The Care 100

In the last year, the worst-case scenario has been realized at so many assisted living homes across the country: covid infection rates soared and so many died, Medicaid patients were evicted for dubious reasons, a sense of desperation expanded as institutions tried to figure out how to keep people safe and apart. In the wake of all of this, many Americans have struggled to figure out how to honor our elders by giving them homes they love. And there will be so many more of them in the year ahead; 10,000 baby boomers turn 65 every day. There is reason to be hopeful. There is a surge in interest in smaller-scale living arrangements like naturally occurring retirement communities (or NORCs) and more intimate versions of assisted living like the Green House Project. The expansion of telehealth and other new healthcare models, like Cityblock Health, are making it more possible for more elders, even those with acute health conditions, to age in place.

These days, parents are more likely than ever to look to intimate, grassroots childcare arrangements; according to the National Survey of Early Care and Education, nearly 4 million providers and caregivers currently care for over 7 million children from birth to age 5 in a home-based setting, far exceeding the number of children cared for in center-based settings (3.8 million). And educators and entrepreneurs are rising to the occasion; on the for-profit side, companies like Wonderschool are making it easier than ever to start your own in-home daycare center, and on the non-profit side, All Our Kin and other long-standing organizations continue their critical work. And it’s not just care for kids that’s getting an overhaul; training for caring for older adults and those with disabilities is also being brought into the 21st century via platforms like CareAcademy with their bite-size, scenario-based online curriculum. Policy is also catching up - many states are passing new laws that protect home health aids, nannies, and house cleaners, and Biden is running on a platformthat includes fair pay, the right to unionize for professional caregivers and more support for home caregivers.

COVID has made clear that many of us are struggling with mental health issues and that it’s normal to reach out for help. We are seeing many more companies willing to direct benefit money towards therapy, as well as many new startups iterating on remote mental health models. And this isn’t just an elite phenomenon; The Centers for Medicare & Medicaid Services dramatically expanded telehealth reimbursement benefits for Medicare patients, including mental health care. AARP estimates that as many as 8 million older adults in America struggle with isolation and that it can be as bad for your health as smoking 15 cigarettes a day. It’s exciting, though, to see that elders are gaining new technological skills at unprecedented rates - accessing lifelong learning opportunities and logging onto Grandpads so they can stay connected with far-flung loved ones. And AI chat bots, like Lena, are not only giving elders a social outlet, but connecting them with much-needed services. In the words of Mahmee CEO Melissa Hanna, “We are trying to figure out how to “digitize and dignify” care.

As the economy came to a grinding halt during COVID-19, the importance of frontline care – and its absence – was felt more acutely than ever. But the average daycare worker earns around $11/hour, home care workers have an annual income of $13,800. Simultaneously, for consumers, care is tremendously expensive with Americans spending around 25% of net family income on childcare and 61% of family caregivers of an older relative saying caregiving has impacted their wages or employment situation.

For too long, we’ve talked about American families as if they are all nuclear, hetero, autonomous, and able-bodied. In fact, we create families in an astounding variety of configurations and, as such, the solutions we design have to reflect this variety. We also know, despite enduring stereotypes, that Black and Latinx fathers are actually more likely to do daily care work than White fathers are. According to Pew Research Center, 41% of American children are now born outside of the context of marriage. Meanwhile, sons are increasingly stepping up to care for their parents and other elders; of the 40 million family caregivers in America, nearly half of them are men. We are beginning to hold media makers accountable when they perpetuate outdated ideas about who the American family is and encouraging them to tell better, more interesting stories instead. And what’s more, we are starting to develop products - like Daybreak Health and Milo - that frame caregiving as a collective endeavour, not just women’s work.