The Age of Diginity: Preparing for the Elder Bloom in a Changing America

Ai-jen Poo with Ariane Conrad

226 pages, The New Press, 2015

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Ai-jen Poo begins The Age of Dignity with a story about her grandfather. She discusses the guilt that she feels because he spent his final months of life in a nursing home—an experience that was “lacking in comfort and beauty.” That story sets up a book that is part personal narrative, part demographic warning, and part call to action. “As America ages, many of us are grappling with the dignity with which our grandmothers, the suns of our universes, will live,” Poo notes. In response to that problem, she off ers a simple vision that many people will want to support. Care, she writes, is “the solution to the personal and economic challenges we face in this country. It doesn’t just heal or comfort people individually; it really is going to save us all.”

Poo, who is director of the National Domestic Workers Alliance, has been organizing caregivers and other workers since 1996. I became aware of her eff orts when, in 2010, she spearheaded the successful campaign to pass the Domestic Worker Bill of Rights in the New York State legislature. In 2014, she became a MacArthur “Genius” Fellow, and in 2012 Time placed her on its list of the “100 Most Influential People in the World.” After years of organizing domestic workers— a labor force that was historically excluded from US labor protections—Poo now aims to organize all Americans to help create a more caring society. “A new society-wide caring infrastructure will enable us to minimize our reliance on the old and often dehumanizing institutional model,” she writes.

The first section of the book introduces readers to a system that is on the brink of failure, and she focuses on three groups that depend on this system. Most important are members of what she calls “the elder boom”—a trend caused by the aging of the baby boom generation and by the fact that Americans are living longer. There are now more senior citizens in the United States than at any other time in history, and the over-85 demographic is the fastest-growing age group in the country. Poo argues that an aging population is actually a blessing. “It is time that we really see and listen to elders,” she writes.

The second group includes members of the so-called sandwich generation. One in eight Americans, most of them women, is juggling responsibilities both for children and for aging loved ones. Increasingly, Americans spend more time caring for elders than they do for their kids. In addition, as families become smaller, each member of the sandwich generation has fewer siblings with whom to share elder care. The current system of informal care is a holdover from a time when life expectancy was about 60 years and when families could rely on women to provide uncompensated care giving labor. Now that so many adults between the ages of 35 and 60 are stretched so thin, that system cannot last for long.

Caregivers, the third group that Poo discusses, make up the fastest-growing workforce in the United States. Their work, although it is in great demand, is difficult and unstable. One-quarter of domestic workers are paid less than the prevailing minimum wage, most do not receive benefits or sick leave, and many experience abuse on the job. Poo wants us to honor this labor—and, more specifically, to improve their access to child care, transportation, and job training. “Turning caregiver jobs into dignified jobs will have a ripple effect of society, on the economy, and on our spiritual health,” she writes. “By doing so, we can affirm the dignity of people at every stage of life.”

Today, Poo contends, we face two possible futures—one marked by increased social polarization, and one characterized by an acceptance of interdependency. Most Americans, she believes, will embrace the latter option. They belong to what she calls the Caring Majority. “In my work,” she writes, “care has emerged as the connective tissue that can keep our diverse interests aligned.”

In the second part of The Age of Dignity, Poo details current efforts to empower this Caring Majority. She advocates building a Care Grid, as she calls it—an infrastructure of support, partly public and partly private, that meets basic needs and brings quality care to every home. One existing eff ort that fi ts her vision is PACE (Program of All-Inclusive Care for the Elderly), an initiative supported by Medicare and Medicaid that delivers subsidized in-home care in 13 states. She also off ers examples from Germany, Japan, and other countries where the care infrastructure is shifting for the better. Many of these examples highlight relationships between middle-aged people and their elders. I wish that Poo had also devoted attention to discussing programs that build partnerships between those who are 25 and younger and those who are 85 and older. There is a lot of untapped potential in such programs.

The Age of Dignity ends with an exercise that involves closing one’s eyes and imagining an ideal future community. In a course that I teach on the sociology of aging, I ask students to engage in a similar exercise, and by and large their visions of an ideal future match the vision that Poo presents in this book. They too seek intergenerational connection, and they too fi nd that they belong to the Caring Majority. As part of the course, students develop semester-long partnerships with local elders, and they are amazed by how much they have in common their older partners. Both groups—the young and the old—yearn for a “circle of care” (to quote Poo) on which they can depend throughout their lives.