I’m curious for your take on the care economy from an impact investor’s perspective. If annual childcare in Seattle averages at $14k per year, my first thought is that I could build a great business taking care of 100 kids ($1.4M revenue) while providing decent livelihoods to immigrant workers. What is the state of innovation in childcare? Are there any federal or local policies that incentivize care innovation? Philanthropy or impact investing?
Also, have you read Being Mortal by Atul Gawande? He compares US and Indian approaches to elder care, including multigenerational housing, where grandparents are expected to care for their grandchildren while getting free elder care in exchange. I know why I don’t want to live in multigenerational housing, but I’m curious if you think it’s something to be encouraged to address the cost of childcare, elder care, and elder loneliness?
I feel like there’s relatively little innovation in childcare. There are a lot of immigrants working in childcare, but for low wages making it tough to live in the cities where they work. Same with elder care. And lower cost care seems to be pretty correlated to lower quality in my experience (less training, high turnover, higher ratios etc). The Au pair program is kind of an example of what you’re describing at the individual level. And most people end up paying their Au pairs more under the table to keep them happy - plus the trade off of having someone living with you. Angela Garbes in Essential Labor describes the US program to recruit Philippino nurses and doctors which resulted in a lot of exploitation. Most of the social innovation in care seems to be tech-based efficiencies or employer-sponsored benefits. Great topic for another newsletter :)
I think the math that David show is why there has been a lot of private equity movement into child care. But I think there are some very hard limits to innovation and efficiencies that can be squeezed out of the sector. There are regulatory obstacles to innovation in center-based childcare - staff-to-child ratio requirements, liability insurance, staff certifications. etc. To the extent that innovation is aimed at reducing labor costs, there isn't a lot that can - or should - be done. I think there's lots of innovation possible for non-center-based care - but also not as big or clear a market. As Anna says, a lot of the investor-class has focused don employer-based services, concierge services, payment management. Some of that has value, but we really need to create a bigger base of support, interest, consumers to make them viable.
We lost my father-in-law to Parkinson's on Monday. In the month before his death, one of his symptoms was aggression and so the nursing facility (supposedly a comprehensive facility ranging from independent living to end of life care) told our family that in order for him to stay we had to pay for their in-house one-on-one support person to the tune of $1,000 per day (on top of the $13,000 per month he paid just to be in the facility). We ended up transferring him to another smaller facility that was able to care for him in what turned out to be the last weeks of his life. It never occurred to us that the facility could charge so much extra for care for a person with expected symptoms of Parkinson's since this was never disclosed to us as a possibility! $1,000 a day. A day! Now that is care math!
I’m so sorry for the loss of your father-in-law. yes, that is some wild care math. And unfortunately I think not uncommon. I was also told that my mother’s first assisted living could handle every stage of care, only to find out that wasn’t the case, and that the cost would triple even before maxing out the level of care. The lack of transparency is hugely problematic.
Another amazing piece, Anna. But whew it’s tough to read. Care math is intense these days. Thank you for shedding light in it and continuing the conversation about our unsustainable society.
🤪😫😱 We need a special caregiving emoji. I'm equally thankful you've laid this all out, disgusted at the costs and shocked.
Before we can discuss cost, there are issues of availability of resources. It's a postcode lottery in the UK: https://www.carermentor.com/p/burning.
I can't lay out the costs because Mum and I cared for Dad, and I care for Mum now. The support we had was from a private carer and a hospice-at-home charity in the last months of Dad's life ( 4years into caring for him)
I had no idea of all the cost and care issues when I chose to help my parents because my choice was motivated by their needs and my love; because I could, was able to and wanted to, I did.
Now, my eyes are wide open. I'm still trying to get my head around it all - it's a maze, and just like I felt in 2015, there's a tsunami of information but no rosetta stone to translate it all! It asks every person to try to learn a system and fit into what's on offer. Impossible in a crisis.
So, the UK has a VERY convoluted care math, a system without resources and a large crisis which is still perceived in the realms of 'not-me-dom'.
I'll be interested to hear other viewpoints on your article.
Yes availability seems to be a rising problem everywhere, particularly post-Covid. The not-me-dom is a great way to describe part of the transparency issues - no one particularly wants to think through possible worst case scenarios, or even the best case ones when it comes to aging and end of life.
Great piece, thanks for linking to my work on summer camp!
Thanks for reading Katherine, I’ve been following your work for a while, I’m a fan and it’s great to be connected!
I’m curious for your take on the care economy from an impact investor’s perspective. If annual childcare in Seattle averages at $14k per year, my first thought is that I could build a great business taking care of 100 kids ($1.4M revenue) while providing decent livelihoods to immigrant workers. What is the state of innovation in childcare? Are there any federal or local policies that incentivize care innovation? Philanthropy or impact investing?
Also, have you read Being Mortal by Atul Gawande? He compares US and Indian approaches to elder care, including multigenerational housing, where grandparents are expected to care for their grandchildren while getting free elder care in exchange. I know why I don’t want to live in multigenerational housing, but I’m curious if you think it’s something to be encouraged to address the cost of childcare, elder care, and elder loneliness?
I should stop, but just saw this: https://www.theatlantic.com/ideas/archive/2024/02/private-equity-childcare/677511/
And a related headline: “Empty Nesters Own Twice As Many Large Homes As Millennials With Kids” https://www.redfin.com/news/empty-nesters-own-large-homes/
I feel like there’s relatively little innovation in childcare. There are a lot of immigrants working in childcare, but for low wages making it tough to live in the cities where they work. Same with elder care. And lower cost care seems to be pretty correlated to lower quality in my experience (less training, high turnover, higher ratios etc). The Au pair program is kind of an example of what you’re describing at the individual level. And most people end up paying their Au pairs more under the table to keep them happy - plus the trade off of having someone living with you. Angela Garbes in Essential Labor describes the US program to recruit Philippino nurses and doctors which resulted in a lot of exploitation. Most of the social innovation in care seems to be tech-based efficiencies or employer-sponsored benefits. Great topic for another newsletter :)
I think the math that David show is why there has been a lot of private equity movement into child care. But I think there are some very hard limits to innovation and efficiencies that can be squeezed out of the sector. There are regulatory obstacles to innovation in center-based childcare - staff-to-child ratio requirements, liability insurance, staff certifications. etc. To the extent that innovation is aimed at reducing labor costs, there isn't a lot that can - or should - be done. I think there's lots of innovation possible for non-center-based care - but also not as big or clear a market. As Anna says, a lot of the investor-class has focused don employer-based services, concierge services, payment management. Some of that has value, but we really need to create a bigger base of support, interest, consumers to make them viable.
We lost my father-in-law to Parkinson's on Monday. In the month before his death, one of his symptoms was aggression and so the nursing facility (supposedly a comprehensive facility ranging from independent living to end of life care) told our family that in order for him to stay we had to pay for their in-house one-on-one support person to the tune of $1,000 per day (on top of the $13,000 per month he paid just to be in the facility). We ended up transferring him to another smaller facility that was able to care for him in what turned out to be the last weeks of his life. It never occurred to us that the facility could charge so much extra for care for a person with expected symptoms of Parkinson's since this was never disclosed to us as a possibility! $1,000 a day. A day! Now that is care math!
I’m so sorry for the loss of your father-in-law. yes, that is some wild care math. And unfortunately I think not uncommon. I was also told that my mother’s first assisted living could handle every stage of care, only to find out that wasn’t the case, and that the cost would triple even before maxing out the level of care. The lack of transparency is hugely problematic.
Another amazing piece, Anna. But whew it’s tough to read. Care math is intense these days. Thank you for shedding light in it and continuing the conversation about our unsustainable society.
Thanks so much for reading and for your support ❤️
🤪😫😱 We need a special caregiving emoji. I'm equally thankful you've laid this all out, disgusted at the costs and shocked.
Before we can discuss cost, there are issues of availability of resources. It's a postcode lottery in the UK: https://www.carermentor.com/p/burning.
I can't lay out the costs because Mum and I cared for Dad, and I care for Mum now. The support we had was from a private carer and a hospice-at-home charity in the last months of Dad's life ( 4years into caring for him)
I had no idea of all the cost and care issues when I chose to help my parents because my choice was motivated by their needs and my love; because I could, was able to and wanted to, I did.
Now, my eyes are wide open. I'm still trying to get my head around it all - it's a maze, and just like I felt in 2015, there's a tsunami of information but no rosetta stone to translate it all! It asks every person to try to learn a system and fit into what's on offer. Impossible in a crisis.
So, the UK has a VERY convoluted care math, a system without resources and a large crisis which is still perceived in the realms of 'not-me-dom'.
I'll be interested to hear other viewpoints on your article.
Yes availability seems to be a rising problem everywhere, particularly post-Covid. The not-me-dom is a great way to describe part of the transparency issues - no one particularly wants to think through possible worst case scenarios, or even the best case ones when it comes to aging and end of life.