Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the COVID-19 Pandemic

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, home health aides (HHAs) provided daily medical and personal care to community-dwelling older adults and those with chronic conditions. Prior qualitative studies have found that providing care during COVID-19 left HHAs susceptible to physical, financial, and emotional risks. However, limited quantitative data exist The objective of this study was to assess the impact of COVID-19 on HHAs and to understand the challenges and opportunities for current and future pandemic planning. A cross-sectional survey of 256 HHAs in the downstate New York region was conducted by telephone in English, French Creole, Chine, Spanish, and Russian between August and November 2020. The survey found that HHAs experienced a variety of physical, financial, and emotional challenges during COVID-19. To better support this work force, action by public health officials and policymakers is warranted, particularly with respect to workplace protections and safety, mental health, compensation, and access to basic resources.

Covid-19: Home Health Aides’ Perceived Preparedness and Self-Reported Availability for Work: Six Month Survey Results

“…27 With the exception of the federal multi-million-dollar National Home Health Aide Survey conducted in 2007, 28 response rates in surveys of HHAs have generally been similar to the 20% yielded by this study. 27 While it is possible that our response rate was depressed by HHAs' concern over employer sponsorship, it is similar to the 22% response rate of the contemporaneous 1199SEIU-sponsored survey, 21 which had no employer sponsorship, and to the 21.8% reported by the Massachusetts Home Health Aide Survey. 27 Nevertheless, low response rates remain a concern because non-responders may differ in meaningful ways from those who do respond, and the validity of survey inferences depends on how well the sample represents the underlying population.…”

“…This finding can be compared to the findings of a contemporaneous 1199SEIU-sponsored NYC-wide survey on the COVID-19-related needs of HHA union members. 21 In that survey 75% of respondents reported they had "enough information" on how to protect themselves from COVID-19 at work, 75% reported they had enough PPE at work, and 88% reported they had enough information on caring for patients with known or suspected COVID-19. 21 Our finding that severe mental distress was negatively associated with both perceived preparedness and availability is especially striking because mental distress was not explicitly measured in the early willingness to work literature.…”

A Qualitative Study of Home Health Aides’ Perspectives towards COVID-19 Vaccination

“…Unlike many other healthcare workers who may have been able to work remotely, aides provided care to patients in their homes without being able to socially distance and often without adequate access to personal protective equipment (PPE) at the beginning of the pandemic ( Markkanen et al, 2021 ). Doing so placed them at high risk for infection, and also posed challenges to their own financial, physical, and emotional well-being, exacerbating existing vulnerabilities among a workforce comprised largely of middle-aged women of color who earn low wages and often lack paid time off ( Bandini et al, 2021 ; PHI, 2019 ; Pinto et al, 2022 ; Rowe et al, 2020 ; Scales, 2021 ; Sterling et al, 2020 ; Tyler et al, 2021 ; U.S. Bureau of Labor Statistics, 2021 ). Many patients with COVID-19 were cared for by aides, and many aides contracted COVID-19 ( HCA Policy Team, 2020 ; Pinto et al, 2022 ; Sama et al, 2021 ).…”

“…Doing so placed them at high risk for infection, and also posed challenges to their own financial, physical, and emotional well-being, exacerbating existing vulnerabilities among a workforce comprised largely of middle-aged women of color who earn low wages and often lack paid time off ( Bandini et al, 2021 ; PHI, 2019 ; Pinto et al, 2022 ; Rowe et al, 2020 ; Scales, 2021 ; Sterling et al, 2020 ; Tyler et al, 2021 ; U.S. Bureau of Labor Statistics, 2021 ). Many patients with COVID-19 were cared for by aides, and many aides contracted COVID-19 ( HCA Policy Team, 2020 ; Pinto et al, 2022 ; Sama et al, 2021 ). Additionally, many home-bound adults were fearful of receiving home care due to the infection risk, which translated into fewer cases and hours for aides and their agencies.…”

“…Bureau of Labor Statistics, 2021). Many patients with COVID-19 were cared for by aides, and many aides contracted COVID-19 (HCA Policy Team, 2020; Pinto et al, 2022; Sama et al, 2021). Additionally, many home-bound adults were fearful of receiving home care due to the infection risk, which translated into fewer cases and hours for aides and their agencies.…”