They are essential workers now, and should continue to be: Social workers and Home Health Care Workers during COVID-19 and Beyond

Abstract

During COVID-19, social workers can ensure safe and quality care for older adults through advocacy and support of home health care workers.

Although much has been said over the past few months about the selfless dedication of frontline healthcare workers during the Coronavirus (COVID-19) pandemic, this deserved recognition stands in stark contrast to the decades of neglect that some members of this workforce have historically endured. That is, while social workers and home health care workers often serve as the backbone of our social service delivery and healthcare systems, they have been and continue to be, seldom seen, heard, or valued. Social workers, despite their roles in hospitals and nursing homes, are not being recognized as “essential” workers (Lipe, 2020). Similarly, home health care workers, despite caring for older adults with those with disabilities, functional deficits, and medical comorbidities, are invisible essential workers in many states during COVID-19.

Currently, 2.3 million workers provide hands-on personal assistance and health care support to 8.3 older adults in the home and community-based settings (Campbell, 2017). These workers are essential to the successful completion of fundamental activities of daily living (ADLs) and instrumental ADLs (IADLs). Additionally, they aid with medically-oriented tasks such as reminding patients to take medications, accompanying them to health care visits, and taking vital signs. Beyond that, they provide emotional support and companionship. Social workers know and understand the value of these workers, since the independence of their clients is contingent on having their support (Sterling & Shaw, 2019; Reckrey et al., 2019).

Yet despite being integral to patient and community care, these workers –who are mostly middle-age women from racial, ethnic and/or immigrant communities -- experience daily hardships. As social workers know, they work long hours, often for multiple agencies, earn minimum wages, and have few opportunities for career advancement. According to data from PHI, home health care workers earn a median hourly wage of $11.52 and an annual salary of $16,200 (Workforce Data Center, 2017). Currently, more than half rely on some form of public assistance. These conditions have led to high turnover rates and workforce shortages, which are likely to be exacerbated during COVID-19 if the workforce is not better supported.

As COVID-19 overwhelms our healthcare and social service systems, and more older adults are asked to manage their symptoms at home, the role and importance of community-based supports, especially home health care workers, will become increasingly important for patients. Yet, because home health care workers are in close contact with frail, elderly, and medically complex clients, they are at an increased risk of exposure to COVID-19. This puts their own health and that of their families’ in jeopardy. Home health care workers in many areas also face shortages of personal protective equipment (PPE), which further increases transmission risk. Unlike other healthcare workers, taking sick leave is not always an option for this group. Beyond losing their own wages, a recent survey by PHI found that 66% of workers are concerned that there won’t be enough workers to replace them if they need to take time off or leave their existing jobs due to COVID-19 (Scales, 2020). All told, the impact of COVID-19 may be devastating for direct care workers and their clients, unless serious action is taken.

Social workers are key players in interdisciplinary healthcare and serve as a critical link to home health care workers by recommending and approving services for clients, managing and training workers, and advocating for client-centered supports. So what can they do for workers during COVID-19? First, social workers can serve as advocates for home health care workers to receive training on COVID-19 and infection control practices from health systems, employers, and government agencies. Evidence suggest that high quality training improves workers’ preparedness and confidence, as well as the quality of care they deliver (Guerrero, Eldridge, & Tan, 2019). Second, technology needs to be leveraged to meet workers’ training needs during COVID, when social distancing is necessary. With physical distancing mandates, social workers can provide or advocate that training be conducted remotely, online, by phone or through information mailings to ensure the safety of both the workers and their clients. Third, home health care workers need supplies. Just as hospitals are scrambling to meet daily PPE requirements, so are community based organizations and social service agencies. Yet, unlike large hospitals, these agencies do not have the same buying power or bargaining ability. Therefore, serious advocacy is necessary for both local and state agencies, home care associations, and healthcare worker unions – and social workers can help. Lastly, policies are needed to better support these workers. COVID-19 is a fitting time to revisit previous calls for a healthcare and employment model that recognizes, rewards, and respects interdisciplinary care, and highlights the role of home health and direct care workers’ contribution to the health, safety, and quality of life of older adults and those with chronic conditions and disabilities. In particular, policies are needed that at the very least, provide workers with living wages and benefits, including paid sick leave, health insurance, and retirement contributions. Ideally, organizations should move away from an approach that relies on temporary and contingent workers. Social workers can serve as advocates for these and other policies that are supportive of these workers and their clients.

As community spread of COVID-19 continues, and as more Americans shelter in place, the burden of care will be increasingly placed on home health and direct care workers, a group of front-line caregivers that has historically been overlooked and undervalued by the healthcare system and society at large. Now is the time to change this. Now is the time for increased awareness and advocacy by the social work community that understands the value and needs of community-based care. Home health care workers need far more than our acknowledgement and appreciation. They need policies that improve training, provide equipment, ensure stable, good paying, and high-quality jobs so they can continue to care for our communities and loved ones safely and securely. Our social work values and ethics demand we do this for our older adults now, and into the future.