People Need More Care, But Lack of Support For Aides Puts Everybody's Health At Risk
The coronavirus pandemic continues to spread like wildfire through the U.S. Amid this pandemic, people need to be able to stay home to stay safe. Yet many workers cannot take time off, even if continued work means putting their own health and that of others at risk. This is especially true for home care workers, who help older adults and people living with disabilities live independently.
The need for direct care workers has become glaringly obvious during the pandemic. For a variety of reasons, older people and people living with disabilities are often hardest hit by COVID-19. These vulnerable populations rely on the work of direct care professionals, along with care from loved ones. In the three months before the recession started, from December 2019 to February 2020, 3.5 million people worked as direct care professionals, based on the Bureau of Labor Statistics’ Current Population Survey. About two-thirds worked as home care aides, while the rest worked in skilled nursing and assisted living facilities.
Surprisingly, while all agree that these workers perform critical work, it is all too often accepted that they are treated as disposable workers. They often have to work with inadequate personal protective equipment (PPE) and struggle with poor pay and minimal fringe benefits. Their own health and financial needs are not met, putting them in an untenable position of having to choose between physical health and financial wellbeing.
The number of direct care workers dropped early in the pandemic, likely for a number of reasons. In the first three months of the recession, from March to May 2020, there were only 3.2 million direct care workers. The number of home care aides dropped by a disproportionate number of 232,000, from the three months before the recession, while the number of people working in facilities fell by only 50,000. Just as the need for added help from home care aides went up, their employment fell.
The drop in the number of home care aides probably follows from two factors. Many aides, worried about their health and that of their families, didn’t feel safe continuing in a job requiring close contact with others. And many care recipients were worried about their own health, amid a spreading pandemic, and thus stopped relying on aides. These concerns were likely exacerbated by the lack of sufficient protective equipment available, among other things.
For many home care aides, staying home likely was a question of protecting their own health. Even with a sharp drop in employment levels, the unemployment rate among home care aides remained relatively modest in the early stages of the pandemic. From March to May 2020, 6.5% of home care aides were unemployed, up from 4.4% in the three months before the recession. The relatively low unemployment rate for home care aides, even as the total number working as home care aides sharply fell, suggests that many stopped working or looking for work during the recession.
Other data further support this observation. Almost half of all home care aides are parents, while many have personal characteristics that put them at higher risk of contracting the virus. The number of employed home care aides with children or who had child care obligations even with no children in their home — for instance, because they were grandparents — dropped by 80,000 during the first three months of the recession, from the three months before it. An additional 18,000 part-time home care aides who stopped working altogether or were absent from work had additional family obligations such as caring for grandchildren, for instance. Finally, 23,000 home care aides who usually worked part time and stopped had their own illnesses or health limitations. All in all, more than half of the decline in employment among home care – 121,000 out of 232,000 — came about among people who cared for children, had other family obligations, or were dealing with their own health issues or concerns. It is likely that many aides stopped working to avoid risking their own health or the health of somebody in their family.
Yet, many aides with elevated risk for COVID-19 kept working. Almost one-third of home care aides are 55 years old or older, more than one-quarter are African-American and more than one-fifth are Latinx. These demographic groups are more likely to have underlying health conditions, which could then make it more likely that they contract and get sick from the novel coronavirus. The share of aides with any physical disability, such as having trouble climbing stairs, increased, as did the share of people age 55 years old or older, and the shares of African-American and Latinx aides. Put differently, the share of aides no longer working during the recession are disproportionately healthier, younger and white. While many aides likely left to protect their own health and the health of their families, many others couldn’t leave, even to protect their own physical well-being. Low pay and few workplace benefits meant that they needed to keep on working to pay their bills. Aides who are older, non-white, or have disabilities disproportionately need to keep working during the pandemic, as many lack the privilege to stop working when it becomes unsafe.
On the other hand, many care recipients likely worry about the risks to their own health from people coming into their homes, especially as PPE for aides and care recipients was often sorely lacking. They then had few choices other than to stop having aides come to help them. In theory, this increases the chance that care recipients will no longer be able to live independently and may have to move to a facility, although no immediate data exist on how care recipients have fared in the pandemic. It also could increase their reliance on family members for care, adding to their growing pressures amid working from home, home schooling and added child care. No wonder that psychological stresses are high during the pandemic.
Home care aides, whose work is especially critical during the pandemic, shouldn’t have to choose between their own health and paying their bills. Serious and persistent policy interventions can make it much easier for home care aides to work, while protecting everybody’s health. Regular and affordable access to PPE, widespread testing and tracing with support for people to safely isolate, safe transportation options, and affordable and adequate health insurance will protect everybody’s health. Higher pay and access to reliable, safe and affordable child care will further ease pressures on home care aides, allowing them to focus on their jobs and also attracting more people into the profession. The need for this critical work is now abundantly clear. Yet, those performing such work often lack the basic protections to stay safe at work or the means to take time off when needed, which particularly impacts aides who are older, non-white, or living with disabilities. Policymakers just need to value this work, so that these workers are no longer treated as disposable.
