Home-care workers facing numerous challenges during pandemic

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: Deborah Crowe

Photo: Deborah Crowe

Is home health care the next COVID-19 hot spot? It may very well be, according to home care workers and leaders of a union that represents many of them. In a video press conference on April 15, several home care workers said that neither their agency nor the federal government was doing enough to keep them safe.

Social distancing while performing in-home care is impossible due to the intimate nature of their jobs, said the workers, who provide personal assistance and health care support. They care for vulnerable older adults and people with serious disabilities who need assistance with basic clinical tasks or activities of daily living, such as bathing, dressing and wound care. Yet, their employers provide little or no assistance in obtaining personal protective equipment such as masks, gowns, and gloves. Most have no paid sick leave and have trouble getting tested for COVID-19. They’ve been forced to choose between working and putting themselves at risk, or staying home and being unable to pay their bills.

“Home care workers were excluded in the last stimulus bill from mandated paid sick leave if exposed to COVID-19, leaving millions of workers on their own,” said Mary Kay Henry, president of the Service Employees International Union (SEIU). While home care workers in 14 states have collective bargaining agreements, those in other states are barred from organizing. SEIU represents approximately 740,000 workers who provide non-medical care in homes.

The CARES Act, the $2.2 trillion stimulus bill passed in March, gave employers the option to exclude home care and other health workers from paid sick leave programs. SEIU is demanding that any future stimulus bill include home care workers among the groups entitled to paid COVID-19-related sick leave. The union also calls on Congress and the Trump administration to act swiftly to ensure all caregivers receive personal protective equipment, affordable health care and access to testing so they can safely care for clients, their families, communities and themselves, Henry said.

Joyce Barnes, a Richmond, Va., home care worker for 30 years, said she has never received gloves or hand sanitizer from her employer, or even a phone call from the agency regarding safety precautions. Barnes, who lacks health insurance, can’t afford to stay home and buys her own protective supplies.

“My patients depend on me, but I’m not getting the help I need,” said Barnes, who works two jobs and earns between $8.25 and $9.40 an hour.

Home care agencies are reporting mixed results in obtaining PPE for employees, according to William Dombi, president of the National Association of Home Care and Hospice (NAHC), a trade association representing the nation’s 33,000 home care and hospice organizations.  Some agencies have successfully obtained and distributed protective gear to their workers. Still, others have faced challenges, such as ordering supplies but receiving items that don’t meet U.S. specifications or have expired. Others say they have no access to normal supply channels but are considered too small to order from other channels catering to large organizations. “Then there’s the group that’s filling in the gap, creating their own,” Dombi said in a telephone interview.

A recent survey of NAHC members found that 46% of respondents had a 10-day or less supply of PPE, and 72% had less than a 20-day supply.

Sepia Coleman works two jobs, as a personal care assistant and as a certified nursing assistant, in Memphis, Tenn., where home care workers are prohibited from unionizing. She makes $10.50 per hour caring for a 30-year-old male paraplegic. Due to underlying conditions, she is at higher risk for complications should she develop COVID-19, but still has to go to the supermarket and pharmacy for her patient. Her agency has tried but has been unsuccessful in obtaining PPE for her. “It’s like sending a firefighter into a burning building without his gear, she said. “Why would you expect a home care worker to go in without proper equipment? It’s inhumane.”

Home health aides (HHAs) and personal care aides (PCAs) provide different levels of care. Requirements vary by state, but HHAs generally have more training. They can help with health-related tasks, such as measuring and recording temperature and blood pressure or assisting with the use and maintenance of medical equipment, according to PHI, a Bronx-based nonprofit that focuses on the direct-care workforce. CNAs are more highly trained and certified from an authorized program. They undergo supervised clinical instruction and must pass a state examination.

An estimated 47% of home health agencies are caring for at least one patient with COVID-19, Dombi said. “The main thing that we’ve tried to do is to get all the stakeholders in PPE to understand this is not just about hospitals, nursing homes and renal dialysis clinics.”

NAHC is among a coalition of home care-related associations pushing FEMA to add home care to the priority list for PPE. Dombi emphasized there are tens of thousands of home care companies in the U.S. Training and reporting requirements vary depending on whether the business is considered a home health agency or a personal care agency.

“Home health agencies and hospices are obligated, under conditions of participation, to have infection control and emergency preparedness operational protocols,” Dombi said. “While they don’t all have perfect ones in terms of this particular pandemic, they were able to step up very quickly on this.”

Agencies that he has contacted say they are screening workers before they go into the home, as well as screening the patient and others in the household. They also say they are establishing standards about how to staff homes in which people are infected or quarantined.

Home care workers are entering high-risk, low reward situations, according to Blakely. Most make less than $25K per year, with the median wage at $11.52 an hour. About half are women of color, and three in 10 are immigrants. Most have no paid sick leave and lack health insurance. One in six home care workers lives below the federal poverty line and more than half rely on some form of public assistance, according to PHI.

“What happens if they get sick?” Blakely said. The need for home care workers is only going to increase, as more people live longer and want to age in place.

Workers often care for patients with multiple complex health problems. “We are their safety net and can help prevent costly ER visits,” said Susie Young, a home care worker in Seattle for 30 years. She received only one set of PPE from her agency.

Before the pandemic, 12 million people in the U.S. were receiving some form of home care annually. Those needs haven’t gone away, according to Dombi. He’s hopeful that the next COVID-19 stimulus legislation will include hazard pay for all health care workers, including those who work in the home. SEIU is working with Rep. Pramila Jayapal of Washington state and Senator Kamila Harris of California, both Democrats, to incorporate their priorities into any new bill.

As Barnes, the worker from Virginia, said, “I don’t understand why they forget about us.”

Journalists may want to contact home care agencies in their community to see how, or if, they’re screening and training workers to handle COVID-19 patients. Here are some questions to ask:

  • Are workers being tested?
  • Do they have enough PPE, and who is supplying it?
  • Are there any state-mandated requirements to provide workers with PPE, or are they on their own?
  • Talk to workers to learn what they’re experiencing. If they don’t have any paid sick leave, what would they do if they became ill?

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