. I think people know that in their guts. This cultural norm that we have around care being an individual responsibility and a responsibility of individual families is one that is very deep. It's not like we're going to move past it overnight. And it's not that it isn't the responsibility of women and families and individuals, but it is about what is our responsibility collectively to each other as a society to ensure that we have real choices and real agency when it comes to the people we love.

Protections for Undocumented Domestic Workers

Can you comment on protections for undocumented domestic workers?

Ai-jen Poo: There are a tremendous number of undocumented workers — essential workers in this industry.

We've been working really hard to make sure that we seize upon this moment as we're imagining an economic recovery that is inclusive and supportive of essential workers and includes undocumented domestic workers and care workers that have kept us safe through the pandemic.

Sen. Alex Padilla from California has introduced legislation to create a path to citizenship for the 5 million essential workers across industries through this time of crisis, and so we are very busy trying to get support for that legislation.

It could be really transformative and it would be inclusive of domestic workers, so let the senator know that you really support his efforts and help us get people signed on to that bill.