The Care Infrastructure: Building Across Movements


Care is a universal experience that rose to the top of the national agenda during the pandemic. But it has always been devalued, because it is generally performed by women, by Black and Brown women in particular, with roots in the history of slavery. Care workers are invisible, underpaid, and overworked. It is past time we consider care a part of our country’s infrastructure, and support and compensate it accordingly. The Domestic Workers Alliance, Caring Across Generations, and Family Values @ Work are teaming up to change laws, cultural norms, and narratives about care and caregiving, and to improve the quality of jobs by centering those most impacted by the work of and demand for care.

Key Words:

care, caregiving, family caregiving, paid care workers, domestic workers, devaluing, Sandwich Generation, infrastructure, Black and Brown women

Care is a universal, shared experience. Every person—of every socioeconomic background, of every race, and across every stage of life—needs care. It is a universal experience—whether as an infant, when recovering from an illness, living with a disability, or as we age. And it is a shared experience—whether as a person needing care or as someone providing care. Rosalynn Carter famously said, “There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers” (The Carter Center, 2011). Care is the most fundamental of human needs, and providing care is among our most important connections to one another.

The COVID-19 pandemic raised our collective need for care to the top of the national agenda. When we sheltered in place and the economy stalled, we acutely felt the absence of the care we rely upon daily. As nursing homes shut down to stop the spread of the virus, families scrambled and our older loved one were suddenly disconnected from the world.

As schools and childcare establishments shuttered, parents—mostly mothers— struggled to manage remote learning and child rearing while working from home, if allowed, resulting in women (disproportionately women of color), leaving the workforce in record numbers (Kashen, Glenn, and Novello, 2020). One year into the pandemic, some 1.6 million (Heggeness et al., 2021) working mothers had left the workforce.

Within a matter of days, the pandemic sharpened our awareness that the care we need will require a more comprehensive, systemic response. COVID-19 shredded our misplaced feeling of embarrassment that somehow our care needs are our unique problem or personal failure. As we struggled to reorient our lives within the constraints of the pandemic, we examined with fresh eyes the systems that had long been in crisis.

Care workers, who have been underpaid and overworked, didn’t have access to the PPE, paid time off, or healthcare they needed to work safely. Domestic workers—the nannies, caregivers, and house cleaners who work in our homes—struggled even more to feed their families and hold onto their homes, as they lost jobs in devastating numbers, without access to economic relief. As working women of color, who are usually the breadwinners and primary caregivers of our households, we found ourselves further squeezed between work, care demands, and an inequitable care system that was never designed with us in mind.

In the moment we all needed care, we saw how fragile our patchwork of care has always been.

Care Historically BIPOC Women’s Work and Underpaid

Historically, care has been the work of the women in the home. Even as recently as 2019, moms reported (U.S. Bureau of Labor Statistics, 2021) the hours they spent on caregiving and housework at nearly double the hours dads reported. Some of the earliest care workers in the United States were enslaved African women, and even today more than half (Wolfe et al., 2020) of domestic workers are Black women and women of color.

While care work is the infrastructure upon which our society and economy are built, it is, at once, invaluable and systemically devalued by a legacy of slavery enshrined in laws dating back to the New Deal in the 1930s that excluded domestic workers from wage and labor protections, while guaranteeing other workers these rights.

Many Sandwich Generation caregivers are also paid care workers, facing even greater stressors.

Today 91 percent (Wolfe et al, 2020) of domestic workers are women, nearly 95 percent (U.S. Bureau of Labor Statistics, 2020a) of childcare workers are women, and an estimated two in three (Family Caregiver Alliance, 2015) family caregivers are women. Study after study on the persistence of the gender wage gap in the United States show that occupations that employ a larger share of women—such as those in the care sector—often pay lower wages simply because they’re female-dominated professions.

The median hourly wage for all domestic workers is $12.01 per hour (Wolfe et al., 2020), compared to $19.97 for other workers. The median wage for a homecare worker is $11.52 per hour (Scales, 2019), and $12.24 (U.S. Bureau of Labor Statistics, 2020b) for a childcare worker. The systematic underpayment and devaluing of caregiving, and the women of color who provide that care, is steeped in this nation’s history of dependence upon coerced or underpaid labor and the marginalization of women—particularly Black and Brown women—immigrants, indigenous, and enslaved people, and their descendants.

Care also has been invisible work, often taking place in the privacy of people’s homes, out of view of the public. Care workers enter homes to begin their workday as others leave to begin theirs. Without a formal contract, many care workers lack any guarantee to rights, recourse, or basic benefits, such as paid leave. Family caregivers—unpaid family members who care for a loved one—also are vulnerable. They provide, on average, nearly 36 hours of care per week (Horwitt, 2019) and, for many, this is on top of their paid job: 69 percent of family caregivers are employed, including 55 percent who are employed full-time.

The economic impact of caregivers is severe: according to AARP (2020), 18 percent of caregivers report high financial strain as a result of caregiving, 45 percent have experienced at least one financial impact, 28 percent have stopped saving, and 23 percent have taken on more debt. Women who work outside of the care industry but have care demands at home often work in a culture that sees their care demands as a weakness or an employment risk. And these same women, much like the women performing domestic work, often lack adequate access to paid leave, equal pay, and advancement opportunities.

In fact, we authors both see ourselves among the “Sandwich Generation” of caregivers: 47 percent of middle-age adults (Parker and Patten, 2013) who are caring for loved ones on both ends of the generational spectrum—children and aging parents. We know that most kids are like ours—growing up in households where all of the adults work outside of the home, out of necessity.

We know lots of families where the Sandwich Generation caregivers are, themselves, also paid care workers, facing many more stressors. Priscilla Smith, 42, learned what it meant to be a caregiver at age 19 when her father was diagnosed with prostate cancer. As a home health aide, Smith worked with aging or disabled people authorized to receive care in their home. When her youngest daughter was diagnosed with a disabling disease, she took on that additional responsibility. Although as a family caregiver Smith is doing the same job she performed professionally for years, she is not paid to provide care for her daughter because state care programs do not recognize the work of family caregivers as deserving of similar compensation and support. While she remains as committed to her clients as a compassionate homecare worker as she does to her daughter in her role as family caregiver, her situation is unsustainable.

We all rely upon infrastructure—communication systems, energy grids, transportation networks—to ensure our full participation in civil society and in our economy. It’s past time our infrastructure investments included care. Each year 4 million children (Martin et al., 2021) are born in the United States, and 4 million people in the Baby Boomer generation (U.S. Census Bureau, 2019) turn age 65. Our country’s collective need for care is growing at both ends of the lifespan of the American population. And meeting these care demands often comes at the cost of taking care of ourselves. Our historic lack of investment in care is documented as costing our country an estimated $64.5 billion (Kashen, Glenn, and Novello, 2020) per year in lost wages and economic activity.

Advocacy Groups Teaming Up to Fight for Fair Wages and Rights

At the National Domestic Workers Alliance, the nation’s leading voice for the respect and dignity of domestic workers, we have formed a coalition of more than seventy-seven affiliates and chapters representing domestic workers across the nation, including We Dream in Black chapters specifically focused on the power and aspirations of Black domestic workers.

Ten years ago, together with Jobs with Justice, we launched Caring Across Generations, to bring us together as a nation, to change the way we value caregiving in our society, and to build a care infrastructure that supports individuals and families in need of care, and the caregivers who provide it (both family caregivers and professional care workers).

Caring Across Generations became a platform to work with organizations such as Family Values @ Work (FV@W), a network of more than sixty state anchor organizations in more than twenty-seven states working on economic justice for Black and Brown people.

‘Our historic lack of investment in care is documented as costing our country an estimated $64.5 billion.’

For nearly two decades, FV@W has helped lead the national push to create a new infrastructure––one founded on care, equity, and respect. Through a network of thirty-five state anchors across the country, we’ve kept up the drumbeat for state and national policies that cover every worker and every working family. These state-based activists won paid leave in nine states and in the District of Columbia, and their work provides a blueprint for an inclusive, permanent federal program. Led by women of color, the FV@W network centers the lived experiences of workers nationwide, amplifying their voices, elevating their stories, and supporting their activism.

Together, we have sought to change laws, cultural norms, and narratives about care and caregiving, and innovate to improve the quality of jobs for all workers in our economy by centering those most impacted by the work of and demand for care. As a result of strategic partnerships like ours that bring together care workers and those who need care, states now have policies on the books for increasing wages, protecting domestic and care workers, and implementing paid family and medical leave, providing a sound model for Congress to follow as it contemplates programs within the Build Back Better budget reconciliation.

Whether it is powerful domestic workers like Priscilla or impacted worker activists, our members keep our efforts anchored in the real need for time to care, and remind us that everyone needs time to care: no matter where you work, where you live, or who you love.

The pandemic deepened our country’s care crisis, a strain already common to working and caregiving women of color. To truly act as infrastructure, the movement for care has to connect each community and family across the country—as do roads and bridges. We now have a once-in-a-generation opportunity to build a care infrastructure that is equitable and reflects our shared desire to care for our families and to live and work with dignity, regardless of age or ability.

We need universal paid family medical leave so that workers don’t risk their livelihoods when they need to provide care to loved ones. We need to ensure universal access to safe, affordable, high-quality childcare from birth to school age. And we need long-term services and supports, through Medicare and Medicaid programs, to ensure dignity, independence and quality of life for people of all ages and abilities. This can all be done while raising wages, and in an environment and climate that is safe for all caregiving families. Access to quality care options shouldn’t be limited to the extremely wealthy, and care workers shouldn’t be working for poverty wages.

The impact of care—or lack of access to it—ripples through society, determining who participates in the labor force, and the quality of life we offer to our loved ones who need care to live full, dignified lives. We must begin to see care as a public good rather than a personal burden, and care failures as system failures rather than personal failures, worthy of public intervention and investment.

We can’t go back to the “normal” we lived before the pandemic. It wasn’t working for most of us. We can’t thrive as a country on the hope that if (or when) we need care, we’ll be able to find it or afford it. We won’t forget the care workers who went to work despite the risks because they lacked paid leave and for whom poverty wages create too-close margins to afford an extended absence. We can never again see past the invisible workforce—paid and unpaid—who support our society and economy with care that we all collectively rely upon. The pandemic is the crisis we didn’t want, but might be the crisis it took for us to collectively change the way we see, value, and invest in the care infrastructure that we all need.

Ai-jen Poo is the cofounder and executive director of the National Domestic Workers Alliance, and cofounder and director of Caring Across Generations. Sade Moonsammy is the deputy director at Family Values @ Work.


AARP. 2020. “Caregiving in the U.S.” Retrieved September 15, 2021.

Family Caregiver Alliance. 2015. “Women and Caregiving: Facts and Figures.” Retrieved September 15, 2021.

Heggeness, M. L., et al. 2021. “Tracking Job Losses for Mothers of School-Age Children During a Health Crisis.” U.S. Census, March 3. Retrieved September 15, 2021.

Hewitt, J. 2019. “Key Findings From Survey on Caregiving.” HART Research. Retrieved September 15, 2021.

Kashen, J., Glynn, S. J., and Novello, A. 2020. “How COVID-19 Sent Women’s Workforce Progress Backward.” Center for American Progress, October 30. Retrieved September 15, 2021.

Martin, J. A., et al. 2021. “Births: Final Data for 2019.” National Vital Statistics Reports. Retrieved September 15, 2021.

Parker, K., and Patten, E. 2013. “The Sandwich Generation.” Pew Research Center. Retrieved September 15, 2021.

Scales, K. 2019. “Envisioning the Future of Home Care: Trends and Opportunities in Workforce Policy and Practice.” PHI. Retrieved September 15, 2021.

The Carter Center. 2011. “Written Testimony of Former First Lady Rosalynn Carter Before the Senate Special Committee on Aging.” Retrieved September 15, 2021.

U.S. Bureau of Labor Statistics. 2021. “American Time Use Survey News Release,” July 22. Retrieved September 15, 2021.

U.S. Bureau of Labor Statistics. 2020a. “Household Data Annual Averages.” Retrieved September 15, 2021. U.S. Bureau of Labor Statistics. 2020b. “Childcare Workers.” Occupational Outlook Handbook. Retrieved September 15, 2021.

U.S. Census Bureau. 2019. “2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers.” Retrieved September 15, 2021.

Wolfe, J., et al. 2020. “Domestic Workers Chartbook: A Comprehensive Look at the Demographics, Wages, Benefits, and Poverty Rates of the Professionals Who Care for Our Family Members and Clean Our Homes.” Economic Policy Institute, May 14. Retrieved September 15, 2021.