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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. Now we'll talk to the New York City commissioner for the Department of Aging affairs and begin the segment with a clip of Bradley Cooper. Now, if that sounds incongruous, here's why it's not. Bradley Cooper has just produced a PBS documentary about family caregivers. We'll have his collaborator, the filmmaker Chris Durrance joining us with Aging Affairs Commissioner Lorraine Cortés-Vázquez. Yes, Bradley Cooper gets the first word from this PBS special called Caregiving.

Bradley Cooper: Like most people, I didn't even think about caregiving until my father was diagnosed with cancer. My dad was somebody who I idolized. I used to dress up like him when I was a kid in kindergarten and get made fun of because I wanted to wear like a suit and a tie. Then to go from that to giving him a bath is quite a traumatic thing.

Brian Lehrer: Bradley Cooper, he has produced the new PBS documentary called Caregiving. Now with us here, the director of the film, Chris Durrance, and the New York City Aging affairs commissioner, Lorraine Cortés-Vázquez. Commissioner, welcome back. Chris Durance, welcome to WNYC.

Chris Durrance: Thank you. Good morning.

Lorraine Cortés-Vázquez: Good morning.

Brian Lehrer: We'll get to the film, but Commissioner, I see you had a conference here in New York last week called Boom that brought in people from around the country to talk about keeping older people in their homes with adequate care. Why was it called Boom and what was the goal of that conference?

Lorraine Cortés-Vázquez: Wonderful. Thank you for asking me. Boom is because on December 31, 2024, the last baby boomer, which is the largest generation in America since the 1800s, I believe. The largest generation in America turns 60, which means that the aging population is growing, and so we named the the conference appropriately Boom. The goal of the-- I'm sorry.

Brian Lehrer: Go ahead.

Lorraine Cortés-Vázquez: The goal of the conference was to get some good thought leadership around current state of older adult needs and wants, the services, are they aligned with them? Then what do we need to do for the future because of this booming aging population? This is not only in the United States. All cities are exposed experiencing this across the United States, but it's also globally that we're just having this phenomena of 60 plus population and explosion in the 60 plus population.

Brian Lehrer: Now you've said that ageism is where the problem starts. Why ageism rather than adequate funding for home care services or things like that?

Lorraine Cortés-Vázquez: All right, thanks. I'm glad you asked me about ageism. It's one of my favorite topics. Ageism is the thread that holds all of this together. Let me just first define ageism to you. Which is the discrimination just solely based on age, or marginalization just solely based on age. It's the only ism that affects all of us if we all have the grace of living long. It comes to us in so many different ways. One of the ways is prioritizing things. People believe that older adults, they're there, they've done these things and might not have needs, and some of that is reflected in the budget size of the United States on supporting ageism. I mean, supporting age needs, the same thing at the state and also at the city level.

It's one of the things that holds everything together. It's the one that-- the ageism keeps older workers from being employed as long as they would want to and as long as they're able to. It is the thing that has marketers marketing to young people when it is older adults who have disposable income and they're just ignored by the marketplace.

Brian Lehrer: Okay. Chris Durrance. We heard the Bradley Cooper clip. He's the producer of the film. You're the director. Why this film for PBS called Caregivers and why now?

Chris Durrance: Thanks, Brian. The film comes at a hugely important time for care in America. I mean, I think the pandemic brought it home to everyone, but this really is a lived experience that so many families share. The reason Bradley got involved is because of the experience he went through with his father. For all the resources in the world, for all the connections that he had, he experienced what the 100 million caregivers in America experience, which is both the joys and the love that come with caregiving, but also the profound challenges that come with it. He felt, and we felt that it was a story that had remarkably not been told, even though it was such a common experience and needed to be told.

Brian Lehrer: I want to play another clip from the film. We heard Bradley Cooper talking about his own hands on experience. This time, we'll hear Ai-jen Poo, President of the National Domestic Workers Alliance, interspersed with the voice of a professional caregiver, a domestic worker talking to a client. Ai-jen Poo speaks first.

Ai-jen Poo: Everyone has a care story. Caring for our families is the most important and invisible work that we will ever do.

Caregiver: Do you think we look alike? There you go.

Ai-jen Poo: Doesn't matter who you are, where you live, what you do, where you come from, you need care.

Caregiver: How are you feeling this morning? You good?

Ai-jen Poo: We have this invisible army who are essentially holding us all up as families and therefore holding the entire economy up.

Brian Lehrer: Chris, we heard the words in that clip. What's the message in that clip or the context in the film?

Chris Durrance: The message is that we take for granted this caregiving, that we all need the 100 million families. Much of this care happens behind closed doors. As Ai-jen Poo says, it's this invisible army, but it's everywhere. It's absolutely everywhere. That's why it felt like a story that had to be told.

Brian Lehrer: Commissioner, how does this film relate to policy issues that you deal with in the city's Department of Aging affairs? I know it's such a big issue in the country, the at home care economy. The Biden administration and the Harris campaign had proposals for expanding funding. Am I right that today the only people who can get this as a government benefit are those poor enough to be on Medicaid or very temporarily after a hospital stay through Medicare?

Lorraine Cortés-Vázquez: That's not totally accurate. There are many other services that people can avail themselves to that are not the poverty level of Medicaid, but they are all-- we were hoping that there was and there's been still some proposal that Medicare will be able to care for Home care. What we need is caregivers need some respite and they need some hands on in home care services. We do have an ISEP program which provides home care services for older adults within 120% of poverty. We also have caregiving programs throughout New York City, 12 of them, that are there as resources to caregivers.

The issue with caregiving and one of the things that the film does touch on is it talks about the army of caregivers, but for many people, they don't even identify as a caregiver. I use myself always as the example. I'm an adult and I care for a mother. I would never have classified myself as a caregiver and I found myself overwhelmed. Caregiving is something that we do have services for, but many people don't even know that they consider themselves a caregiver, nor do they, as a result of that, do not even know how to ask for help when they're so overburdened.

Brian Lehrer: Who should contact the city's Department of Aging or any other city agency if they think they may qualify for some kind of help in this respect?

Lorraine Cortés-Vázquez: I would say that either a family member or an older adult themselves should make sure that they contact us. We have an incredible helpline that will direct you to the appropriate resources. One of the things that we do is we will help you navigate to see what are the services that you best need. Would it be transportation? Would it be some support for some medical attention? Would it be some caregiving support? Would it be a support for the caregiver? I'm going to give you this number, all right? The number is 212-244-6469.

You can call that number and you will have an actual person answer the phone, not an avatar, and that you can share with them what your needs are, what your interest is, and they can direct you to the appropriate resources.

Brian Lehrer: Listeners, we have a few minutes for a story or a question from some of you about elder care policy and economics for our guests, director of the PBS film Caregivers, Chris Durance, and the New York City Aging Affairs Commissioner Lorraine Cortés-Vázquez. 212-433-WNYC, 212-433-9692. Let's take a call right now from Paul in Brooklyn, who has already called in. Hi, Paul. You're on WNYC.

Paul: Good morning, Brian. Thank you so much for taking my call, and thank you to Commissioner Cortés-Vázquez for her hard work over time. My story is simple. I served as primary caregiver for my mom. Coincidentally, Ms. Cortés-Vázquez knows my mom, Elba Cabrera. She was known as La Madrina de la Saltes. She was written up in the New York Times. My mom was an amazing woman. I served as her primary caregiver for, roughly speaking, the last 15 months of her life. It was extraordinarily difficult for me. Mom was sharp as a tech mentally, but her body began to fail because she was 90 years old.

The key element here is this. There is very little support from federal, state or local government and very little support in the public because most people like Mr. Cooper are not aware of the challenges of caregivers until they were thrown into the mix. It is a tremendous difficulty. The Times last year did an article that elder care in these circumstances can cost approximately $84,000 a year, which means that many people wind up having to spend down their assets just to be able to stay alive and be well cared for.

I can use a basic example. If you are trying to stay home, you have to be able to pay caregivers for, let's just say 16 hours a day during the week. What do you do on a weekend? You have circumstances where-- I'm sorry, Brian, just give me one more moment.

Brian Lehrer: Sure.

Paul: Circumstances where it is extraordinarily difficult just to maintain, and you're being asked to spend down your assets to be able to do so. Basically, we talk about race a lot in terms of class, but people that have a lot of money are able to take care of the families, people that do not spend on their assets and then they are bankrupt or wind up not being able to pass on that generational wealth because they had to work just to stay alive.

Brian Lehrer: Paul, I'm going to leave it there. You've put, obviously, some very heartfelt and personal experience, earned ideas and questions on the table. Commissioner, how do you react to anything that Paul said?

Lorraine Cortés-Vázquez: Absolutely, I would love to react to Paul's statement. Paul, you're absolutely right, which is one of the reasons it is a daunting process. It can be an expensive process. That is why our perspective and our value system is that we support a community care plan so that families can have those supports in their homes rather than institutionalizing their loved one until it is absolutely necessary or by choice. If you look at it from a cost perspective, it costs a community care plan for one individual about $56,000. That, I mean, includes food, transportation, some home care assistance, while in a nursing home, it costs $186,000 a year.

It just makes more sense economically and also from a prudent public financing perspective to shift more funding to community care rather than the medical model that has been in place, that is old and outdated for looking at elder care from a medical model solely, which is why so much money goes into Medicare and not Medicaid. I'm sorry. Not enough of that goes into a community care. We need to look at some of the shifting of that money and also with what the intent is. When this system was designed about over 50 years ago, it was very different and the older adults and family values were very different than who the older adult is today and what their needs and wants are.

Brian Lehrer: Listener writes, and it relates to another thing from Paul's call that I want to follow up on. Listener writes, "I've been taking care of my elderly mother on Medicare in her home for the last four years and was shocked to learn that there's no kind of tax break or subsidy for people like me who have had to cut employment hours and lose earning potential in order to be available for caregiving." Commissioner, would you comment on that? Paul brought it up, too. I'll throw in that I've seen these commercials on TV recently advertising that you can get paid to take care of your elderly relative. I think it's through Medicaid, but respond to that whole kind of bucket.

Lorraine Cortés-Vázquez: One of the things that we're looking at is to have legislation keep up with what the needs are. We're looking at the Family Leave Act to make sure that it does provide more benefits to a caregiver so that the caregiver is not at risk of losing their jobs. Many people sometimes have to make that decision. There is no tax benefit. You cannot write off the expenses unless they pass a particular threshold that you spend as a caregiver. There is also-- we're looking at things just like you get a child tax credit to see if there is some opportunities for caregiving tax credit.

There are many things that we need to do is like what I said before when these laws and and proposals were done, this was not the time. The older adult is not the older adult of today or the family needs, but this caregiving crisis. I applaud Bradley Cooper for doing this and highlighting this. He's standing on the shoulders of Rosalynn Carter, who started this whole notion that caregiving is growing and caregiving is a real need in families.

Brian Lehrer: Chris, as director of that film, Caregivers on PBS, produced by Bradley Cooper, here's a text for you, kind of challenging one. It says, "Lifting up home health workers and domestic work, paid and unpaid, is one of the great labor issues of our time. I don't understand how this is an ageism issue. Our government is a gerontocracy, and Social Security and Medicare are the largest social welfare programs in the country, only available to seniors. To me," writes this listener, "it's more about the sexism and racism against the workers. How do you square these tensions in the film?" Do you address anything like that in the film, Chris?

Chris Durrance: Absolutely. We look at family caregiving, we look at paid caregiving. I know this segment is about aging, but in the film, we look at people with disabilities. We look at working families and the issues they face, particularly sandwich generations, the sandwich generation, where they're caught looking after young children and elderly adults, something that the commissioner was alluding to that's very new for us in this country.

We also look at the plight of child caregivers. There's over 5 million kids, people under the age of 18, who are caregiving many, many hours a week for parents, grandparents, siblings, and we look at that as well. Across the board, there is not just a caregiving crisis with the elderly, but a caregiving crisis that's affecting all families. For many families, what they're doing is a mix of family members helping out and paid work, pinch hitting where they can, trying to cobble something together so that they can stay in work and they can keep a loved one looked after when they need to.

Exactly what the first caller was talking about, trying to make this work. For many of the paid caregivers, one of the challenges is that they need the hours, but those hours take them away from their own families. It's a really challenging, really, really challenging situation, and we explore all of that in the film.

Brian Lehrer: We played that clip earlier from the film of Ai-jen Poo, President of the National Domestic Workers Alliance. She represents the workers, obviously in this field. She's been a guest on this show a number of times. Commissioner, does the issue of adequate pay and working conditions for the caregivers intersect with the quality and enough care for the clients?

Lorraine Cortés-Vázquez: Absolutely. Care workers, home care attendants, private nurses, all of these are essential labor forces, and they need to get paid adequately. Because the quality of care that we want is a high quality of care and we need to have people who are well trained as well as well compensated for the work that they do. It is very hard work to be a full time home care assistant or a home care attendant. You are learning how to lift someone, to bathe someone, to do so in a way that you're protecting yourself as well as making sure that the individual is not harmed. It is an essential task. It is going to be a growing need. These workers, which we have a paucity of them, we also need to make sure that all workers are adequately compensated.

Brian Lehrer: [crosstalk] Sorry, go ahead, Chris. Last thought.

Chris Durrance: That they get benefits, that they get sick leave. They get all the things that people in employment expect and deserve and need.

Brian Lehrer: The director of the new PBS documentary Caregivers, Chris Durrance, and the New York City Aging Affairs Commissioner, Lorraine Cortés-Vázquez. Commissioner, a number of people are asking for that phone number again. Just give that number and remind people who should call it for what kinds of services.

Lorraine Cortés-Vázquez: You can call it for two things. Call it for any help you may need to navigate services, to also get informed about services and the location of services, the languages that services are offered in and any information that you want regarding aging services in New York City. The number is 212-Aging-NYC, and the actual number is 212-244-6469. Please, it could be a family member, it could be an older person themselves. It could be a neighbor or a friend. Is to avail yourself of information on how and what is available to support our older New Yorkers of the 1.7 that have chosen to stay in New York.

Brian Lehrer: Thanks to both of you so much for joining us.

Lorraine Cortés-Vázquez: Our pleasure.

Chris Durrance: Thank you.

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