Ai-jen Poo: No One Wins When We Devalue Care

A BIG Ideas Interview with Care Warrior & Visionary Ai-Jen Poo

The high costs of childcare and elder care, combined with the low wages and lack of benefits for care workers, create a crisis that is breaking families and the care workforce—Ai-jen Poo, President/CEO, National Domestic Worker’s Alliance

—A little over a decade ago, searching for affordable childcare for my twins in New York City nearly took me out^[i].

I couldn’t believe the cost—just over half my salary at the time—and the massive waitlists. In some instances, my infants would have become toddlers before snagging a coveted slot. The open-to-close hours and late pick-up penalties also left much to be desired.

Back then, I wondered how families made it work since no one spoke openly about it, particularly do-it-all career women like me, who were expected to figure it out and keep it moving. Why were we so quiet? Did they know something I didn’t!? And also, why weren’t we rising up?

Learning of my dilemma, and perhaps taking pity on me, my grandmother uprooted her life and moved nearly 3000 miles to provide care. It was the only way I could have returned to work. She lived with us for 18 months in a tiny one-bedroom Brooklyn apartment with a cat and a dog. She was a saint. When she left, I made her take the dog.

However, being dogless did not alleviate the unpredictability of motherhood, a demanding job, and the sometimes irregular hours and sporadic all-day closures at my daycare facility. What was I supposed to do with my kids on National Houseplant Appreciation Day?!

Something had to give. I eventually off-ramped my career and took a significant pay cut until my kids were about seven years old.

I blamed myself for not being able to figure it out. I rationalized that it was my decision to become a Single Mother-by-Choice and to live in one of the most expensive cities in the country—I just had to deal with it.

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My Big Ideas interview with McArthur Genius, author, and President/CEO of the National Domestic Worker’s Alliance, Ai-jen Poo, reminded me of that chaotic chapter of my life and the constrained choices I felt I had to make. It also made me wonder once more—Why aren’t we rising up?

You can listen to the full interview here.

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The Rising Cost of Care in America

Over the last decade, childcare costs for families in the U.S. have risen by 36 percent and can consume over 20 percent of a family's household income, more in high-cost-of-living cities. At the other end of the continuum, families often pay more than $10,000 a month to care for aging loved ones.

These figures don’t account for the unpaid labor of women and girls who absorb most caregiving responsibilities in families--estimated to be about $600 billion annually.

The system is also not functioning for care workers; many have left the sector due to long hours, low pay, and insufficient job protections and benefits. The median hourly wage for care workers is $14.63, equating to an annual salary of $30,408, which falls below the federal poverty line for a family of four.

Pandemic-era funds designed to support childcare centers and assist families in affording care expired in 2023. Since then, a gridlocked Congress has been unable to pass legislation to make care more affordable for families. Threats of cuts to Medicaid and a new proposal from the Administration to eliminate Head Start further impede efforts.

My interview with Ai-jen explores the challenges families face in finding and affording quality childcare and elder care, the lack of government support and infrastructure for care, and the necessity for a new social contract that values care and caregiving. She also discusses her experiences with caregiving, why we should all stick together, and how we can win big on care.

C. Nicole Mason, PhD (CNM): Ai-Jen, you’ve been on the frontlines sounding the alarm about our inadequate care infrastructure for more than two decades. Your commitment and dedication have been unwavering, even as the work has gotten much harder over the last few months, and I want to talk about that. Still, before we jump into that discussion, I want to briefly talk about how you began working on care issues.

I read your book, The Age of Dignity, to prepare for our interview. In it, you mention your grandparents and mother as key inspirations or guideposts for how you think about care and what should be done. Could you start by sharing a bit about that?

Ai-jen Poo (AJP): My grandparents played a huge role in raising me. I can't imagine how my mother could have pursued her dreams without our village. From three months old, my paternal grandmother was my caregiver. Afterward, I went to Taiwan and was cared for before I could attend preschool, as my parents couldn't afford childcare. They pieced it together. With my grandparents' intergenerational care and wisdom, I felt love, care, and support.

As I grew up, I realized how little support people have in caring for loved ones and the struggles families face without extended family. Childcare is expensive, and elder care is often overlooked. When my grandparents aged, our intergenerational family worked together to find the proper care for my grandfather as he lost his sight and faced mobility issues. Although he wanted to age in place, we had to place him in a nursing home, which was heartbreaking.

The facility was incredibly dehumanizing. He shared a room with strangers in severe pain and couldn't sleep or eat the unrecognizable food. The flickering lights and my grandfather in such an environment are seared into my memory. Many of us have heroes in our elders who do so much for their families, yet they spend their final days in deplorable conditions. They don’t deserve that.

It also reinforced what I already knew: the work of care, primarily done by women in our families and society, is undervalued and taken for granted, often assumed to be something they will do, no questions asked. We must confront how we devalue one of the most important aspects of life, care, leaving it up to women to figure it out and’ woman up. ‘This upside-downness of our societal and economic life is something I began wanting to address at an early age.

No One Wins When We Devalue Care

CNM: Thank you so much for setting that context and speaking about your grandfather. You’ve said care and aging should not be considered burdens, but we should think of care as love. I’ve had my own experiences scrambling to find high-quality, affordable care for my children, and most recently, my grandmother spent her final days in hospice care—the cost of care was real in my family.

We all have stories about care and feel responsible to make it work, thinking something is wrong if we can't. However, I understand the problem is larger than any individual or family. The system is broken and failing—we have to fix it for everyone. That's why I'm grateful for your work and that of the National Domestic Workers Alliance and Caring Across Generations.

AJP: Nicole, you're such a numbers person, and when it comes to care, the figures don't add up. There's just no way to manage this alone. Most Americans earn less than $60,000 a year, working hard every day. If the average cost of childcare exceeds 11 grand a year and the average cost of a nursing home surpasses a hundred grand a year, how are we expected to handle this by ourselves?

CNM: You said it earlier; we just expect women to do it for free. We expect a grandparent, as the vice president said, to swoop in to save the day. When I returned from maternity leave, I remember crunching the numbers for childcare. No matter what I cut, it just didn’t add up. There was no money to get from anywhere else. And I said to myself, I don't know why we are not all rising up—this is bananas. You’ve said care is one of, if not the most significant, issues of our time, and we should prioritize it. Say more.

AJP: That's right. It's always been number five in the top three [policy] priorities, but for all of us who get up every day and have people that care for loved ones in hospice, bills to pay, or our ability to work depends on it, it is the number one.

CNM: You’re right. It is a top issue. I like the connection you make between care and the economy. Care is an economic driver and makes all other jobs possible. It is fundamental.

AJP: Caring for our families is critical to our day-to-day realities and lives. However, care is not part of the economic story we tell about work and, therefore, is not supported by public policies.

The U.S. is one of only two countries in the world without a paid national family leave program.

It is as if we've designed our entire economy and social contract to erase the family instead of supporting it. Imagine if we flipped that and created an economic model with families at the center; it would be amazing and unleash so much human potential.

CNM: I want to discuss your work with the National Domestic Workers Alliance and Caring Across Generations. NWDA was founded in 2007, almost 20 years ago, and Caring Across Generations was established in 2011. Can you talk about both organizations, then and now, and the necessity for both?

AJP: Sure. The National Domestic Workers Alliance was founded to uplift the workforce of primarily women of color who provide caregiving and cleaning services. We aim to bring this vital work out of the shadows and into the economy, earning respect and protection. These jobs are among the fastest growing in our economy, driven by increased demand for home care as our population ages, yet average wages remain under $13 an hour.

Eighty percent of domestic workers lack paid sick days, job security, and clear agreements. These jobs cannot be outsourced or automated; no robot can care for my child or mother-in-law. Therefore, we must make them good jobs that benefit both workers and those who rely on their services.

CNM: What are some of the most significant barriers or obstacles to creating a strong care infrastructure in the U.S.? And why do we devalue caregiving?

AJP: The reason we devalue care work is connected to the larger problem of how, as a society, we have not historically valued caregivers or the work associated with providing care. At the federal or state level, we have not invested in the infrastructure, public policies, or programs needed to make care affordable and accessible. We need a new social contract to meet the needs of working families in modern America.

You and I know everyone is struggling. Family caregivers are overwhelmed, trying to balance work and care. Parents can't afford childcare and frequently leave the workforce. Individuals with disabilities are confined to nursing homes, experiencing segregation while they could be living fulfilling lives with the proper supports. No one wins when care is devalued.

CNM: I like the idea of updating our social contract to address families' needs and realities today. When I think about social contracts, I imagine what we owe to one another, as well as what we should expect from the government and what it owes us, the American people. We need a new social contract in the US- a renegotiation, because the current one is not working for most of us, even if you are middle or upper middle class--it's still not working for them either.

AJP: You’re right. There's so much change happening. This could be a moment for us to start imagining what that new agreement might look like: new terms, new conditions, and new realities.

CNM: This makes me think of other countries with strong care infrastructures, such as Canada, Norway, and Sweden. How is the U.S. similar to or dissimilar to these countries?

AJP: As people live longer, there is a global need for care, and many countries have implemented solutions, adding long-term care to their national healthcare systems and making it accessible and affordable. Other countries subsidize childcare and have paid family leave. High-quality center-based childcare is available to everyone in Canada. They cap the cost of childcare at $10 per day. It's pretty simple.

In the U.S., one out of every four moms returns to work within two weeks of giving birth. Some people have a year, some people have two weeks--those people are in the US and that's our reality. We are so far behind.

CNM: We are certainly so far behind. Before time is up, I want to discuss two things: narrative change and policy priorities.

A few weeks ago, a Washington Post article featured a woman upset about her daughter-in-law, questioning why she couldn't add elder care for an aging relative to her responsibilities as a stay-at-home mom. During the last election, Vice President Vance proposed involving grandparents in the childcare crisis, likely referring to grandmothers. How do public attitudes towards care hinder the creation of a care infrastructure and necessary investments?

We've internalized the belief that care is a personal responsibility.

AJP: We've internalized the belief that care is a personal responsibility. If we can't afford or manage it, we feel like failures. This misconception ignores the system failure affecting society as a whole. Care is essential, and it's impossible to handle alone. We assume women will manage it at home, despite the fact that most households require every adult to work to make ends meet. This narrative is out of touch with our reality.

Often, the solution in the narrative seems to be either individual action or government intervention. In reality, the role of government is to support individuals in taking responsibility in sustainable and dignified ways. That's all we want. As families, we want a strong foundation and the tools to handle our responsibilities with dignity. Caring for our loved ones is a responsibility that individuals will never relinquish because it is central to our identity. We love our families and will do everything we can for them. We are giving our all as individuals, but there is a limit to what we can do because we lack a solid foundation, which is breaking us. The government has a role to play. It's not just an either-or situation; it is meant to complement individual responsibility and ownership in our sacred role as caregivers for our loved ones.

CNM: I love how you put that—I agree with you; the government has a role to play in ensuring that we can all pursue our dreams and opportunities, take care of and provide for our families, and live a good life. These are core democratic values and part of living in a civil society.

AJP: Exactly.

CNM: Regarding policy priorities related to care, what two or three things should we be thinking about?

AJP: I want us to do everything in our power to protect Medicaid. Let’s come together and build the biggest, boldest, most beautiful movement to preserve this program that is sacred to 80 million of us.

Let's ensure we continue to stick together, no matter what happens. As you said, this is about all of us, and the stakes couldn’t be higher. Our ability to care for our loved ones and ourselves is at stake.

They will try to divide and pit us against each other in various ways, and we have to understand that this is part of the playbook. We must not fall for it; we are in this together for the future of this country and all the things we hold sacred about it.

Protecting and expanding programs like Medicaid, which provide essential care services, is a critical priority. —Ai-Jen Poo

CNM: You're right. We can't fall for division, for the old playbook that continues to be run. And we have so much work to do, even if we are tired. Even if you don't want to get out of bed or don't want to do it for one more day, I promise that if we continue to do the work and come together in solidarity, we will win.

AJP: That's right. We will win.

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^[i] “Took me out" means to surprise or shock someone significantly, often to the point of humor or disbelief. It's a way of expressing that something unexpected or outlandish has left you utterly stunned or impressed.