Bonus: Showing Up for Care in 2025
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Hey, everyone. It's me, Sujan Pak, host of Uncared For, and we are back with another bonus episode for you. And this one is so timely. It is so needed. With the 2024 election behind us, right? The new year here is right around the corner. We're going to look at where things stand when it comes to the care economy. We're going to look at where things stand when it comes to the care economy.

What does a GOP-led White House and Congress mean for families, older adults, and care workers? And what are the next steps to work toward better aging and disability care and good paying care jobs? How do we build an even bigger and stronger care movement? To talk through all of this, we are so lucky we have a very special guest from this past season, caregiving expert and policy advocate Ai-jen Poo.

Ai-jen is the president of the National Domestic Workers Alliance, executive director of Caring Across Generations, and author of the book, Age of Dignity, Preparing for the Elder Boom in a Changing America. Ai-jen has spent her career fighting tirelessly to make us care about care. So let's dig into it. Welcome back to Uncared for, Ai-jen.

I cannot even imagine how busy you've been the past few weeks. So thank you. Thank you so much for coming back to Uncared For. Oh, thank you for having me. I always, always love time with you and on my favorite topic. And this will be very healing for me. Well, you know, I've seen you on the press appearances. I've seen you out there. And every time you talk, I'm like, see, it's going to be okay. It's going to be fine. Everybody feels

Calm down. I mean, you just have that presence. So I know you're carrying so much, but I mean, thank you so much. Thank you. I mean, we're in this together. Well, how are you feeling post-election? What has shifted in your world? What continues to remain, you know, the same and on task? Like, can you give me a sense of what is happening? Yes. Yeah.

Well, so I have been a part of a growing movement of caregivers and people whose lives are touched by the need for care. And that movement had a really powerful year of mobilizing and organizing to let voters know that care was on the ballot this year and to engage voters all over this country on these issues. And we really did find that our hypothesis that

Care is an issue that everyone is touched by, everyone can relate to across geography and race and age and all kinds of differences in our country. Like, this is something that connects us. And we did so much, and the election outcome was not what we had hoped for.

Vice President Kamala Harris had this really powerful idea called Medicare at Home that she announced when she made an appearance on The View. And wow, the responses to that idea that were on my feed, in the socials, on the interwebs. I mean, it was so important and resonant with people. Yeah. And...

Obviously, the election outcome was not what I expected or what I had hoped. And I think what I'm sitting with is that everything that was revealed and everything that was built and everything that was done cannot be undone. And that what we have built is

is still there for us to stand on, to build upon, and to keep going with. And so that is, I'm, you know, moving through my stages of grief and adaptation towards the reality that we have so much work to do. And it is the right work. And it really matters to people.

Yeah, I think there is a sense of like, we do need a moment to sort of, okay, take a collective breath. But like you said, I mean, this work you've been doing for so long and especially ramping up this year and the support across, like you said, any sort of differences we have, we can all agree on this universal responsibility.

thing of care that touches all of us. I want to get to some of these stats that you know very well. I'm going to repeat it again here for our listeners just so that we can contextualize how big this issue is and how no one is not affected by this. There are 53 million of us who are caring for aging or disabled loved ones. There are 33 million of us raising young children.

11 million then are squeezed in between that, right? Between caring for an elder or disabled person and childcare and about 9 million professional care workers. Just already the math is...

It's extraordinary. It's just not mathing. You know, 9 million professional care workers out of all of these numbers, right, in child care and direct care. So can you help us put these numbers in context in terms of where this country is when it comes to caring for our loved ones? What is that holistic picture you really want people to understand? Well, you know what's so wild is that since the last time we talked—

RAND Corporation came out with a new data point on the number of family caregivers, and it has doubled. We are now 105.6 million family caregivers in our country. And so it has doubled in the last decade. That is how...

intense and central this question of care is for this country. And all these family caregivers can't do this alone. We're going to need a lot of support and we're going to need a strong workforce. And so

The demand for care, the pressures on caregivers, the pressures on workers are only going to increase, which is why having solutions that really support us and invest in our ability to take care of each other that make care more affordable, like Medicare at Home or investing in Medicaid services so more people can have access to care.

Like those kinds of, and so we can raise the wages for the workers so they can sustain in this job and take care of their family members too. These are not just nice to haves. This goes to the core of our economic and well-being and our health as a country. And when you tell me that this number has doubled in the last 10 years, it's

It kind of blows my mind because I'm trying to imagine a world where we have enough people to support this, enough people in the workforce. The shortages are, that's the headline that I see everywhere. Is it just getting the disparity between what we need and the people that can do these jobs? Like, is that growing bigger? Like, what's going on to fill that gap? Because

We have to take time off of work. You know, all of these things have to happen, right, for us to be able to move forward as a country in this economy. And care, to me, is right there. We talked about it last time you were here. We're talking about infrastructure. Like, this is not an option. That's right. But, yeah, I'm looking at it even personally, you know, like trying to find care for my parents now.

It has been such a daunting task. I still don't have it. It's still just me. And I've been looking for months. Yeah. No, and you're not alone. About half of my text messages every week are from people who are like, hey, I live in this place. And do you know where I can go if I need a caregiver? I mean, literally, it's

We are all searching because we haven't actually built the systems that would allow us to be able to support people.

a care workforce to support us and also to coordinate that care and that those services as we need them. I mean, other countries have invested exponentially more. And so the reality is, is that to deliver good care, to offer safe quality childcare or to offer good dignified care for an older person, there are some like fixed costs associated with that. And again,

Because the government hasn't invested in the baseline of support to cover some of those costs, it's all falling on the shoulders of individual families. So then you have family members who are kind of like, do I go to work and spend a huge portion of my paycheck on care? Or do I stay home and take care of my loved one?

When that's not really an option, because how am I going to pay the bills? That's like the cycle that a lot of people, especially women, are in. And so the costs are either passed on to family members or they're passed on to workers who are just trapped in poverty because their wages never get to a rate that is sustainable.

Right now, the median income of a home care worker is $22,000 per year in our country. That is just not enough to pay the bills.

People do this work because they see it as a calling. They actually sacrifice their own health and ability to take care of, you know, because they're passionate about caring for other people and they really want to do this work. And if we invested in them and made it sustainable to do this work, it could be a game changer. And it's such a win-win for everyone.

because then we'd all have more economic choices, including them. Related to that, I was reading in the research about these childcare deserts and these home care deserts. Can you talk about this? Because this was like the first time I've heard of, you know, food deserts. I just had never thought of it this way. Yeah. Well, it's kind of like if we take the infrastructure metaphor, for example, it's kind of like, you know, there are parts of...

A state, maybe rural, small town, where there's no bridge across this lake because the state hasn't invested in it. So it means that people who need to get from one side of the lake to the other side of the lake have to drive an extra four hours, right? Right.

So like that's what's happened in a bunch of places when it comes to care is that we simply have not created the infrastructure that would create better choices for people. So they're either having to drive an hour or more to get access to daycare.

or there's no home care infrastructure, so they have to go to a nursing home or send their parents to a nursing home three hours away. So it's basically about the fact because we have not as a country or as a state invested in the baseline infrastructure that gives people choices, they're having to make incredible sacrifices to meet their basic needs.

We're going to take a quick break, but we'll be right back with more on Uncared For.

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I know that you were on this bus tour for Care Can't Wait. I love it. Like a rock star. I was watching all the stops, you know, online. I'd get little updates. Wait, can I tell you something about this? What? So, you know, I was expecting... We said we were going to do a bus tour and we were really excited about it. And I love a bus tour because I just like to be out in the community talking to people.

But, you know, they have these like rock star, like rock band tour buses that are pretty souped up. They have like nice couches and fridges. Yeah, they're like houses. Yeah. Like homes on wheels. Yeah. Yeah. I kind of thought it was going to be like that. But it turns out those buses are not wheelchair accessible. Oh, no.

So the search for a wheelchair accessible bus for the Care Can't Wait bus tour. I mean, the irony. Exactly. So, you know, we ended up in a bus that was...

I love my bus driver, but the bus was kind of janky and you really did not want to use the toilet. But it was important to us because we had to have an accessible bus. I mean, there's just no way we were going to go around the country talking about disability care and not have like the ability for disabled people to be a part of it.

Right. So it was such a fascinating lens to me on just like some of these basic ways in which our society isn't designed to support human agency for people who have different levels of disabilities or different ages, different needs. And if we are going to advocate for

for a system that actually gives us all agency. We've got work to do. I'll just say that. But there are accessible buses that you can take on tour. I love that. And you've talked to people before. You're out there a lot. Was there something new that you learned? Something surprising?

whether it was a story or a trend or just something you were experiencing as you were out there that you thought, wow, this is putting something in a different perspective that I hadn't considered or something has changed? I think that this could be...

such a powerful way to reclaim intergenerational movements and community building. The gatherings of people who would greet the bus were so intergenerational. And there was moms with their babies who would come and some of our stops were in playgrounds and parks, public parks. And

And then there were also like great grandmas. And everybody was so connected to their sense of agency, like showing up to greet the Care Can't Wait bus, like ragtag group of people going around the country talking about care. And people were excited to see us and excited to share their care stories. And whoo, did people have stories like, and each of those stories was about human agency and

And that's what was so amazing to me is like, you can have the person who is, you know, 95 years old talking about how they're caring for somebody else and how now they're like advocates. And I just think we as a country have written different people off for different reasons. And if we want to write everyone back into the story, I think care is a way that we can. And, um,

So that was exciting to me to see. And so many older people were involved in the elections work that I was a part of around the country in Battleground, like so many of the volunteers who showed up to, you know, vote for care, to volunteer, to save our democracy, whatever the reasons were that people showed up. It was like a lot of older people. And I love that. Yeah.

It was such a good reminder of how, I mean, we can only hope to be older and to live, you know, to age. Aging is a blessing. Yeah. And aging is, there's still agency in that. There's still importance in that. There's still work in that and wisdom in that. And like vanguardism. Like they're going to be on the front lines of the fight for care. And I love that. I don't want...

the election result to take away from that energy, that truth, which is that people will continue to show up for these issues and believe in these solutions. And that is the thing that I think we need to just always hold in our hearts because it is true. It is a fact. Yeah. I mean, you've seen it. So, okay. We are now on the other side.

We have had time to sit with things. Some people may need more time. That's fine. Take it. But what does a Trump presidency and a Republican-led Congress mean for the care economy, for care workers, and for families? I did look through Project 2025, and the things that really concerned me were, one, the goal to...

Medicaid funding. Medicaid is the program through which the vast majority of people in our country who receive any form of long-term care, any form of senior or disability care, the vast majority of us receive it through the Medicaid program. The desire to cut funding from Medicaid is an intention that

that they have had for a long time. And it was very clear. And one of the things that will happen next year is there's going to be a big debate in Congress over taxes and tax cuts. And they want to cut taxes for the rich and corporations by upwards of $2 trillion, maybe more. And the only place that that kind of money can be found is in the Medicaid program.

And in the SNAP program, which is food assistance for poor families and children. And then the other place is the Head Start program, which offers child care to hundreds of thousands of low-income children around the country. So we know that it is in the plan of the Trump administration to...

essentially cut these really precious and essential care programs. And I think we're going to need every one of your listeners to

to help protect these programs because it is a matter of life and death. We can fight for them. We can let them know, sorry, you can't touch these. I'm also very worried that their plans around mass deportations of immigrants is going to be devastating on so many levels.

to so many communities, but looking at it from the lens of care, about a third of our care workforce in this country are immigrants. Already, there is no way that we can care for the people that we love in the United States of America today with programs that have so much unmet need without immigrants.

If we try to deport the immigrants in our care economy, it will be a complete collapse. And so I also just want to say that we should really be on the alert for what we as a care community can do to protect the caregivers in our midst. And it's really quite existential. Yeah.

We're already dealing with worker shortages and, you know... We were just talking about that. Yeah, this is just going... This is... It's direct impact. Exactly. You know, like there's just no way around it. I know that we were reading that Trump had proposed a tax credit for family caregivers as part of his campaign. I don't know. The details haven't been announced, but...

This was something apparently proposed by a bipartisan group of legislators earlier this year. What are your thoughts on this? Do you think that this is a possibility? How do you feel about this? The nature of a caregiver tax credit is that it really benefits people who have the capacity already to spend a significant amount of money on care.

And so that is like a more upper middle class demographic. I see. So your everyday working class or low income family is not going to benefit as much from a caregiver tax credit. But it's not to say that some people won't. But if I were to look at our caregiving systems and our infrastructure, that would certainly not be the place that I invest to help the most people.

and especially the people who need it the most. I would really think about how we raise the wages for care workers to stabilize the workforce that we have so more of us could actually get access to care. And then from there, make care more affordable and accessible for people through programs like Medicare at Home. And then we could think about caregiver tax credits for people who are paying out of pocket for care. All of these things

can together add up to the kind of caregiving investments that we need to make as a society. But pretending like a tax credit is going to actually get at what we need or benefit the people who need it the most, it's just not the way I would prioritize investments. Okay, hold tight, everyone. We're going to take one more quick break and we'll be back with more on Uncared For.

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So let's talk about Medicare. What changes do you think need to be made to the Medicare system to achieve some of the policies you want to see? With Medicare, people love Medicare because it is something that you earn and that you count on. And so it is actually a great pillar of our social contract in America. And I think what we could do is actually continue to invest in it by expanding it, expanding

extending it to cover the cost of home care. And what's so interesting is that a lot of people already think that Medicare covers long-term care, and it does not. And they find themselves trying to apply for it, and they learn very quickly that except in very narrow circumstances and on very short-term bases, Medicare does not cover care costs.

either in a nursing home or in the home and community long-term. And so that is huge. And the idea that Vice President Harris had Medicare at Home was a very simple idea to say, let's start extending access to Medicare coverage by focusing on home care and allowing people who need home care to

to pay for it with Medicare. And I think it's such an elegant and powerful idea. And she even had a way to pay for it. She said, we are going to pay for it by allowing Medicare to renegotiate drug prices, which actually does generate a huge amount

of revenue. Everywhere I went, as I was talking to people about this idea, it was so popular and so resonant. And this is clearly something people really understand and understand how important it is. So is there a world in which that

kind of program still lives on? Are we abandoning that now or what do you think? We are not. In fact, I think it's such a good idea. We should never abandon great ideas. And sometimes a great idea is something that gets seeded and socialized in pockets. And then all of a sudden there's this opening.

And I think what we're in the process of right now is socializing it in enough communities so that when the opening moment is here upon us, we are ready. We're ready to jump through. We know exactly what we're talking about. We know what it means. Yes, Medicare at home. We understand the importance of it. I think that that socializing aspect, that seeding of it, I think is...

is more important than we sometimes can imagine because it does feel like

what can one person do? But it's this. It's continuing to have these conversations and offering solutions that are there. This is it. You don't have to do the work. Yeah. A lot of people don't realize that there are solutions that are so possible and so practical and would be game changers. So this is the time. And truly, I think it's really important that we do this person-to-person information sharing thing

and do the work that there's often no shortcuts for of really socializing this idea and building power behind it. So can you highlight some specific care policies and programs you really want us to focus on for 2025? Like moving that needle, you know? I would say one is raising wages, which can be done at the state level for workers who work in home care and in child care.

So that is something that you can call your local state representative or local state senator to say, hey, this is an issue that is really important to me. I want to make sure that the workers whose job it is to care for our families actually have living wages, wages where they can sustain themselves and their own families. So that is one piece. The second piece is to protect Medicaid. This is the program that

exists currently that most of us who need aging and disability care count on. Let's make sure that it stays strong and that it is protected in the next few years as we look to expand programs also in the states and in every place that we can. I'll say the good news is

For example, there are three states, Missouri, Alaska, and Nebraska, that passed paid sick leave legislation on the ballot. So voters overwhelmingly voted at the state level to pass those ballot initiatives. In a number of counties, including Travis County, Texas, voters voted to raise taxes to fund childcare for the lowest income people in those communities.

And in Washington state, we were able to defeat two ballot initiatives that were going to defund this really important long-term care benefit called Law Cares and a child care program, also really important. We voted and we stopped those initiatives, which is so great. So it's like we at the state and local level can continue to have our voices heard and have it have an impact here.

and strengthening our care systems and raising wages and making a difference in people's lives. Is there a possibility of this being a bipartisan issue? Absolutely. This is a bipartisan issue. I mean, voters...

across Republican, independent and Democrat support care. They even support paying higher taxes for care. They support candidates more who want to raise wages for care workers and want to make care more affordable. I mean, there's so much data to prove this. And so we're going to keep fighting.

There's no political terrain in which we can't fight. So as we wrap up, I want to ask, and we talked a bit about this, about the way that we can socialize and seed these ideas in our communities. But what is one thing you want people to either understand about this or as they're listening to this conversation, what is the thing that we can do that we can empower ourselves as individuals? Because I think it is so easy to get lost in

in the rhetoric of, well, it's too big. So what do you want listeners to walk away with? Something that we can do. I think there's so much we can do at the individual and community level first, which is one,

to have a conversation at your own dinner table. And the holidays are coming up, so this is a great season to do this. When families are together, to actually have a conversation that is about our family plan for care.

What is your vision or what would it feel like to you to have a care situation that really supported your own sense of agency? When you think of what would be ideal for you, what would it look like? And what would you ask of your family members? Yeah.

And what are you prepared to do to support your other family members to also have agency and also have dignity and also have real choices? Like this conversation is a conversation that doesn't have to be heavy and it doesn't have to be a crisis. It can actually be one that's about planning. Yeah. And so...

Just starting to lean towards it as a family and then remembering that as a country, we have to start to lean towards it. So maybe, you know, in the new year, you just kind of spend an hour understanding who is your state, your

Your representative to the state legislature? Who is your representative to the state senate? Who is your member of congress? Who is the point person in your governor's office who is in charge of care?

And how do you stay in regular communication with those people about your priorities as a family, as a caregiver, and what your hope is for them as they are responsible? They work for you. They're responsible for making your life better.

And for them to be able to hear from you on a regular basis that care, investing in care and supporting caregiving is something that is important to you as a constituent, that is so important. Do not be isolated in this moment. Know that there is a growing movement that is powerful.

and is unstoppable, that is going to be able to create change. I think change is inevitable. It is just a question of how bold, how soon. And I think that that really is up to us. And the more we stay together, the more that we find each other, the more that we get involved and engaged, the more we share our stories.

That is how we will catalyze the most change the fastest. So stay in it and stay together. More than ever. Don't isolate. Yes, exactly. Well, Ai-jen, thank you so much. I mean, it's just always so great to sit with you. We just continue to support your work. We continue to support you. So thank you so much for being here. Thank you for having me.

Uncared for is a production of Lemonada Media. I'm your host, Sujin Pak. Muna Danish is our senior producer. Lisa Fu is our producer. Bobby Woody is our audio engineer. Music is by Andrea, Kristen's daughter. Jackie Danziger is our VP of partnerships and production. Executive producers are Stephanie Whittleswax and Jessica Cordova-Kramer.

This season of Uncared For is presented by the Commonwealth Fund, a nonprofit foundation making grants to promote an equitable, high-performing healthcare system. Help others find our show by leaving us a rating and writing a review. You can follow me on Instagram at sujimpok and Lemonada at Lemonada Media across all social platforms.

Follow Uncared for wherever you get your podcasts and listen ad-free on Amazon Music with your Prime membership. This show is presented by the Commonwealth Fund, a nonprofit foundation whose mission is to promote a high-performing, equitable healthcare system.

The Commonwealth Fund supports research to improve health care policy and practice and has a long history of exploring what the U.S. can learn from the best health care around the world to do better here at home, especially for people of color, people with low income, and those who are uninsured. To learn more, visit CommonwealthFund.org. ♪

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