Amid the COVID-19 pandemic, home health workers find themselves in an incredibly difficult bind – how can they deliver necessary services while keeping themselves and their clients safe? Home health workers have to travel, often via public transportation, to their clients’ homes, risking their own and their family’s health, as well as that of the people they serve and others in their households. Older adults and people with disabilities who rely on home health workers must risk possible exposure to COVID-19 in order to receive the support they need to live independently. To make matters worse, home health agencies are experiencing extreme shortages in personal protective equipment (PPE). 

Even before the pandemic hit, the day-to-day reality for home health workers was unsustainable. Workers, disproportionately immigrants and women of color (especially Black, Latino or Hispanic people), often earn minimum wage and receive few employer-sponsored benefits such as paid sick leave or premium pay. According to a recent PHI report, one in four home care workers live in households below the poverty line and earn a median annual income of $13,300. Despite being the critical workforce that makes long-term care possible, home health workers do not receive adequate wages, benefits or workplace protections.  

Both people using home-based services and home health workers are disproportionately from populations that are the most impacted by the pandemic. Home health workers of color, especially Black workers, are experiencing the severe health consequences of structural racism. Having to work without sufficient PPE only increases their risk of COVID-19 exposure and further endangers the communities they live in. People with complex needs are already at risk of disability-based discrimination if they seek medical care for COVID-19. Now more than ever, it is essential they are able to utilize the home health care they rely on to stay healthy, independent, and at home. Every precaution must be taken to limit their risk of exposure from a visiting care worker. In order to protect these communities, we must work to ensure adequate supports and protections for home health workers. There are a variety of federal and state actions that advocates should promote: 

 

  • Prioritize home care organizations in PPE distribution and recognize home health workers as an essential part of the health care workforce. State policymakers can designate all home health workers as “essential” under statewide definitions and include home care agencies in statewide PPE calculations. 

  • Improve wages and workplace protections for home health workers. The Coronavirus Relief for Seniors and People with Disabilities Act (S. 3544) seeks to address some of the unmet needs of the disability community and older adults by providing wage increases, overtime pay, and paid sick, family and medical leave to workers. 

  • Allow family members and legal guardians to work as paid caregivers. States can use their 1915 (c) Appendix K waiver authority to compensate family members and legal guardians to provide care to their family members with care needs that would otherwise be provided by a home health worker. This helps close the home health services gap and allows families at high risk of infection to quarantine safely. A few states, including Colorado, Kansas and Pennsylvania, already allow family members to work as home health workers for loved ones with complex care needs.  

Home and community-based services and supports is a critical yet often overlooked part of the health care system that enables older adults and people with disabilities to live independently in the community. Just as we need strong critical care capacity, our success in fighting COVID-19 also depends on the work of home health workers, helping assure the people they care for remain healthy, so they will not need a hospital admission, with its attendant risks. By not making significant needed investments in the home health workforce, we are putting at grave risk the lives of older adults and people with disabilities, as well as low-income workers of color. Home health workers are long overdue for safe and fair workplace conditions, and the current pandemic highlights the dangers of neglecting this workforce any longer.