Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors.
Every day, we learn more about the virus that has upended our world and is killing our family and friends. Early in the pandemic’s progression, New York City saw a disproportionate impact on people of color. Further analysis tied the severity of illness and likelihood of death to the prevalence of underlying chronic medical conditions, including diabetes and chronic heart ailments—conditions which themselves can reflect lifelong struggles with poverty, food insecurity, and economic stress. The heat maps pulse deepest red where the virus is taking its greatest toll, in low-income communities and neighborhoods where families live in cramped quarters.
Every day, we also see fresh evidence of what we have known all along: home care is an essential service. For those with severe physical disabilities and the frailest among older New Yorkers, the only practical alternatives to home care are nursing homes or hospitals. But in this time of extraordinary and overwhelming stress on the institutional health care delivery system—as facilities struggle to keep their uninfected patients safe and their staff equipped with adequate protection to avoid falling ill themselves—these alternatives are either dangerous or unavailable.
One bright spot during this pandemic: technology and remote monitoring are advancing by leaps and bounds. The urgency of remote work has prompted public and private payers to ease some of the payment and regulatory barriers that were slowing adoption before this outbreak. New partnerships between technology companies and service delivery organizations born in the pandemic will surely prove to strengthen home care’s effectiveness in averting serious episodes of illness after the virus is tamed.
But remote monitoring cannot assist with taking a bath, feeding someone too weak to eat, or providing intimate assistance to someone with advanced illness or extensive physical limitations.
Home health aides are the essential workforce who make it possible for thousands of New Yorkers to have good days at home and to stay out of institutions. They are overwhelmingly women of color, and they and their families live in the very communities that are hardest hit by this virus and where social distancing is a privilege not available to them. At community-based providers like JASA, these caregivers are themselves part of the high-risk population—one in five JASA caregivers are 65 years of age or older. While a few aides live nearby and can walk, the vast majority ride crowded subways and buses to get to their clients’ homes. They make multiple trips to grocery stores for themselves and their clients, where delivery or online ordering are not available and limited finances don’t allow them to stock up for weeks and limit their trips. Home health aides do it all with grace and care, and for their labors are paid only minimum wage.
Home health aides deserve our gratitude and respect. More than that, they deserve fair pay and the tools they need to stay safe. Home health is health care, and it should therefore be included in priority distribution of personal protective equipment like masks, gloves, and gowns. Taxi and Limousine Commission drivers could provide alternative transportation for home health aides similar to how they have been redeployed for food deliveries. Governor Cuomo recently called on the federal government to provide differential pay for essential public workers on the frontlines, in the form of a 50 percent bonus; home health aides are no doubt essential and should be included in any future up-pay proposal. As Congress considers the next federal relief package, Medicaid providers must be part of the discussion so that home care agencies and other critical parts of the safety net can get the resources they need to weather the storm.
After this pandemic, when we begin the work of rebuilding and remaking health care, perhaps then we will be willing to engage in the conversations that up until now we have avoided. Now that many of us have seen the dedication of this essential workforce during a crisis, perhaps we can finally offer them the same level of dignity and respect that they provide to their clients each day.
Kathryn Haslanger is the CEO of JASA, one of New York’s largest agencies serving older adults in the Bronx, Brooklyn, Manhattan, and Queens.
United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Kathryn Haslanger looks at the essential role of home health aides during the COVID-19 pandemic and how they can be better supported. – UHF President Tony Shih