S2E1: What If Our Country’s Care Workforce Vanished Overnight?

Direct care and childcare workers are the backbone of support for millions of older adults, people with disabilities, and young children, as well as their families. Despite their vital contributions, these essential workers are often undervalued, leading to unsustainable turnover rates. Without prompt intervention, the current challenges in care could quickly spiral into a major crisis.

In the opening episode of season 2 of A Question of Care, host Robert Espinoza speaks with Josephine Kalipeni, the former Executive Director of Family Values@Work and a longtime advocate for care workers and a leader in advocacy related to care, the workforce, and families. They discuss the centrality of care workers to our economy, why these jobs suffer in quality, and how to make a profound difference for care workers and those they support.

Robert Espinoza: What would happen to families everywhere if more than 5 million direct care and childcare workers in this country were to vanish overnight? Welcome to Season 2 of A Question of Care, a podcast that explores this question through different viewpoints and topics. I'm your host, Robert Espinoza, a national expert and frequent speaker on aging, long-term care, and the workforce. To kick off this season, we'll be joined by Josie Kalipeni to give us an overview of the current state of the care workforce and the challenges that confront our country.

Josephine Kalipeni: My name is Josephine Kalipeni; I go by Josie. I'm the executive director of Family Values at Work. I have been in policy and research and advocacy work for over 20 years. I started off as a social worker, really seeing some of these critical programs and systems and infrastructures interacting, particularly for families with low wages, and particularly for families of color.

I was born in Malawi, Africa, so I get to carry an international perspective that allows me to see the care infrastructure from a developing country and really put that perspective against the care infrastructure here in the United States. I'm also the oldest of six and a remote caregiver, oftentimes supporting the care of my mom.

Robert Espinoza: Josie, you bring such incredible experience to this topic of care work, and I want to learn more about your organization. What is Family Values at Work?

Josephine Kalipeni: Family Values at Work is a national, multi-state organization. We are a movement network of grassroots coalition in more than two dozen states working towards economic, and racial and gender justice. We work particularly around issues, policies such as paid family and medical leave, paid sick and safe days, and deeply understand how that intertwines with affordable and accessible, high-quality care. Whether that's child care, or home care, or general health care access.

We have about 33 partners in over a dozen states, and we continue to grow our partnership through grassroots partners that are often running incredible, incredible campaigns at their state level through coalitions and partnerships, while also learning and doing the work to galvanize that power into federal momentum so that we also win federal legislation.

Robert Espinoza: This vision of creating high-quality, affordable, and accessible care is really relying on workers, on care workers, direct care, and child care workers, which is the focus of the second season of A Question of Care. The fact is, most of us will need this type of support at some point in our lives. And I want to know, in your opinion, why are these jobs so essential to our country and to people?

Josephine Kalipeni: Robert, I feel like you and I have had this conversation multiple times over the last several years that we've known each other. The reality is that we're all either going to give or receive care, and the care workforce is critical to how that care happens. Even if we were to do the best we can with the care workforce, there's always going to be a need for family caregivers. But I talk to a lot of family caregivers who still require the support of care workers, and so this care workforce is critical to our country.

Additionally, you and I talk about how the need for care is continuously increasing. People continue to need care, whether that's intermittent care, whether that's short-term care or long-term care. Some folks with disabilities have needed care since birth, and this workforce is critical for both ensuring that care is happening, but also for ensuring that folks can engage in our economy through work. Care workers are critical for people with disabilities who are working. Care workers are critical for family caregivers who provide some care to a family member, but spend some of their day in the workforce.

Additionally, we know that the care demands in this country are going to increase. Our population is changing. We know, by 2030, that the baby boomers and older population in this country will really be at a peak point, and that will further exacerbate the care demands in this country. The other reason I will say that it's critical, Robert, is because the care workforce is made up of a majority of women, women of color, and immigrants. That's a increasing and growing population in this country. If we don't figure out how to take care of that workforce and make those jobs critical, we are really compromising the livelihoods of care workers, of immigrants and women of color care workers. Their ability to take care of themselves, their ability to take care of their families, their ability to engage in their communities. This workforce is of critical importance.

Robert Espinoza: Josie, this workforce includes direct care workers who are supporting older adults and people with disabilities, and childcare workers which are supporting children. And when we think about the care workforce as a whole, in those different types of occupations, what are some of the shared experiences across the care workforce?

Josephine Kalipeni: Yes. Some of the shared experiences across the workforce include the fact that, for many care workers, they're in low-wage jobs. So, a lot of the care work that we're familiar with; home care workers, child care workers, are often in minimum wage jobs and are making, oftentimes, less than $30,000 a year. That is a shared experience across this country. Additionally, many care workers are trying to figure out a pipeline to increasing their skills, being able to move across different work titles to be able to improve the quality of their work, to be able to change their own economic pathway.

So, we're talking about a workforce that often lacks access to affordable and quality care for themselves and their families. They're often misqualified as workers, oftentimes qualified as contract workers, which often means that they lack labor force protections. They lack access to overtime pay. They also oftentimes lack benefits like paid family and medical leave to care for themselves and to care for their own families, which means that the people that are caring for us are unable to care for themselves and their own families, which is just a conundrum that I don't know how we tolerate in this country.

Robert Espinoza: It really is a travesty that these workers are essential to our lives and our country, and yet they are so undervalued. On your website for Family Values at Work, this work highlights, quote, “The human consequences of current workplace policies.” What are those consequences?

Josephine Kalipeni: Oh, Robert, there are so many human consequences that I think sometimes are really hard to quantify in data and research. I think often about a really poignant conversation I had with my mom, actually, a few years ago. I remember we were all sitting at Christmas about three years ago, and we were all reflecting on our various experiences as children with my mom present. And I remember we were all raising some of our observations about my mom and my dad being absent in critical moments of our lives as kids.

I remember recalling that I couldn't remember my mom being at any of my softball games, and we were talking about it as kids from one perspective. And I remember my mom saying to me… My mom who was a domestic worker, and then a care worker, and then became a nurse later on in her career, I remember her saying to us that if she could have been there, she would have. And that there was nowhere else she would rather be than showing up for her kids. And she went on to talk about the pressure to need to work really extensive hours just to make the ends meet, and the inability to be able to take paid time off in order to show up for critical moments in her kids' lives.

 I remember she missed the burial of several of her siblings because she couldn't afford to attend and she couldn't afford to take the time off that she needed. It would compromise her ability to help pay the mortgage, and put food on the table, and make sure that we all had what we needed. And those are some of the unseen human costs of not taking care of the care workforce in the way that we need to.

Robert Espinoza: You mentioned this in your response, Josie, but could you describe the extent that workers in this country have or don't have paid family leave and paid sick days?

Josephine Kalipeni: Yes. So like many benefits and services, I think many of us go to work thinking that there is a safety net infrastructure that we can pull on in critical moments when we need it. And the reality is, it's often not until those critical moments that we learn that we don't have access to affordable home care, that we don't have the care workforce that we might need in times where we need to pull on a care worker and employ a care worker for ourselves, or in times when we need paid leave from work. It's often in those critical emergency times that we learn that we don't actually have access to the critical safety net benefits that we need. And, in this country, while Family Values at Work has worked really extensively to win paid family and medical leave at the state level, winning in 14 states to date, there's still a lot of states that don't have a requirement to provide workers with paid family and medical leave, and we don't have a federal law guaranteeing paid family and medical leave.

 I am not talking about paid parental leave, I am talking about the opportunity to take paid leave from work to care for yourself or anyone, not just in the case of having a child. The other thing that I often recall is that I think we underestimate sometimes the time we need when we need time off. So, for example, I had surgery in 2018. I was told that the recovery time period would be four to six weeks. As a strong black woman, I was committed to healing in two to three weeks, and the actual time for me to recover was about 13 weeks. I, in one health situation, blew past my paid leave from my job and had to try to access benefits through the Family and Medical Leave Act, which are unpaid benefits.

Robert Espinoza: I think a lot of us can empathize with the experience of needing these types of supports and then not realizing that the safety net doesn't exist until we have a crisis, at which point it's a bit late. I love it you said ‘in this country’ in your response, because it always stuns me that so many industrialized countries have much better family policies and healthcare support than the US. Why is that?

Josephine Kalipeni: This is a great question. My partner is from the UK, and he often chuckles when I talk about my work, and when I talk about the benefits for workers, and for families, and for individuals here in this country. In other countries, the difference is really culture and policy. In other countries, there is an expectation that the government will assume the risk of basic needs for their citizens, and individual citizens from those countries agree with contributing to what it might take to have access to those benefits for themselves and for everyone in their community.

It does, at times, mean paying higher taxes, but almost everyone I've talked to in England and in other countries are okay with paying those higher taxes because the return on the other end is a level of peace, and assurance, and access to affordable services that they need, whether that's childcare, or home care, or healthcare. England still has home visits from doctors. Parents get home visits from a qualified nurse for the first six months that they're home. And folks, at the end of the day, having access to these benefits and having experienced them are more than willing to pay their fair share to ensure that themselves and their family members or community members have access to those benefits.

So, in many ways, it is a policy decision, it is a political decision, and it is a tax and revenue decision that requires a return on investment for all citizens paying their fair share. So, this is critical to understand. The other thing that I will say is that, in many countries, there's a deeper sense of communal responsibility, and that these sorts of benefits are a common good that everyone in the country should have access to. There is more of a sense of interdependence versus independence, which I think is a common cultural norm in this country. There is a deeper sense of what we call Ubuntu, which is a responsibility to community.

When I think about Africa, there's just an increased sense of extended familial relationships. So, you understand that who you call family might not be your immediate family, and yet you're responsible for them anyways. And so, there's a difference in how we culturally see and value the work of care, the work of caregiving, the understanding of family and community, and our responsibility to that.

Robert Espinoza: It's an excellent point, Josie, and we have so much to learn as a country from all countries around the world about what it means to care for families and how policy can play a role. You mentioned this earlier, which I want to talk a little bit more, about societal inequalities.

We know that most care workers are women, women of color, immigrants, and they're struggling often with poverty. Likewise, research does show that the life and the aging trajectory on average of a woman of color, as just one example, is much harsher than that of a white man. And we need to look at the systems in order to understand why. What do you believe are the reasons for these inequities, and how do they play out in the issues that you're addressing?

Josephine Kalipeni: I think we have to reckon with the reality that this country was established by and for white, elite, wealthy men. And when that is the foundation of a country's systems and policies, it starts off intentionally exclusive versus intentionally inclusive. And when that's deeply rooted, it takes time and intensive long-term work to change that. But it also means that it's deeply ingrained into systems, and policies, and key decisions that impact everyone else that is not of that profile.

It means that the care infrastructure that existed during colonialism and when folks were quote-unquote, ‘founding this country,’ was based on devaluing care, seen and unseen care, devaluing the role of women in general, let alone women of color and black enslaved women's care. And then, when you overlap that with capitalism, which is deeply concerned with the bottom line number and the profit margin, you're going to develop a system and a country that is based on finding as many areas to cut and devalue as possible in order to increase the profit margin that only benefits a select few. And, oftentimes, that combined with the idea that we devalue care and caregiving, seen and unseen care, work and labor, often means that's where the cuts are being made.

Robert Espinoza: What I appreciate about your response is that it shows the harm that these inequities have on women and people of color, and yet, ultimately, it harms all of us if we're not able to access the care. This season of A Question of Care is focused on care workers, and we're asking all of our guests to imagine what our society would look like if we had no care workers. So, Josie, I want to start with just that question. What would our society look like if we didn't have any care workers?

Josephine Kalipeni: Robert, this is a really hard question to imagine and to sit with. It makes my heart swell 10 times over my body, and it makes a big lump form in my throat. For many, many reasons, if I imagine this, I can't imagine that I would be where I am today, particularly in thinking about my mom. My mom was a domestic worker, then a home care worker, then a nurse, then a nursing administrator. It was those foundations of hard work and the resilience she built through that work that contributed to the opportunities I've been able to have and build for myself. I see care workers everywhere, and I think that's because of the nature of our work, Robert. But many people don't see care workers, it is the unseen labor.

But I often think about times that I've been in New York where I'm walking through New York and walking through some of the parks, and you can see who's a care worker at a park with a child or a care worker who's walking through one of the neighborhoods with an older person, paying such close attention and giving such compassionate care, and I imagine what our communities would look like if those care workers were not present. That would mean those kids aren't at the park. That would mean that those children's parents aren't at work. That would mean that elder members in their community is stuck in their homes and not outside walking, and enjoying fresh air, and still engaging in their community.

And I also want to say that I think it would create a complete collapse of our economic infrastructure. Care work is indeed the work that makes all other work possible. I think many of us experienced that during the pandemic, but it would mean that families and parents couldn't get to work. And I am not over exaggerating when I say that I think it would be a collapse of our economic infrastructure to not have care workers.

Robert Espinoza: It does seem like a devastating picture, and it makes me want to talk about solutions so we're never at that point. In 2019, you and I were part of a path-breaking report from the National Academy of Social Insurance that focused on this issue of universal family care, and specifically the unique roles that states could play in creating this type of system, although certainly there are federal opportunities as well. What is universal family care and what are some of the benefits?

Josephine Kalipeni: Universal family care is the policy and programmatic concept that combines key care infrastructure that we know are needed across the lifespan, from child care to paid leave, to home care, to general health care access. And it includes deep investments in the workforce infrastructure needed to uphold all of those care systems and access to those care systems. It's really exciting to think about a continuum of care and a continuum of care benefits that we would be able to depend on and access at any given point of need in a way that's flexible and affordable and takes into consideration equitable and sustainable revenue infrastructure.

Robert Espinoza: There's a role for government, for sure, and yet there's also a role for employers. I noticed that, on your website you highlight, quote “The promising practices of employers who support the dignity of their workers and staff through their workforce policies.” What should employers do to address this issue that we've been discussing?

Josephine Kalipeni: So, I think there's lots of things that employers can do. One, I still don't think that employers necessarily orient their workspace towards the growing population of working caregivers, and that could look different from employer to employer, but is the minimal starting point. Is to ask ourselves as employers, as workplaces, how do we create an environment that is welcoming and supportive of our working caregivers?

The other thing that I would say is that we have to think about paid family and medical leave and the benefits that employers provide to their workers. We've talked to the employers through our partners, like Main Street Alliance, who are small business owners, who will tell you that having a paid family and medical leave benefit is both a retention program, a recruitment program. And being able to provide those benefits in partnership with a state program is affordable and manageable. And so, every employer needs to look into... And then lastly, Robert, I will say we still have a culture in this country where we examine resumes and people's qualifications in a way that looks at gaps in work that disregards soft skills that are gained by being a caregiver, that doesn't look for the opportunities to support care workers and bring on care workers because of soft, transferable skills.

Robert Espinoza: It's an excellent point. And anyone who's ever navigated the care system and the paperwork, all of those details, knows how much skill and knowledge it takes and what you learn along the way. Thank you for that.

Josie, I want to end with one question that really tries to imagine what a society could achieve if we really adopted some of the ideas that you're discussing. If you could wave a magic wand and implement one significant change to better support care workers and family-focused policies, what would it be?

Josephine Kalipeni: I would wave a magic wand and make the experiences of care workers and family caregivers visible and personal to everyone in this country. I really think that it is easy to dismiss care workers and caregivers until it's personal. It's easy to assume what's happening in the caregiving workforce and what benefits family caregivers have until it's personal. So I would just make it visible and personal for everyone.

Robert Espinoza: Josie's emotional reaction to the idea of a society without care workers comes from deep personal experience, and it's one shared by millions of families who know the importance of these workers. They help new parents they employ after a child is born. They provide breaks for family caregivers who are supporting loved ones with dementia, and they assist people with disabilities every single day. Without them, these individuals' lives in our entire society would fall apart.

In this season of A Question of Care, we ask each guest to imagine a world without care workers, their answers are eye-opening. One guest suggests we're not far from this grim reality, another says our economy would collapse, and many agree that it's unimaginable and it must be prevented. Care workers are vital to our society, especially during and beyond health crises. Working in homes and in care centers to keep people healthy and alive, yet they struggle with low wages, high injury rates, and limited career options.

Most care workers are women, often women of color, and increasingly, they are immigrants and older people. They are devalued by public policy and a history of discrimination that, unfortunately, denies them fair employment and earnings opportunities. Join us this season as we explore different parts of the care workforce to learn how our country can support them and create a thriving care economy for everyone.

Thank you to my guest, Josie Kalipeni, and to you, our listeners. If you enjoyed this episode of A Question of Care, please share it on your social channels and stay tuned for future episodes. This podcast was produced by me, Robert Espinoza, in partnership with Modry Media. Please make sure to rate and review the podcast wherever you're listening.