Our COVID-19 response has not recognized the importance of the invisible direct care workforce.
A new blog published by The Commonwealth Fund draws strong parallels between direct care workers and their care recipients. Essentially, the authors suggest, both workers and clients represent highly vulnerable populations.
On the one hand, many recipients of in-home personal care have low incomes and qualify for home and community-based services (HCBS) through Medicaid. These HCBS recipients are disproportionately older adults and people of color, have chronic illnesses, and are at high risk for serious illness and death if they contract COVID-19.
“If their in-home care system falls apart, they could easily end up with worsening health, hospitalized, or in a nursing home.,” write Kristi L. Kirschner, M.D., of the University of Illinois College of Medicine, Lisa I. Iezzoni, M.D., of Harvard Medical School, and Tanya Shah, of The Commonwealth Fund.
On the other hand, 18% of direct care workers live in poverty and 44% have low incomes. More than half (53%) rely on some form of public assistance. About one-quarter have Medicaid (26%) or use supplemental nutrition (SNAP) benefits (24%). One in five lacks health insurance.
“Most communities have no system for distributing PPE to these workers or testing them routinely for coronavirus,” the authors write. “Some direct care workers are therefore unknowingly bringing coronavirus into the homes of their clients or having to make the difficult choice of putting themselves and others at risk in order to work.”
Kirschner, Iezzoni, and Shah suggest the country can better support direct care workers and their clients during the pandemic by:
- Designating direct care workers as “essential workers” so they can receive supports such as personal protective equipment (PPE) and childcare that are reserved for essential workers.
- Developing statewide or local registries of workers to quickly identify those in this workforce and provide benefits and protections.
- Providing access to coronavirus testing and PPE, and implementing policies to address infection monitoring and treatment.
- Increasing compensation rates or providing hazard pay.
- Providing guaranteed health insurance and sick leave.