Caregivers are burned out and underpaid. A new housing model aims to make their work more visible.

Collaborator: Streetlight
Published: 05/15/2022, 11:21 PM

(NATIONAL) On a typical morning, June Barrett walks more than an hour to the bus that takes them to the house where they work as a caregiver in the Miami-Dade area in Florida. 

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Barrett doesn’t have a car, so after a 15-minute wait, they ride for nearly a half hour before beginning the 20-minute walk to work. By the end of their commute, Barrett has traveled a nearly two-hour journey just to start a shift. 

Even with grueling 30-hour shifts, Barrett is barely scraping by. Private in-home care workers in the Miami area typically earn between $15 and $20 an hour, and rent for the apartment Barrett shares with their sister and her two sons rose by $500 this year to reach $1,995 per month — almost double the $1,100 monthly rent they paid when they moved back in 2009.

“It’s not enough to live on,” said Barrett, who is also a labor activist for domestic workers.

Lack of affordable workforce housing and meager wages are just a couple of the pain points that make domestic care work difficult to sustain. At the end of 2021, 44% of domestic workers surveyed by the National Domestic Workers’ Alliance (NDWA) Labs were facing housing insecurity and said they were unable to pay their monthly rent or mortgage. At the same time, the pandemic intensified high turnover rates and a longstanding shortfall of home care workers. 

“Care workers … are so exhausted from doing different work, running from here, running from there,” Barrett said. “Caregivers get strokes. Caregivers are dying from stress.” 

“A lot of people forget that caregivers are human beings,” they added.

Domestic workers must be “paid a living wage so that they themselves can afford housing and childcare and the things that somebody needs to be able to steadily maintain a job,” echoed Samara Scheckler, a research associate at the Joint Center for Housing Studies of Harvard University. The frequent commutes often required for these jobs can be problematic for workers in rural areas or places with poor transportation, and many people lost in-home caregivers during the pandemic because those workers lost childcare, Scheckler said. 

“When the caregiver doesn’t have their own basic needs met, they’re not going to be able to consistently show up for the older adult,” Scheckler said.

Reducing caregiver turnover can also help address older adults’ housing preferences. The overwhelming majority of adults over 50 say they want to age in place rather than in institutions. 

But the current system isn’t built to meet those wishes when it comes to care options, affordability and homes that suit a range of mobility needs. People who qualify for Medicaid remain on waitlists for home care services about four years on average, according to the Kaiser Family Foundation. Meanwhile, less than 4% of homes in the United States had basic accessibility features in 2011, the latest year with available data, according to Harvard’s Joint Center for Housing Studies.

Elevating domestic work and designing beyond basic accessibility

An alternative housing model being developed in Baltimore, Maryland aims to tackle these colliding crises. Carehaus is designed to be the first care-based, co-housing project in the United States — an intergenerational community that will house professional caregivers and their families, older adults and people with disabilities under one roof.

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The project leaders want to center what society too often makes invisible: aging adults and those who care for them.

“(We were) designing against this idea of older, disabled adults being tucked invisibly out of sight, out of mind,” said Marisa Morán Jahn, a New York City-based artist who has worked with the NDWA for more than a decade and co-founded Carehaus.

At the same time, the building is designed to elevate and make visible the labor of domestic work, Jahn said. 

Another focus is on creating a community that feels dignified and humane.

“As a society, … our common approach is a very institutionalized way of shaping spaces for elders,” said Rafi Segal, an architect and associate professor at the Massachusetts Institute of Technology who co-founded Carehaus.

But there are ways this can be done differently: “There are so many levels on which design can impact life in older ages,” he said.

Alongside local community partners, the team is working to start construction this year in Baltimore, the first city to test this model. While a goal of the project is to make accessing care more affordable, Carehaus will not technically be classified as affordable housing.

The building will include 21 units designated for older adults and disabled people, professional caregivers and their families and a site manager. Residents will live in independent units but have access to services like communal meals, childcare for caregivers and creative arts programming. 

This proximity between caregivers and older adults could take certain emergencies that can often disrupt work out of the picture, Scheckler said.

“If people are affordably housed as caregivers, they’re less likely to have to suddenly up and move in with their family two towns over,” she said. “If people have some kind of childcare built into the housing model, they’re less likely to have kid emergencies that pull them away.”

[ Read more: For renters with disabilities, many homes aren’t accessible ]

Throughout the design process, Carehaus founders had co-design sessions with professional caregivers, including Barrett. They also brought together architects, disability advocates, gerontologists, community members from where Carehaus will be located and family caregivers — perspectives not typically reflected in the design of senior living, Jahn said.

Carehaus will move beyond typical accessibility features, according to Segal. The community is designed to accommodate different abilities with a hyper-attentiveness to visual disabilities and memory loss, Jahn said. Certain features, like a bathroom faucet, might incorporate bright colors to help low-vision residents, for example. The architecture and design will include tactile, mnemonic and visual cues to help residents navigate the space beyond memory or sight, such as textured floorboards that might signal a resident is approaching the kitchen.

“A person is more or less disabled based on interactions with their environment,” said Nicole LeBlanc, a Silver Spring, Maryland disability rights activist who is on the autism spectrum and has other disabilities. “Now more than ever, we must design housing that plans for disability so that when we develop chronic health issues and reach our golden years, we can stay in our own homes with the least amount of disruption as possible.”

Beyond Baltimore, Carehaus owners are also considering plans for Houston, Texas and are focusing on building in historically underserved neighborhoods.

“We see our concept as something that every community can develop,” said Ernst Valery, founder and president of Ernst Valery Investments Corp., who is a co-founder and the real estate developer for Carehaus.

The United States needs innovative approaches like this to develop workforce housing and senior housing that serves vulnerable populations, he said.

Though some say this model could prove innovative, there are logistics still to be ironed out. Housing experts like Scheckler will be watching to see how residents are selected, the pay structure for residents and how transitions into and out of the community are managed as people’s needs change over time.

Barrett, on the other hand, is curious about the age group Carehaus is targeting and how paid live-in caregivers would juggle rotations and shifts.

In the meantime, Barrett will keep pushing through taxing shifts and days that stretch on with wearying commutes. The bus doesn’t stop in some of the neighborhoods they work in, so when Barrett is especially tired after a long shift, they take an Uber. 

A ride at peak hours might consume more than an hour’s wages. Sometimes this is a worthy trade for Barrett to be back in their own bed, after nights of watching over others while they sleep.

Though Barrett spends their waking hours caring for older adults, they don’t earn enough to save and enough to plan for their own future.

“When I get old, when I age out, what’s going to happen to me? I push that at the back of my mind,” Barrett said. “I have enough to bury me.”

But a model like Carehaus gives them “a glimmer of hope.” It’s a community they’d want to live in, both as a caregiver and later as a resident.

“I’m 58 now,” said Barrett. “Maybe I will end up in a Carehaus.”

This story was written with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Commonwealth Fund.

Carly Stern is a freelance reporter based in San Francisco who covers housing, disability, aging and economic hardship. She can be reached at Follow her on Twitter. is a nonprofit news site based in Oklahoma City. Our mission is to report stories that envision a more equitable world and energize our readers to improve their communities. Donate to support our work here.


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