Our Caregiving Crisis Is a Values Crisis

We need to ask ourselves, what do we value in the new world we are building?

Juanmonino / Getty Images
Juanmonino / Getty Images

We don’t know when the pandemic will end, but we can clearly see some of the fundamental cracks in our society that it has exposed. These cracks reveal the pre-existing conditions we went into the pandemic with. And one of the most urgent among them is our caregiving crisis. 

People caring for other people — for children, whether at home, day care or school; for parents and grandparents; for the sick or disabled — is the tie that binds all other parts of our society together. It’s what makes our families, our communities and our economy work. The caregiving economy is now in tatters, and if we are going to build an economy of the future that is healthy, equitable and sustainable, caregiving has to be at its center. 

Transformative change rarely happens without a catalyst or a crucible — a time of profound disruption that necessitates the creation of something new and better. That’s why it’s not enough to simply restart an economy that was already not working for millions.

Caregiving was a crisis that was surging long before anyone had heard of COVID-19. In 2018, the U.S. Bureau of Labor Statistics estimated that the number of home health aides and personal care aides was projected to grow 36% by the year 2028. And yet the median annual wage was just over $24,000.

Likewise, our nursing homes, which have accounted for 42% of pandemic deaths, were already in a state of crisis. In May, a study in the New England Journal of Medicine declared that “long-term care in the United States has been marginalized for decades,” and called for “a time of reckoning.” About 1.5 million of those 65 and over live in nursing homes, while there are 2.6 million “grandfamilies” in the U.S. — households in which grandparents provide caregiving for children. But of those, one-fifth were living at or below the poverty level. 

What can we do to support this kind of organic family caregiving? It was central in my own life, as my mother lived with us and helped me care for my children up until she died. Part of the solution involves changing social norms, which would make multigenerational families more common, as they are in many countries. 

Of course, child care was already in a state of crisis long before we tried the wildly problematic experiment of combining “remote learning” with “working from home.” Here are the stats that are fueling the deepening crisis as we look at most schools not opening in the fall: Two-thirds of single moms work, and two-thirds of married parents with children both work. According to a June survey from the University of Oregon, 47% of the respondents said they’d lost the child care arrangements they had before the pandemic.

“We are not burned out,” wrote Deb Perelman in The New York Times, “because life is hard this year. We are burned out because we are being rolled over by the wheels of an economy that has bafflingly declared working parents inessential.” 

And of course, we know the burden of child care doesn’t fall equally on mothers and fathers. And that already lopsided burden has become much heavier for millions of working mothers during the pandemic. 

The trade-offs women were facing were already having an impact on their careers, but as University of Michigan labor economist Betsey Stevenson put it: “The impact of the child care crisis on women’s outcomes is going to be felt over the next decade.” A study published in July in the journal Gender, Work & Organization found that in households with young children, mothers had reduced their work hours four to five times more than fathers.

In July, Joe Biden rolled out his caregiver economy plan. The $775 billion proposal includes expanded child care programs and tax credits for working parents, expanded long-term care access for the elderly and disabled, universal pre-K, funding for the construction of new child care centers and a bailout for the many that are at risk of being shuttered. The plan has a goal of creating three million caregiving jobs and calls for higher pay for caregivers, whom Biden said are “too often underpaid, unseen and undervalued.”

And a week later, the House of Representatives passed a $60 billion package to support child care. The two bills, The Child Care is Essential Act and the Child Care for Economic Recovery Act, would provide funds for added personnel, training, safety programs, construction and renovation for child care centers. As Rep. Rosa DeLauro (D-Conn.), one of the bill’s sponsors put it, “We are not going to reopen this economy if there isn’t a substantial child care investment.” 

It’s a good start, but this isn’t something that can be fixed just with tax credits and new construction alone, as valuable and necessary as those may be. Our caregiving crisis is a values crisis. It requires rethinking our economy at a more fundamental level. We need to ask ourselves, what do we value in the new world we’re building? And can we create an economy that more accurately reflects and values what we know should be valued?

In fact, even before the pandemic, another crisis that should have forced us to ask ourselves these questions was already bearing down on us. In his brilliant book, A.I. Superpowers: China, Silicon Valley, and the New World Order, Kai-Fu Lee, a venture capitalist and former President of Google China, argues that, since A.I. and automation are going to take away half of all jobs in the next decade, we should reorient our economy around what A.I. can’t replace: “humanistic labors of love.” Which is to say, caregiving. “Doing this,” he writes, “will require rewriting our fundamental social contracts and restructuring economic incentives to reward socially productive activities in the same way that the industrial economy rewarded economically productive activities.”

Lee’s proposal for how to get there involves what he calls a “social investment stipend,” which would mean adequately rewarding those who spend their time creating a “kind, compassionate, and creative society” in child care, caring for the elderly, helping those with disabilities and community service (like after-school programs). “Orchestrating a true shift in culture will require not just creating these jobs but turning them into true careers with respectable pay and greater dignity,” he writes.

“No economic or social policy,” Lee writes, “can ‘brute force’ a change in our hearts. But in choosing different policies, we can reward different behaviors and start to nudge our culture in different directions.” And nothing has shown us the urgent need for a new direction like the pandemic has. Amid all the challenges and tragedies of this time, we’re presented with a transformational opportunity to shed and purge what was not working, augment our humanity, rebuild what we have neglected and emerge stronger than before. Why should women have to choose between their careers and their children? Why do we underinvest in early childhood education when we know the lasting benefits it brings? Why are we not as focused on keeping schools open as we are with keeping airlines flying? Why are people not given the support they need to keep their parents at home, instead of feeling like they have to send them off to isolating and underfunded institutions?

We’ve honored caregiving in the tradition of the 7 p.m. clap, a nightly way for residents of many cities to publicly honor essential frontline workers. We need to extend that spirit. Caregiving is something that happens not just at hospitals but within every family and in every community. It’s the connective tissue that makes us thrive, both individually and collectively.

The pandemic has changed everything about our lives and exposed both what was overvalued and what was undervalued. As we rebuild, we need to create a caregiving economy that strengthens and rewards the ties that bind us. 

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