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How Can States Support Direct Care Workers during This Pandemic?

March 26, 2020

The novel coronavirus, COVID-19, has already deeply impacted nursing homes across the country, starting with an outbreak at Life Care Center in the Seattle suburb of Kirkland, where 35 residents died from the disease. Without swift action, we will see more and more tragic outbreaks across long-term care, given the vulnerability of consumers and direct care workers alike.

These outbreaks are fueled by immense systemic challenges in long-term care—challenges that include the scarcity of protective supplies, inadequate paid leave for the direct care workforce, and persistent direct care workforce shortages, among others. Nonetheless, states have numerous options to stabilize the direct care workforce and the care they provide, largely through existing policymaking channels and increased federal funding (with the potential of more funding on the way).

This article lays out seven strategies that states can use to invest in direct care workers and mitigate the impact of COVID-19 on the long-term care system.

1. Designate direct care workers as essential workers

Most states have placed restrictions on movement outside of the home, with exceptions for “essential workers.” In this critical moment, direct care workers must be deemed “essential” workers in every state for three primary reasons: 1) to help consumers access needed services, 2) so that workers receive the supports that are reserved for essential workers, like personal protective equipment (PPE) and childcare, and 3) to enable workers to stay in their jobs, where they are so critically needed.

2. Provide essential workers (including direct care workers) with free childcare

One in five direct care workers has a child between the ages of 5 and 17. In order to ensure these low-wage workers can afford to stay on the job during school closures, or as their work hours intensify, they will need free childcare. Other states can look to the executive order that Governor Tim Waltz in Minnesota signed on February 20 of this year, which guarantees free child care to all essential workers, including the entire long-term care workforce.

3. Ensure direct care workers have access to personal protective equipment (PPE)

Direct care workers have frequent, direct interaction with older adults and people with multiple comorbidities—those who are at highest risk of the complications from COVID-19. As states make plans to mass manufacture and distribute PPE, they must account for direct care workers’ need to protect themselves and the people they serve from infection.

4. Fill the gaps in emergency paid sick leave policies for direct care workers

Thanks to the passage of the Families First Coronavirus Response Act (the “Families First Act”) at the federal level, some workers will have paid sick leave and paid family and medical leave for the first time. However, this critical legislation has notable gaps. First, workers employed by establishments with fewer than 50 employees can be excluded from protections—which could exclude a large numbers of direct care workers in the home care and residential care industries. Nursing assistants in nursing homes might be exempted as well because they are considered health care providers by the U.S. Department of Labor. (Home care workers are not.) Requiring sick caregivers to continue working will do more harm than good, so these workers must be guaranteed paid leave. States should step in where the federal government has fallen short.

5. Disseminate training on COVID-19 to all direct care workers

Training requirements vary across direct care occupations and long-term care settings, but in all cases, workers need access to high-quality training on caring for themselves and their clients during the COVID-19 pandemic. However, training for direct care workers is chronically underfunded. Employers and other training providers will need additional state funding to develop and disseminate competency-based, adult learner-centered training that can be accessed remotely.

6. Expand access to affordable health care, including coronavirus testing and treatment

The Families First Act helps make coronavirus testing (and related services) mostly free, but individuals are still on the hook for steep costs if they visit a doctor or emergency room with relevant symptoms but do not receive a test. Moreover, one in eight direct care workers is uninsured, which leaves them with no affordable treatment options. States should explore every strategy for expanding coverage to direct care workers, including through Medicaid, subsidized marketplace plans, and employer-provided insurance.

7. Build pipelines into direct care jobs

To ensure that long-term care employers have enough replacements for those who are sick or on leave, states will need to devise methods to recruit new direct care workers. One approach is to replicate the WisCaregiver Careers model, which draws on public communications strategies, free training and testing, and a six-month retention bonus to grow the state’s nursing assistant workforce. States could create similar programs in other long-term care industries (funded with federal workforce development dollars) for workers who have been recently displaced by the COVID-19 crisis and are looking for new job opportunities.

This is a pivotal moment for state policymakers. Social distancing, shifting care arrangements, and impending economic disaster have only just begun to affect long-term care delivery. State action is urgently needed now, before these intensifying challenges become unmanageable.

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