Caring for Caregivers as COVID-19 Spreads

In Colorado, approximately 59,000 direct care workers — home health aides, personal care aides, and certified nursing assistants (CNAs) — provide essential care and support to Colorado’s older adults and people with disabilities.

They are an important part of Colorado’s health care workforce, and they will only become more important as the population of older adults in the state grows. For the past six months, CHI has been investigating a shortage of direct care workers in Colorado as part of a project funded by the NextFifty Initiative.  

As COVID-19 spreads, however, direct care workers find themselves at risk of infection and job loss, should exposure to the virus prevent them from working. People who work in these roles provide physically and often emotionally demanding services that can involve long hours of assistance with daily activities, such as bathing and cooking, and in some cases, clinical care, such as checking vitals and administering medication.

The vulnerability of workers who provide services to older adults is not hypothetical: In Washington State, 34 staff members at a Seattle-area nursing facility became infected with the coronavirus last month. The Colorado Trust profiled a home care provider in Colorado who became sick in March in a story last week.

Despite the renewed attention to the safety and well-being of our health care workers, direct care workers are often overlooked by policymakers and the public.

Direct care workers typically receive low wages and limited benefits, such as health insurance, which puts them in a precarious position if they or their family members fall ill. On average, direct care workers in Colorado make between $11 and $16 an hour. About 44 percent are considered low-income, meaning they have incomes that are at or below 200 percent of the Federal Poverty Level (FPL), about $52,400 a year for a family of four. And 12.9 percent report being uninsured according to the American Community Survey, compared with 8.1 percent of all Coloradans.

Direct care workers also often lack essential benefits such as sick leave or paid time off, and have historically been left out of labor protections extended to other workers, such as minimum wage and overtime pay.

The relative low pay and limited protections for direct care workers likely did not come about by chance. The direct care workforce is disproportionately composed of women and people of color – groups who have experienced systemic discrimination throughout American history, and who remain disadvantaged by gender and racial/ethnic pay gaps to this day. In Colorado, 82 percent of direct care workers are women, and 38 percent are black or Hispanic/Latinx, according to the American Community Survey.

Luckily, there has been some recognition at the federal level to protect people with these jobs. On March 19, Sen. Bob Casey (D-PA) introduced the “Coronavirus Relief for Seniors and People with Disabilities Act,” a bill that would provide additional assistance to older adults and wage increases and paid sick leave for home health care workers.

The CARES Act passed on March 27 includes financial assistance for a wide range industries and occupations, including funds to establish or maintain training and education programs for home health workers.

In Colorado, Gov. Jared Polis has identified home health care employers as “critical businesses,” meaning they are permitted to stay open during the state-mandated lockdown if they practice proper safety measures. Colorado’s home care agencies have received instructions about screening staff members for the virus and have been provided with guidelines from the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control (CDC). However, there aren’t currently protocols in place to ensure direct care workers have access to equipment like N95 masks or benefits like paid sick leave, protections that can keep them — and the older adults with whom they work — safe.

In the meantime, there are steps employers and state officials can take to invest in and protect their direct care workers. PHI, a long-term care research group, has developed seven strategies that states can take to care for their long-term care workers. For instance, deeming these workers “essential” would give them ability to continue their work. Providing personal protective equipment can help keep them safe. And offering free child care while schools are closed can ensure workers have a safe place to bring their children while they are at work.

The vulnerability of the direct care workforce is not an inevitability, but their safety and well-being during the COVID-19 outbreak is not guaranteed unless leaders in both the public and private sectors take action.

The challenges that Colorado’s direct care workers face are not new, but the crisis at hand shines a light on the urgency taking better care of our caregivers. By taking steps to ensure their safety and security, Colorado has an opportunity to protect their livelihoods, reduce the transmission of COVID-19, and ensure that older adults and people with disabilities in our communities continue to receive the care they need.

Julia Char Gilbert, a research analyst at CHI, contributed to this post.

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