Ai-jen Poo: Building universal family care
Summit (S): What brings you to Hawaiʻi now? What kind of things are you working on?
Ai-jen Poo (AJP): I've been to
Hawaiʻi several times. It's one of my favorite places on Earth
because—especially now in the political climate that we are in—it is wonderful to
be able to come to a place that is as diverse as Hawaiʻi is, that is
as global in perspective, and that is as rooted in culture as Hawaiʻi
is, both in immigrant culture and indigenous culture. The aloha
spirit is something that the whole country needs; I know I certainly
I worked here on legislation for
domestic workers; for the women who go to work in our homes, caring
for our children and our aging loved ones, and cleaning our homes so
that we can go to work everyday and do what we do knowing that our
domestic lives are taken care of. Hawaiʻi was actually the second
state in the nation to pass a domestic workers' bill of rights. So
Hawaiʻi has been really a leader in ensuring that some of the most
vulnerable workers in our economy are protected.
As I was doing that work around the
country establishing protections and basic recognition, one of the
things that I began to realize was that this workforce is becoming
increasingly important because more and more of us have family
members who are growing old and living longer, and we want them to be
able to stay at home and be a part of their families and their
communities. The need for care is just exploding. And so I am now here
in Hawaiʻi and few other states around the country working on
legislation to help us take care of our aging loved ones—our
elders—and to make sure that they have a dignified quality of life;
and to make sure that the workforce that is responsible for ensuring
their quality of life is able to live and work with dignity.
We have a major problem in this country where we really underpay and undervalue our caregivers—whether they are family caregivers or professional caregivers. Hawaiʻi is poised to become the first state in the country to reverse that trend. We passed a bill through the legislature this session, thanks to a campaign called Caring 4 Our Kupuna, that is about investing in our caregivers and supporting
our families as they take care of our kupuna.
S: Can you
share some numbers with us to put this into context? How many people
are we talking about here, both in terms of the number of caregivers
and the number of beneficiaries of that care?
Right now, because the Baby Boomer generation—which was this very
large, very influential generation—is aging very quickly, every day
10,000 people turn 65 in America; every 8 seconds someone turns 65.
That's 4 million people per year turning 65. And because of advances
in healthcare and medicine, people are living longer than ever
before. In Hawaiʻi, people actually have a very long life
expectancy and we are looking at, by the year 2020, about 300,000
people will be over 65 here in the state. Hawaiʻi is a state
that is aging.
It's potentially a
great opportunity: the ability to live longer also means the ability
to connect with your family longer, to work longer, to learn, to
contribute, to love—all these opportunities, if we have the right
support in place to actually take care of people and to make sure
they have what they need to live healthy lives. And that's what this
campaign is all about.
S: How many caregivers are we
talking about, both professional and familial, that are taking care
of this growing aging population?
about 4 million home care workers and caregivers that are providing
elder care in the United States and about 52 million family care
givers: people who are providing up to 20 hours a week of care for
their family members on top of full-time jobs. It's a huge number of
people that are dealing with the pressures of working and holding
down a job and supporting family through earning a living and also
taking care of loved ones. Managing that pressure is one of the main
pain-points that working families in this country are dealing with
At the same time,
we also have this other phenomenon where millennials are entering
their 30s and having children. There's 4 million babies being born
every year with really no childcare infrastructure either to support
families. So you end up with this sandwiching effect on the
millennial generation, where working age adults are being pressured
from both sides by the demands of childcare and elder care with no
infrastructure or support.
Let's imagine for a second that we could scrap the whole system and
redesign it. What would an ideal series of social nets look like?
Our vision is for something called universal family care, where every
single working age adult in this country would have access to a fund
to help them afford childcare, elder care and paid family leave. So it
would be a new type of social insurance like social security or
medicare. It would be available to everyone; we would all contribute
to it and then all benefit from it. It would prevent the kind of
economic disasters that can happen when a family member is diagnosed
with a serious illness like Alzheimer's and needs care. Or the kind of
disaster that happens when somebody has an accident and develops a
disability and is unable to work.
There are all
kinds of disasters that—when families are already working paycheck
to paycheck—an accident or a stroke or a disease diagnosis can
really put them under. Whereas if we had this kind of a fund, it
would support people in being able to both take care of their
families and work too, which is really what we need in the 21st
It would be funded through some variant on the payroll tax while the
person is working and then they can draw on it over the course of
their elongating life?
Exactly. Initially it should be funded, I think, by wealthy people
actually contributing more. We have unprecedented levels of
inequality in this country. There's been a tremendous amount of
wealth that's been generated over the last four decades, but everyday
working people have not really benefited from that wealth: wages have
stagnated for the 40 years and we're in a situation where 75 percent
of the American workforce earns less than $50,000 a year.
average cost of a private room in a nursing home is between $87,000
per year, on the low end, and more than $125,000 per year, on the
high end. The math just doesn't work. We need a system where we are all
contributing and we can all benefit. It would be sliding scale, and
we think that people who are in a position to contribute more should
do so. It's about the health and balance of our workforce.
How would that compare with another idea that has been gaining some
traction internationally, which is universal basic income?
It's a related concept. In the 21st century, in the digital age, the
nature of work has changed and we are no longer a manufacturing-based
economy—we are in fact a globalized economy that's heavily
service-driven. We used to have the kind of economy in which you
could depend on stable employment for most of your life, with
intermittent periods of unemployment, perhaps, in which you might
apply for unemployment insurance. What we now have, instead, is a lot
of people working temporary jobs, independently-contracted jobs,
without access to a safety net, without access to benefits and basic
services. We need to actually rethink the universal starting points
that all working people and families have access to.
course we need to be creating good jobs. We have to make sure that
the types of jobs in which we are seeing growth—like
caregivers—are, in fact, good jobs for the 21st century. But we
also need to put into place a new social contract that includes ideas
like universal family care and universal basic income, so that
everybody can actually expect a starting point that is fair and that
allows people to have some quality of life.
In Scandinavian countries, their social nets developed at least
partially as a result of amazing political organizing on the ground,
and the creation of alternative institutions like credit unions and
which then forced the government to create the now-amazing social
democracies there. What processes do you see happening in the U.S.
for instituting things like universal basic income or universal
years ago, after Occupy Wall Street, I had an opportunity to hear the
social movement historian Frances Fox Piven speak. What she was
seeing in some of the activism that was happening on the ground
around the country was, what she called, “precursors” to a really
vibrant social movement that was on its way. She cited the
Dreamers—the immigrant youth—who were engaged in activism, she
Fight for $15—the campaign to raise the minimum wage to
$15, she cited Occupy, I'm sure she would include
Black Lives Matter
now, I'm sure she would include the movement that developed out of
Standing Rock and
water struggles around the world: she was
forecasting a social movement so great that it would have the power
to fundamentally transform our democracy the way the Civil Rights
movement had done, the way the labor movement of the 1930s had done.
was predicting that this social movement would be focused on
addressing inequality in America and around the world. She also said
that we would know it was coming when millions of everyday people
actually started to take action; that it wasn't just the activists
that we were seeing, but the neighbors, your hairdresser, the
schoolteacher, the crossing guard—everybody—in motion. And I will
tell you that I was in Washington D.C. for the Women's March on
Washington and it was nothing short of what felt like millions of
everyday people in motion.
think what we're seeing now is a movement that's building not just
against economic inequality, but also against political inequality
and the fact that millions and millions of people feel that their
voices are not heard and they're not being represented in American
political life. I think that this is what it will take to actually
achieve the social contract that we deserve and that will work in the
What are your hopes are for the legislation that was just passed this
session in Hawaiʻi? What will that achieve?
AJP: The legislation would create what is called the Kupuna Caregiver Fund and it is a groundbreaking piece of legislation—the first of its kind in the country—that would really invest in what we call the caregiving infrastructure. When we think of infrastructure—and there will probably be an infrastructure bill introduced in Washington at the federal level—we think of roads and bridges and pipes and fiberoptic cables but in the 21st century, when 75 percent of children are growing up in households where all of the adults are working outside the home, we actually need a whole new infrastructure to support people while they care for their families. We used to rely on women to stay home and take care of the kids and take care of their parents, but that option no longer exists. So we actually have to put an infrastructure in place.
And Hawaiʻi, through the Kupuna Caregiver bill, would actually become the first state to invest in that infrastructure, to invest in the ability of working families to keep their loved ones at home instead of putting them in institutions, and insuring that the workforce that is helping to support that is fairly compensated. It would invest in both the workers and the families.
It's about the value of caregiving. One of the reasons why I think it's so appropriate that Hawaiʻi be the first place to do this is that there is a tradition in these islands of caring for our elders; it is a part of the culture and it is something that the rest of the country could really learn from and, actually, has to adopt in order to create the solutions we need given the increasingly massive demand for elder care that we will experience in the future. If we continue to treat our elders as disposable and invisible, we will fail that impending test. Because Hawaiʻi already embraces that concept culturally, it could potentially create the breakthrough precedent of investment in this infrastructure that we need for the idea to be pushed through nationally.