Home care workers feel stressed and alone – Finance and Commerce

Editors note: Business content from The New York Times will now be included with your subscription to Finance & Commerce. Not a subscriber? Start your subscription here.

For 15 years, Yvette Dessin spent long workdays with her elderly patients, accompanying them on walks, cooking them meals and bathing those who needed that most intimate kind of care. If a patient died, Dessin and her adult daughter attended the funeral services to pay their respects.

Dessin worked up to 60 hours a week as a home health aide, her daughter said, making minimum wage. She often worried about being able to pay the mortgage on her Queens, New York, home. She was one of roughly 2.4 million home care workers in the United States most of them low-income women of color and many of them immigrants who assist elderly or disabled patients in private residences or group homes.

The industry is in the midst of enormous growth. By 2030, 21% of the U.S. population will be at the retirement age, up from 15% in 2014, and older adults have long been moving away from institutionalized care. In a 2018 AARP survey, 76% of those age 50 and older said they preferred to remain in their current residence as they age. In 2019, national spending on home health care reached a high of $113.5 billion, a 40% increase from 2013, according to the most recent data from the Centers for Medicare and Medicaid Services.

The ranks of home care aides are expected to grow by more than those of any other job in the next decade, according to the Bureau of Labor Statistics. It is also among the lowest-paying occupations on the list.

Nearly 1 in 5 aides lives below the poverty line. In six states, the average hourly wage for home care aides is less than $11, and nationally, the median pay has increased just $1.75 an hour over the past decade, when adjusted for inflation.

Much of the aides low wages are paid for with taxpayer dollars about two-thirds of home care revenue is through public programs, primarily Medicaid, according to the nonprofit PHI, which monitors the eldercare workforce. The state and the federal government and sometimes the local municipality split the cost of Medicaid, which makes for varying rules from state to state, including on what services home health aides can provide.

The pandemic only made things worse, exposing the vulnerability not only of the elderly and infirm but also of those who care for them. As COVID-19 spread across the country, many families turned to home health care as an alternative to nursing homes, which had become hot spots for the virus. Shortages of personal protective equipment made the work risky.

Although home health aides qualify for sick leave under New York City law, many people interviewed were unaware of that or did not feel as if they were truly permitted to take time off.

In conversations with more than 50 home health aides around the country, many workers described unpaid or late-paid wages, unaffordable benefits and chronic injuries.

For some, like Dessin, those conditions amid a pandemic proved fatal. She was at high risk because of her age and preexisting conditions and became one of at least 275 aides at her company who contracted the virus, according to her union. Her company said she was one of seven of its employees to die from COVID-19.

Dessins daughter, Dany St. Laurent, believes that her mother felt trapped during the pandemic. Her work came before everything, she said. Including herself.

[[bold subhed]]

Private work, public regulation

Americare, Dessins employer, is one of about 1,500 home health care providers in New York state, and among the citys largest, with more than 5,000 employees and about as many patients in the five boroughs and surrounding counties.

The private nature of the work makes oversight of home care agencies challenging, even when regulators try to step in.

In 2018, an investigation by the New York City Department of Consumer and Worker Protection found that Americare was among more than 30 home care agencies that had failed to follow paid sick leave regulations. It determined that Americares sick time policies violated city law and noted that the company had a history of noncompliance with labor laws. The company was ordered to change its policies, notify employees of their rights and train managers on complying with city sick leave law.

The company is also the subject of a lawsuit by workers claiming a systemic, long-standing underpayment of wages going back to 2005. In court documents, Americare denied the accusations. Oral arguments regarding the workers motion for the case to proceed as a class action are scheduled to begin later this year.

Americare was investigated twice by the attorney generals office for Medicaid compliance issues in 2005 for improper billing and in 2008 for failing to detect workers with falsified training certificates. The investigations resulted in a total of $15 million in reimbursements.

In an interview, an Americare representative said that Medicaid audit settlements were common in the industry.

There are an estimated 65,000 home care agencies across the country. Americare may have a fraught history, but it is also a microcosm for the industry itself.

[[bold subhed]]

Doing what she loved

When Dessin moved to New York from Haiti in the mid-1980s, she realized that the unpaid caregiving work she had been doing in her home country was a marketable skill.

Speaking nine months after her mothers death, St. Laurent described how life in New York looked from Haiti as if money grows on trees, she told us last winter. From what theyve seen on the internet, you could just go in the garden and pick up $100.

For almost two decades, Dessin ran a day care center out of her apartment. In 2005, at 50 years old, she decided to pursue a home health aide certification. When she completed the training program that fall, she had her certificate framed.

This lure of education and financial independence also drew Helen Monah, a Guyanese immigrant who moved to New York City in 2018 and began home health care training. She texted her daughter, Rubena Durbin, photos of her progress a stack of open textbooks and pictures of herself in glasses and scrubs. In December, she was hired by Americare.

She was so happy to be working in that environment doing what she loved, Durbin said.

The work itself was onerous. Apart from regular patient care, Americare home health aides are also required to provide light housekeeping, including washing toilets, removing garbage and dusting, according to an employee handbook obtained during the citys 2018 investigation.

It also puts aides in close contact with their clients. They often have to lift and lower their patients, with their bodies pressed together and faces inches apart.

An Americare executive acknowledged that early in the pandemic, personal protective equipment was in short supply, so the company gave priority to workers assigned to high-risk patients. The executive said that the company distributed information in multiple languages on how workers could protect themselves and that workers were permitted to use paid time off as needed, adding that at one point in April 2020, as many as 250 aides were quarantining.

Numerous Americare nurses, therapists and aides said they would not be able to work due to their own underlying conditions, family concerns or general anxiety decisions that weve honored and respected, said Gallagher, Americares vice president.

As of August 2021, at least 275 Americare aides had been infected with COVID-19, according to Francine Streich, a field director at United Food and Commercial Workers Local 2013, the union representing Americare workers. She noted, though, that the number was probably an undercount, as the company had stopped providing numbers of cases to the union. Americare said that number was accurate as of February; it did not provide an updated number.

As the pandemic began spreading through the city, St. Laurent and Durbin both tried to persuade their mothers to quit. But their paychecks helped them achieve the financial independence both women had yearned for for most of their lives.

Dessin spent March 2020 working as many hours as possible 40 hours a week from Americare and more from another company. Later that month, she came home from work exhausted.

Mom, stay home, call out sick, her daughter, St. Laurent, pleaded, as Dessin sat down to catch her breath on the couch.

But Dessin was only five months away from when she had planned to retire and decided to keep working. Several days later, her condition had worsened. Dessin struggled to walk and needed her daughter to wash her hair as she sat on a chair in the bathtub.

The next day, St. Laurent drove her mother to the hospital. She was put on a ventilator that same night. Four days later, on April 7, Dessin was gone.

Meanwhile, Monah had bought a ticket back to Guyana for her sons wedding, her first visit in four years. After this trip, she told her daughter, maybe she would go on a cruise. Once she got to New York and started making her own money, she wanted to live, Durbin said.

Durbin was concerned when her mother told her that an aide who had worked a shift before her at a patients house was coughing, but Monah assured her daughter that she had cleaned the area with supplies she bought with her own money.

By April, she, too, had become ill and was treating her flulike symptoms with home remedies and over-the-counter medicines. On April 11, she began experiencing acute pain in her legs and stomach.

At the hospital, doctors diagnosed a blood clot in her stomach related to COVID-19 and recommended surgery. She sent her daughter a voice note via WhatsApp. Im going to make it, she said through fits of raspy coughing. Im a fighter.

But Monah never woke up, and on April 26 three weeks after Dessins death she, too, died.

This article originally appeared in The New York Times.

See original here:

Home care workers feel stressed and alone - Finance and Commerce