Strapping on masks. Rationing supplies for patients. Putting themselves in potential danger during the epidemic.
The frontline for keeping the coronavirus at bay isn’t just in hospitals, it’s also maintained by Pennsylvania’s tens of thousands of home health care workers, deployed to bedsides across the commonwealth.
Like grocery store clerks and delivery drivers, providers of in-home care are considered “essential” during Pennsylvania’s coronavirus lockdown. In this job, social distancing is impossible, and the clients are some of the most vulnerable to becoming seriously ill from the virus.
“l love helping people, seniors and people with disabilities, who cannot do for themselves,” said Lolita Owens, a home care worker with Liberty Resources Home Choices in Philadelphia. “The downfall is not making enough money, [enough] benefits, and, at this present point in time, this particular virus.”
Owens spends 40-60 hours a week working with two elderly people. Just this week, one got sick and thought it could be COVID-19. She hustled to get her client care and answers, she said, before it became clear that the illness was something else.
The home health care industry ranks second in the commonwealth for projected job growth, a state where more than 16% of residents are 65 and over. The field encompasses everything from skilled nursing to hospice care to more basic assistance with tasks like getting dressed and washing the dishes.
Under normal circumstances, these high touch and often low-paid workers provide their home-bound clients a critical link to the outside world.
Now, in a time of ‘stay-at-home’ orders, home care aides worry about the health implications of the job, which state data shows averages a $25,000 salary. Are they putting themselves at risk? Their clients? Owens, 49, is concerned about doing things other people are avoiding right now, such as taking public transportation.
“It’s scary, but that’s the only way I’m going to get there,” she said. “So I don’t have a choice but to do it.”
There’s real fear on the client side as well.
Jack Freedman, 24, of West Chester, has a neuromuscular disease that’s required round-the-clock care from a team of home care aides for his entire life. He has a tracheostomy, a tube in his windpipe, and mechanical ventilation to help him breathe. Even getting a cold can be dangerous.
Now, as care workers come and go, his parents can’t help but feeling more anxious.
“[We] feel like we’ve been dodging bullets for a long time. This virus feels like we’re dodging bullets from a machine gun,” said his dad Al Freedman, who estimates his son has spent more than 300 nights in an intensive care unit during his lifetime.
There are also looming concerns for the home care industry as a whole at the moment.
The shortage of protective equipment, like gloves and masks, has hit home care hard. Home health agencies are scrambling to provide supplies, often the same ones doctors and hospitals also need, to their workers.
“It’s a real challenge and obviously a challenge for all,” said Teri Henning, CEO of the Pennsylvania Homecare Association.
As nursing homes and assisted living facilities have closed to visitors, there’s also been some confusion about whether home care aides can enter facilities during lockdown.
Last week, the Pennsylvania Homecare Association reached out to the state Department of Health, requesting more information on how to get a hold of personal protective equipment, and asking for “clearer guidance… to clarify that home health, hospice and homecare providers are healthcare providers,” and should be allowed in nursing homes and assisted living facilities if they are taking proper precautions.
“It’s a significant issue. Sometimes there really are life-critical services that are being provided, and we just try to do the best we can,” Henning said.
With coronavirus cases now reported in nursing homes in Pennsylvania, groups representing elderly Pennsylvanians and their caretakers have sounded the alarm about the “inadequate” supply of protective equipment and asked for a $290 infusion of cash to pay staff and keep supplies flowing.
Fear and a sudden downturn in the economy has also cost some home care workers their jobs. Especially hard hit are the large numbers of aides who work more informally, often directly for an individual or family.
“Domestic workers…really are on the frontlines of keeping family’s homes safe and clean which is so critical during this time, yet are either being put in the position of not being able to pay their bills and not being able to pay rent on April 1, or putting themselves physically in harm’s way,” said Nicole Kligerman, director of the Pennsylvania Domestic Workers Alliance.
The group represents house cleaners, nannies and domestic caregivers who work for cash, the majority of whom are immigrants not authorized to work in the United States.
Nearly all are losing work, and without access to unemployment benefits and other supports, according to Kligerman.
“They’re completely screwed,” she said.
The Pennsylvania Domestic Workers Alliance is a part of a national group that launched a “coronavirus care fund,” to help pay homecare workers who get sick or lose wages.
They’re also urging the City of Philadelphia to provide assistance for contract and informal workers.
The virus itself is also keeping caregivers from their jobs.
In Jack Freedman’s case, more than 10 care workers from four different agencies are a part of his care team. But three have already dropped out due to coronavirus related restrictions — two in quarantine, and one who traveled to West Africa to visit family and now cannot travel back.
Tuesday evening, nurse Dawn Pye went over the family’s new enhanced sanitization protocol, used by many of the nurses at her agency, Lincoln Healthcare.
Now, they wear masks and bring a change of clothes if they’re not coming directly from home. Shoes are left outside, and phones wiped down.
She also went through Freedman’s supply list, marking off which things could be reused or rationed to make them last longer. Trach filters, catheters, oxygen supplies, ventilating equipment were catalogued and gamed out — in case they become harder to come by.
“Anything can be cleaned and reused in a dire need,” she said.
Sojourner Ahebee contributed reporting.