Productivity and Affinity in the Age of Dignity

PRODUCTIVITY AND AFFINITY IN THE AGE OF DIGNITYTHE AGE OF DIGNITY: PREPARING FOR THE ELDER BOOM IN A CHANGING AMERICA. By Ai-jen Poo with Ariane Conrad. New York and London: The New Press. 2015. P. 176. $25.95.INTRODUCTIONAmericans are living longer than ever before. The decline in the infant mortality rate, a reduction in heart disease- and cancer-related deaths among adults, and the successes of other public-health initiatives help explain our newfound national longevity.1 Traditionally, the elderly have been cared for by family members, but the "elder boom"-and the uncertain period of care it invites-is testing the limits of what families can do on their own. While our lives have gotten longer, our pockets have not necessarily gotten deeper. The strict policies on eldercare-related leave that most workplaces continue to maintain exacerbate this reality.2 The challenges posed by the elder boom go beyond finding enough money to pay for services. Even the wealthy among us-who can afford outside help-have reasons to worry about securing care for their elders: labor studies project a shortage of caregivers in future labor markets.3 All of this forces an urgent question: Who will take care of us once we are too old to take care of ourselves? Ai-jen Poo,4 a nationally recognized activist and 2014 MacArthur "genius grant" recipient, takes up this question in The Age of Dignity: Preparing for the Elder Boom in a Changing America.5In tracing the consequences of the coming elder boom, Poo begins with the observation that existing federal programs offer very little support for those in need of home care (pp. 35-36). She notes that Americans overwhelmingly prefer to care for their elders at home with the help of family, but that such an arrangement is simply too costly for most families (pp. 2, 5). Programs like Medicaid provide some coverage for home-care services but only for those at the lower end of the wage scale (pp. 36-37). Such a policy most directly affects middle-class Americans who have no meaningful options when it comes time to care for an elder (pp. 32-36). Meanwhile, the difficult work of home care, domestic work, and nursing is often performed by immigrant women, and especially unauthorized immigrant women, which means that caregivers are often underpaid6 and lacking in basic workplace protections.7 Caregiving takes place at home beyond the public's view, which makes detecting labor and employment violations virtually impossible.The Age of Dignity concludes with a call for a "comprehensive federal policy of caring" that makes eldercare more affordable for those who need it and less exploitative of those who provide it (p. 154). Poo's vision for reform includes a number of different interventions, ranging from expanding the availability of tax breaks (thus alleviating some of the burden borne by middle-class families)8 to the bolstering of existing labor protections (thus ensuring a safer and more dignified workplace for caregivers).9 The Age of Dignity also offers support for comprehensive immigration reform that includes a path to citizenship, a reduction in deportations, and a system for managing future flows of care workers (pp. 163-65). It is this last aspect of the book that I focus on in this Review. Poo argues that immigration reform should include "channels for workers to migrate legally to the United States in the future to work as care workers" and that these channels should include anti-exploitation features like "portable status" to prevent wards and their families from exploiting these workers (p. 164). This Review examines Poo's choice to lodge her vision of reform within the labor migration system. Pushing for greater opportunities and stronger protections for labor migrants offers intuitive appeal. After all, Poo advocates on behalf of eldercare workers. But the intuitive choice is not an inevitable one, or even the best one depending on one's larger aspirations.To start with, caregiving work undermines what I call the "productivity/ affinity" binary, which undergirds our immigrant admissions system. …