There are more than 2 million home health and personal care aides working in the United States. They provide support and heath care assistance in people’s homes across America. Before COVID-19, and certainly now, they face unique risks. These individuals are critical in providing comfort, aid, and maintenance of dignity for patients and family members alike. Yet, they are poorly compensated and often work more than one job while supporting their own families.
The median hourly wage of home health workers is about $10 per hour, and the work is inconsistent, often offering only part-time or part-year employment. This inconsistency leaves a quarter of home care workers below the federal poverty line and more than half reliant on public assistance. Many home health workers must work second jobs to make ends meet, making them more likely to encounter the coronavirus and spread it to others.
The pandemic has highlighted the need for adequate occupational protections such as employer-sponsored paid time off and health benefits for home health workers. These individuals help aged and disabled individuals perform basic tasks and are valuable in recognizing changes in symptoms and behavior in their patients, avoiding expensive hospitalizations. Avoiding hospitalization means big savings for American health care.
But those savings do not trickle back down to these workers. Their pay doesn’t meet the cost of living in many regions, and now they face the additional cost of childcare due to school closings. This workforce needs more stability.
Stability of this crucial home care workforce can be improved through uptake and expansion of state Medicaid under the Affordable Care Act – many workers would qualify by income. Also helpful would be strict enforcement of the Fair Labor Standards Act, in effect since 2015, which provides for expanded wage and overtime protections for home care workers.
While experts have recommended that individuals avoid large crowds, stay home from work, and contact a health care provider if they feel unwell, many home health workers cannot afford to follow these recommendations.
Home health workers are on the front lines of the pandemic – undeniably necessary for home care as well as hospice (care at the end-of-life) in our communities. More than 10 million Americans rely on home health workers; we have been touched by their good work. Of the 2 million home care workers, the majority are women and people of color. Since the pandemic started, there have been disproportionate rates of COVID-19 illness and death in African American communities. This disparity is attributed to factors like housing conditions, chronic health conditions and stress.
The need for home health workers will continue to rise alongside the rising aging segment of the American population. However, low wages, inconsistent employment, stressful occupational conditions, and a lack of employer-provided benefits continues to deter individuals from entering the home health workforce. Without the means to quarantine away from family members if exposed or take time off work, home health workers risk infecting those in their family as well as their patients.
Without adequate paid time off and adequate health insurance, direct and indirect costs of sickness and dependent care can destroy individuals’ lives. Providing greater financial security and personal health security in the home health care sector could ensure that home health workers can safely meet our needs when we ourselves require care in our communities.
Nathan Boucher is an assistant professor at Duke University’s School of Medicine and Sanford School of Public Policy.