Pandemic puts home care workforce on the front lines

Underscores need for better pay, working conditions in fast-growing industry

masked hero
"We're on the front lines, and we're being put right in the middle of this," says home care worker Melissa Morales. (Photo: Pashtana Usufzy.)

Melissa Morales, a Southern Nevada-based personal care assistant, isn’t sure how her finances will look next week.

Before the novel coronavirus spread, Morales worked seven days a week, traversing the city to help clients get changed, fed, showered and ushered off to doctors’ appointments. Despite her efforts to socially distance, accrue personal protective equipment (PPE) and ensure safe visits to each of about 10 weekly clients’ homes, the cancellations began. 

She’s temporarily lost most of her clients, and as a result, Morales’ income dropped nearly $2,300 a month. She’s earning just about $80 a week now.

Even with help from her retired father, she’s unsure how she can keep up her finances with four kids at home. And she’s still working in close proximity with her remaining clients in the midst of the pandemic.

“We’re on the front lines, and we’re being put right in the middle of this,” she said. “We don’t make enough, and they’re reducing patients, so what am I supposed to do by next week?”

Home health workers and personal care assistants fill a critical gap in heath care by providing day-to-day services to formerly hospitalized individuals, those living with disabilities and others. However, these essential workers — who in Nevada are largely female and mostly without college degrees  —  fill this role while working largely labor-intensive, low-paying jobs, sometimes without benefits like health insurance and sick leave.

Many are not guaranteed 40 hours a week of work despite being “full-time” employees who travel all across the Valley without reimbursements for gas or mileage. In the midst of the pandemic, several told the Nevada Current they’ve had to secure at least some of their own PPE.

In May 2019, the median hourly wage for home health and personal care workers nationally was just $12.15. In Nevada, the state’s estimated 14,760 home health and personal care aides took in $11.44 an hour in median wages, according to the Bureau of Labor Statistics, or BLS.

Rozetta Love, a full-time employee at a local home health agency that she declined to name, currently works as a personal care assistant for clients receiving benefits from the United States Department of Veterans Affairs.

The relationship with those individuals is more than just a work bond. From helping with showers to listening to their stories, Love is a participant in some of the most intimate moments of their lives.

“You become a family because you begin to understand what they need and why they need it,” she said.

Love, who has worked for the same company for 10 years, earns $10.25 an hour. If she were to become infected with coronavirus while working closely with one of her clients, she has no paid sick leave to utilize.

“I enjoy what I do for other people. What I do not enjoy is the lack of PPE, the lack of training, the lack of wages, the lack of healthcare,” she said.

The U.S. home health and personal care fields are expected to see significant growth in the next decade. Employment was projected to surge 36 percent in those fields from 2018 to 2028, which is “much faster than the average for all occupations” of just 5 percent, according to the BLS.

“As the baby-boom population ages and the elderly population grows, the demand for the services of home health aides and personal care aides will continue to increase,” according to the bureau’s website.

That growth represents both hope and potential disappointment for local home health and personal care aides like Morales and Love, both of whom are working with the Service Employees International Union to advocate for better work conditions in Nevada.

The women say much of the problem is that reimbursement rates set by payers like Medicaid and Medicare are simply too low. The companies that hire home health workers use those funds to pay their employees. If action isn’t taken to increase them, the incoming hordes of new home health workers may face similarly low wages without benefits. 

The women say the amount of hours a client may receive services should also be examined by payers. Multiple home health workers who spoke to the Current said it’s not uncommon for them to go off the clock to meet the needs of their clients. If they refuse to do so, a client could go without a meal or a shower until their next visit from the home health or personal care worker.

Luz Castro, an allied health specialist who oversees the Home Care Aide Training certificate program at the College of Southern Nevada, said that when students in the program enter the workforce, they face some of the same challenges Morales and Love described: low income, challenging commutes and lack of sufficient hours.

The college’s 120-hour training can offer students an advantage by providing lessons on everything from personal care to handling adverse situations and understanding privacy laws. Since home health care providers in Nevada are not required to receive a special license, such certification can be a tool used by participants to boost earning potential.

Offered at a cost of $1,640, the course includes trainings as well as background checks and tuberculosis test costs.

Though the program’s enrollment is diverse, participants are mostly women and are often black and Latina. In Nevada, most home health workers are people of color, according to direct care worker and user advocacy organization PHI.

According to the organization, “one in four home care workers lives below the federal poverty line.”

The matter of home health worker and personal care assistant pay and benefits has received national attention in recent days.

A letter sent to U.S. House leadership Thursday and co-signed by nearly 50 representatives requested an expanded definition of “essential worker” that includes home health aides as well as early education and childcare workers. The letter, which seeks for the change to be included in an upcoming coronavirus relief bill, suggests such workers should receive a “living wage” with hazard pay, COVID-19 training, access to affordable health care and free personal protective equipment. The letter also calls for expanded investment in the nation’s child and home care infrastructure. 

Love and Morales said greater investments in home health care generally could help not only secure the futures of current home health workers but also ensure a stable workforce for Nevada.

“I want to be on the ground floor. This is not about me. I’m a 55 year old woman,” Love said. “I want this for the next generation of home care workers.”

Pashtana Usufzy
Pashtana Usufzy is a freelance general features and health reporter based in Las Vegas. She previously worked as a health care reporter at the Las Vegas Review-Journal and prior to that as a local news reporter at the Las Vegas Sun.