On the Gentrification of Caregiving
There's a particular phenomenon that unfolds when a neglected urban neighborhood begins to transform. First come the pioneering small businesses, the artists seeking affordable space, the young families priced out of established areas. Then, as the neighborhood gains cachet, larger forces arrive: developers, chain stores, and rising rents that eventually displace the very people who breathed new life into the community.
This is gentrification—a process that promises renewal but often delivers homogenization, where authentic character is gradually replaced by standardized aesthetics and experiences designed to appeal to those with deeper pockets.
I've been thinking about how this same pattern is playing out in caregiving.
The caregiving industry—whether elder care, disability services, or child welfare—is experiencing its own form of gentrification. What began as neighborhood-based, relationship-centered support is increasingly dominated by corporate entities promising streamlined services and professional management. The small homes and community-based programs are being absorbed or outcompeted by organizations with gleaming websites, standardized protocols, and investor backing.
But something essential is being lost in this transition.
The Resolution Problem
In photography, we talk about resolution—the ability to see fine detail. The higher the resolution, the more clarity and nuance are visible. The same concept applies to caregiving organizations.
As caregiving companies grow larger, the resolution at which leadership can see what's happening on the ground diminishes dramatically. Executives become reliant on reports, dashboards, and aggregated data rather than direct observation and relationships. The daily realities of clients and frontline staff become abstractions, statistics to be managed rather than lives to be supported.
This isn't malicious—it's a natural consequence of scale. But it creates an environment where decisions that profoundly affect vulnerable people's lives are made by those furthest removed from understanding their daily experiences.
Fixed Rates, Fixed Thinking
The business structure of most caregiving further complicates this picture. Unlike other industries where innovation and quality can command premium prices, caregiving operates largely in a fixed-rate environment. Medicare, Medicaid, state programs, and insurance companies establish what will be paid for services, regardless of quality differentials.
This creates a perverse incentive structure: innovation is financially punished rather than rewarded. Why invest in developing better approaches when they cost more but don't generate additional revenue? Why take risks on new models when the safest path financially is to deliver the minimum acceptable service at the maximum billable rate?
The system inherently gravitates toward mediocrity—not because caregiving leaders lack vision, but because the structures themselves resist meaningful change.
The Cognitive Dissonance of Care
No caregiving organization markets itself as average. Look at any website or brochure and you'll find aspirational language about person-centered care, innovative approaches, and commitment to excellence.
Yet the reality—shaped by the disconnection of leadership from frontline realities and the structural punishment of risk-taking—often falls far short of these claims. This creates a profound cognitive dissonance that permeates the industry.
Staff feel it when they're told about the organization's values while struggling with impossible caseloads. Clients experience it when the individualized support promised in glossy materials materializes as rigid, standardized protocols. Leadership lives it when they genuinely believe in their mission but find themselves making decisions that prioritize organizational survival over client well-being.
Our Approach
At Curtis Homes LLC, we've been actively fighting against these industry trends by developing a management philosophy that preserves high-resolution awareness even as we grow. Our approach focuses on interwoven layers of support and oversight—a structure specifically designed to maintain connection between all levels of the organization.
Our management model resembles a tightly woven fabric rather than a distant hierarchy. We organize our operations into "sectors," each with its own ecosystem of support and leadership. Within each sector, we maintain four distinct yet closely connected management layers:
House Managers work directly within our residential programs, maintaining daily contact with both residents and direct support professionals. They don't just visit the homes—they're embedded in them.
Operations Managers oversee multiple programs, providing the first layer of support to House Managers. Their limited span of control allows them to maintain intimate knowledge of each program's unique dynamics and challenges.
Directors coordinate groups of programs, synthesizing operational insights while still maintaining regular in-person presence across their programs.
Vice Presidents lead entire sectors, but with a critical difference from typical corporate structures—they maintain active, regular contact with every layer below them. No VP is more than three conversations away from understanding what's happening in any home.
This deliberate structure distributes management responsibilities across the right number of people while ensuring information flows both up and down the organization with minimal distortion. When a VP makes a decision that affects service delivery, that decision is informed by genuine understanding of frontline realities—not just metrics on a spreadsheet.
The tight linkage between each layer mitigates the distance typically created in hierarchical organizations. Problems are spotted quickly, innovations can be recognized and shared, and most importantly, the individuals we serve remain people, not statistics.
This approach costs more to maintain than leaner management structures—we employ more middle managers than efficiency experts might recommend. But we've found this investment essential to maintain the quality and humanity of our services as we grow.
Resisting Gentrification
Is there an alternative to this gentrification of caregiving? I believe there is, but it requires intentional resistance against powerful market forces.
Some innovative organizations are finding ways to maintain human scale even as they grow—creating smaller, more autonomous units within larger structures. Others are experimenting with cooperative models where caregivers and care recipients share ownership and governance (Self Determination, for example). Technology, when used thoughtfully, can reduce administrative burdens without replacing human connection.
Most importantly, we need to acknowledge the true cost of quality care. As a society, we must decide whether caring for our most vulnerable members is a commodity to be delivered at the lowest possible price or an essential expression of our shared humanity worth proper investment.
The gentrification of caregiving isn't inevitable. But resisting it requires honest recognition of the forces at play and courageous leadership willing to prioritize genuine care over corporate growth. Only then can we ensure that in our quest to improve caregiving systems, we don't displace the heart and soul of care itself.
