Aging in America News

| Highlights from Season 2 of The “Question of Care” Podcast

| A longtime leader in aging, caregiving and the workforce as well as a Distinguished Fellow at the National Academy of Social Insurance, Robert Espinoza recently wrapped up the second season of his award-winning podcast A Question of Care. Each episode features an expert guest discussing a different dimension of the care economy. A season 2 eBook with all the transcripts comes out September 1. 

Here, we present a few of the most memorable moments from these dialogues.

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

Guest: Josephine (“Josie”) Kalipeni, former executive director, Family Values @ Work

It always stuns me that so many industrialized countries have much better family policies and healthcare support than the U.S. Why is that?

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.

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S2E2: How Should Society Invest in Childcare Workers?

Guest: Julie Kashen, director, Women’s Economic Justice and senior fellow,  Century Foundation

How would you strengthen the public narrative on childcare work to finally achieve [greater public investment]?

I think we need to dream bigger. I think we need to keep imagining what’s possible. Can we think about what if there were a childcare program that was free to families, that was paid for with public funds, where early educators were paid well. And it was in every community, and you could just count on that. And that those programs really worked for every family because there was a diversity thinking about cultural needs, thinking about children with disabilities, and what their needs are, and there was enough money in the system to support everyone.

S2E3: What Future Can We Imagine for Home Care Workers?

Guest: Helen Adeosun, CEO and Founder, CareAcademy

What are the qualities and characteristics that allow a home care worker to succeed?

We have to see the home care worker as the Swiss Army knife across all the things we expect lots of clinicians to do in our lives.

How can we ensure that home care workers receive adequate training and support to meet the diverse needs of the people they’re serving?

We need to make it part and parcel of any other training system and expectation that we have within healthcare. I think some states are already moving ahead in that. 

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S2E4: Who Supports People with Developmental Disabilities?

Guest: Joe Macbeth, President and CEO, National Alliance for Direct Support Professionals

What are some of the challenges faced by direct support professionals in their day-to-day work?

Well, I think, if you surveyed 100 direct support professionals, 99 of them would say that the wages are not adequate. That’s not a living wage. And this is not a new issue. Direct support professionals have always been low-wage earners. And it’s complicated, but it’s, in large part, due to society that may not value people with disabilities, therefore they may not value the people who support people with disabilities. Wages are a long-term issue. Many direct support professionals work more than one job. Many of them work a lot of overtime, and they are suffering. We just helped the state of New York do a survey with nearly 4,000 direct support professionals. Half of them report that they have insecurities around housing and insecurities around food.

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S2E5: Why Are Nursing Assistant Jobs Overlooked?

Guest: Kezia Scales, Vice President, Research and Evaluation,  PHI

In terms of demographics, who is the typical nursing assistant?

Consistent with the caregiving workforce overall, the typical nursing assistant is a woman of color in her middle years, around 40. Also, about 20% of nursing assistants were born outside the United States.

They are some of the most marginalized populations in this country. How does this demographic reality affect how nursing assistants are treated?

I would add one further element of marginalization, which is that nursing assistants also work the physical margins of our communities, in nursing homes, behind closed doors, in places where most people don’t go or don’t even see until they or a loved one needs that level of care. All of these compounding factors make it an uphill battle for nursing assistants to be seen and recognized, and for their jobs to be improved through better wages, better benefits, better training, and so on…. But, at the same time, it’s important to say that there is a lot of effort underway right now to improve conditions for those who give and receive care. So, the marginalization that you described is all too real, but it’s not inevitable or intrinsic to the care economy. It can be made visible, and it can be overcome.

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S2E6: Why Aren’t More People Using Consumer Direction?

Guest: Corinne Eldridge, President and CEO, Center for Caregiver Advancement

What are the key principles of consumer direction programs in home care, and how are they different from traditional home care models?

A consumer-directed program ensures that the voice, the deeds, and the desires of the consumer are honored and are centered in the values of the program and how they get care from an individual.

When you think about the policies and cultural shifts that are needed to expand and strengthen consumer direction, what are those policies and cultural shifts?

One of the main changes, I think, is around narrative change on the value of this work, the value of this workforce, the people who are doing this work, and the fact that what they do keeps low-income seniors and people with disabilities out of institutional care.

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S2E7: Who Are the Care Workers in Hospice and Palliative Care?

Guest: Brynn Bowman, CEO, Center to Advance Palliative Care

What are some of the most common misconceptions about palliative care?

The most common misperception… is that palliative care is about end of life. This feeling that, “Oh, my patient’s not ready for palliative care, or they’re not sick enough yet.” …. If you have a diagnosis of serious illness, you have pain, you have symptoms, you have difficult decisions that you’re sifting through. You have trouble getting to the clinic to go to your doctor’s appointment. You have fear about the future. Those are the issues that palliative care teams deal with, and those can happen from the moment of diagnosis on. So,we are very careful to make sure that patients understand, families understand, clinicians understand that palliative care is not an end-of-life service, it’s an added layer of support at any point while you’re coping with a serious illness.

What kinds of public policies or systemic changes do you believe are needed to better support care workers in palliative care?

If we’re talking about care workers, they need a living wage, period. And the way that we pay them needs to match what is happening in the lives of people with serious illness.

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S2E8: How Are Home Care Businesses Evolving for Workers?

Guest: Kevin Smith, CEO and owner, Best of Care

What are some of the most profound lessons you’ve learned as a business owner about the home care system and about workers in particular over the years?

What is profound as well as surprising, and I’m gleaning this sort of anecdotal data point from an employee survey that we did in late 2023 where, above all, what was most important to home care workers at Best of Care, beyond pay, was loyalty and dedication to their clients. And neck and neck with that was education, opportunities, training… which training always carries this really nebulous sort of attachment in the home care industry.

Why are wages so low in this sector, and how would you address this challenge at Best of Care? How do you address this challenge?

Wages are so low because most home care organizations are totally controlled by the rate of [Medicaid] reimbursement. If you’re only getting paid $20 per hour by the payer source, what are you supposed to do?ss aging and disability is going to become even more important in the future.