Pivotal Ventures Makes the Case for Why Care Can’t Wait

When it comes to caring for one another, many countries do a far better job than we do. Most other OECD countries not only have national health systems; they also provide child care and paid family leave, as well as long-term care for the elderly. People with disabilities in the U.S. also face daunting barriers to care.

The issue of inadequate access to care in the U.S. and how to strengthen our care systems is a big priority for Pivotal Ventures, the philanthropy created by Melinda French Gates. Pivotal supports programs that promote caregiving and paid family and medical leave, along with other issues impacting women and families.

As a sign of where its thinking is around care, Pivotal recently published a post titled “The Data-driven Case for Care.” To make that case, Renee Wittemyer, vice president of program strategy, cited the findings of a survey Pivotal co-commissioned revealing the financial and professional impact of our current care system, identified widespread support among voters — across party lines — for investments in care, and pointed to the economic benefits of creating robust care infrastructure.

At Inside Philanthropy, we’ve been following the evolution of Melinda French Gates’ giving as she steps away from the Gates Foundation – which she did formally last month. Shortly before that, she announced a $1 billion commitment to organizations supporting women and girls’ causes around the world and reproductive rights in the U.S. Pivotal Ventures also focuses on youth mental health, and recently backed a funding challenge for organizations working to help young people navigate the digital landscape.

Pivotal’s focus on care makes sense since women continue to shoulder most of the burden of caregiving in the U.S. It was one of the issues Melinda French Gates pointed to in 2019 when she announced that she was committing $1 billion to promote gender equality, an initial commitment through Pivotal that this year’s additional $1 billion effectively doubled.

As Wittemyer wrote, “Our country — and our economy — is powered by the work of caregivers… But right now, the public and private sectors are not investing enough in our care system, and it’s families — and especially women — who are footing the bill. It’s a price most cannot afford to pay.”

North star

In the years following the outbreak of COVID, which shone a spotlight on the many inadequacies and outright failures of the U.S. care system, numerous funders have made care a priority, including the growing number working to improve our system of early care. For instance, a pooled funding initiative, the CARE Fund, was launched in 2021 with $50 million from heavyweights including the Ford Foundation, the W.K. Kellogg Foundation and Schusterman Family Philanthropies to strengthen care infrastructure. More funders joined the following year, including Pivotal Ventures, as IP reported, and additional partners have signed on since then. Meanwhile, a handful of funders focus on care for the seniors, including palliative care and innovative approaches to elder care. Still, care is an area that could use far more support, given the central role it plays — sooner or later — in all of our lives.

Haven Ley, Pivotal Ventures’ chief strategy officer, said that care aligns with the organization's north star: gender equality and support for women and families. “A lot of our caregiving work is centered around the fact that caregiving burdens continue to be the No. 1 reason why women don't succeed or pursue other careers — and continue to hold them back in the workforce,” Ley said in a recent interview. “And [caregiving burdens] are disproportionately bad for white women, but they're horrific for women of color. At the same time, for so long, [care] has been an under-invested-in and under-acknowledged space, something that families have to handle on their own in America. Our proposition — which is really core to how we think about our strategy — is that it doesn't have to be like this.”

Ley worked with French Gates at the Gates Foundation and then left to help start Pivotal Ventures, which is structured not as a private foundation, but as an LLC. “By design, [Pivotal Ventures] was meant to be a very flexible, very nimble, very lean organization, able to move capital quite quickly where it needed to go, and also to use different types of capital,” she said. “So philanthropy was obviously going to be at the core of our work and grantmaking. But [French Gates] also asked us to stand up an investment function, which is scaled to this very day. And to think about advocacy and policy change, as well.”

Pivotal Ventures is deploying all of these tools to address the issue of care and caregiving: grantmaking, advocacy, policy reform and investment capital. “We need a wide variety of solutions to catch fire and change the name of the game for women — women in the workforce and women at home,” Ley said.

The case for care

In making Pivotal Ventures’ “data-driven case for care,” Wittemyer included findings from a survey the organization commissioned with Bipartisan Policy Center Action, conducted by Morning Consult. According to the survey, 2 in 3 caregivers say that caring for loved ones has affected their personal finances, forcing over a third to take on additional credit card debt. It also found that “caregiving responsibilities are one of the main reasons why women are forced to cut back at work or leave the workforce altogether.” The survey identified broad support from voters across the political spectrum for investments “that make it easier for Americans to care for their loved ones.”

Pivotal is supporting efforts to impact care policies by partners including Bipartisan Policy Center Action (a 501(c)(4) “partner” of the Bipartisan Policy Center), The First Five Years Fund and Caring Across Generations. Wittemyer bolstered the case by pointing to research showing the benefit to business: “child care and other caregiving support for employees have become must-haves for businesses that want to recruit and retain top talent and keep pace with global competitors.”

Finally, Wittemyer encouraged investments in “caregiving innovation” in the realm of private enterprise, pointing out that Americans spend $648 billion on care every year and caregivers “control $6 trillion of household income.” She named several early-stage companies Pivotal itself is supporting. “While we’re seeing more investors and entrepreneurs focus on innovation in caregiving, there is still a huge and under-tapped market opportunity to create products and services that make caregiving easier and more joyful for everyone,” she wrote.

“The work that makes all other work possible”

As Pivotal Ventures expands its multifaceted efforts to advance the care field, it has its work cut out for it when it comes to national policy — regardless of the results of this year’s elections. A report titled “A Playbook to Transform How America Cares,” published last year by New America’s Better Life Lab (New America was among the grantees in Pivotal’s recent $1 billion funding commitment) provides a deep dive into recent efforts by the care movement to strengthen our system of care. It explores the policy landscape, recent challenges and advances, and tactics for 2024 and beyond.

The report ticks off the sweeping list of care initiatives included in President Joe Biden’s proposed Build Back Better package in Congress, including “Paid family and medical leave; universal pre-K; federally funded and subsidized child care programs; funds for long-term, home and community-based care with living wages; and better benefits for care workers were all included in the original framework.”

That framework didn’t survive in Congress, thanks to Republican lawmakers and Democrats including Sen. Joe Manchin, but getting a truly expansive care agenda even that far was a significant accomplishment, particularly given the imbalance in resources between care advocates and the powerful groups opposing them in D.C. The report includes data from Open Secrets showing the vast discrepancy in lobbying dollars spent by care advocates compared to business interests that opposed Build Back Better (including the U.S. Chamber of Commerce, the Business Roundtable and the National Retail Federation).

Ai-Jen Poo, president of the National Domestic Workers Alliance, underscored the care movement’s accomplishment in the New America report: “A group of determined, mostly women, all running underfunded organizations with very little real political capacity, has seriously punched above our weight and is making generational historic progress on an issue that no one saw was even an issue five years ago.” The alliance, which advocates for the rights of nannies, house cleaners and home care workers, was a grantee in Pivotal’s recent funding commitment.

Support from funders like Pivotal Ventures can ensure that progress continues for what Ai-Jen Poo has called “the work that makes all other work possible.”

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