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We Finally Have a Coronavirus Bill for Home Care Workers

March 23, 2020

Last Thursday, Sen. Bob Casey (D-CA) introduced the Coronavirus Relief for Seniors and People with Disabilities Act, which would respond to the COVID-19 crisis by increasing funding for nursing home surveys to promote infection control; covering the cost of COVID-19 treatment for low-income older adults and people with disabilities, while ensuring they can also access meals and home-based services; and supporting state Medicaid programs to temporarily boost their home and community-based services, including by strengthening their home care workforces.

In regard to home care workers and their employers, the Act would provide federal funding to states, in the form of Medicaid grants, that would allow states to increase rates for home care agencies with the stipulation that they also increase their workers’ compensation. These grants could also fund employers to provide direct care workers with paid sick leave, paid family and medical leave, hazard pay, overtime pay, and shift differential pay. Other ways that states and employers could use this funding include: expanding home and community-based services to individuals on wait lists; purchasing emergency supplies and equipment to protect home care workers; covering travel-related costs for workers to reach their clients; recruiting new home care workers; and providing COVID-specific training to home care workers, among various other measures.

Sen. Casey should be highly commended for his leadership on this issue, and as advocates we must galvanize support for this bill in Congress and ensure its passage. But the bill also highlights a persistent, widespread bias in the national and state-level response to the COVID-19 epidemic: while direct care workers (across long-term care settings, not just home care) and their employers are increasingly designated “essential” workers and businesses when cities and states shut down to “flatten the curve,” the long-term care sector is being largely left out of emergency funding packages related to this coronavirus. This disconnect leaves direct care workers and their employers—deemed as essential to our public health—financially unprepared to respond safely and effectively.

Why do direct care workers need targeted assistance at this moment? They are the primary source of paid support for older people and people with disabilities, many of whom are at heightened risk to the complications of COVID-19 because of their age and medical status. For workers, the requisite in-person nature of direct care places them at risk, yet their poverty-level wages and general lack of paid leave and childcare leave them with almost no financial option to take care of themselves when illness hits. Will they risk their health and the health of their clients by going to work sick? Will they stay home without pay and descend deeper into poverty? Will they leave this field, which would worsen the growing workforce shortage in this sector? All these scenarios could occur unless state and federal governments intervene with substantive resources.

The employers of these workers—home care agencies, nursing homes, and residential care providers—are also strapped for funding and have been rightfully demanding emergency support. A recent survey of nearly 300 New York State home care providers (that together support more than 14,000 high-risk clients) revealed their desperation: 68 percent reported not having adequate personal protective equipment and about 48 percent reported that their clients and family members were turning away home care workers for fear of infection. The Home Care Association of New York, which administered this survey, called for “access to supplies, regulatory flexibility and emergency aid.” These concerns are not particular to New York and might soon reflect the realities of home care agencies and other long-term care providers throughout the country, as coronavirus cases surge and the health and long-term care sectors struggle to keep pace. (On this point, PHI has issued a national survey of long-term care employers, direct care workers, and others to better understand the barriers they’re facing in responding to COVID-19.)

These direct care employers have long been chronically underfunded, operating on marginal funding and insufficient reimbursement rates (primarily under Medicaid)—and saddled by limited staffing and growing challenges with recruitment and retention. Direct care workers have also been undervalued, providing essential supports despite poor-quality jobs characterized by low compensation, insufficient training, and limited career paths. Culturally, they’re marginalized on multiple levels as a workforce comprised largely of women, people of color, and immigrants, which heightens their vulnerability.

It shouldn’t take a global pandemic to see these problems and recognize that this sector needs a transformation. Rep. Casey’s bill might represent an important turning point for the direct are workforce—time will tell—but continuing to minimize these workers in the national response only perpetuates their inequalities and further threatens both their livelihood and their clients.

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