While the safety of physicians and nurses has received much attention during the coronavirus pandemic, hospital housekeepers and nursing home and home health aides also need greater protection and support, labor and industry groups say.
The most pressing need is for adequate supplies of personal protection equipment like N95 masks and gloves for these workers, whose safety often has gotten a lower priority. Housekeepers sometimes enter rooms wearing only gloves and find nurses garbed in head-to-toe protective equipment, said Anne Igoe, vice president for health systems at Service Employees International Union Healthcare in Chicago.
"Why the different standards?" she asked.
Of the 4.5 million direct care workers in 2018, nearly 90% were women, almost 60% were people of color, and about 1 in 4 was an immigrant, according to a new report from PHI, a long-term care research group, based on data from the U.S. Bureau of Labor Statistics and the Census Bureau.
These non-professional workers, who typically are paid relatively low wages, also need more training in COVID-19 protocols, better paid leave policies if they contract the virus, free child care as schools close, and expanded access to affordable health coverage, experts say.
Supporting and protecting food service workers, patient transporters, nursing aides, janitors, and others in acute and post-acute settings is just as important as protecting front-line professionals in keeping the healthcare system functioning during the pandemic, many say. Government officials should declare them essential workers and offer them benefits such as free child care, they add.
"This workforce should be front and center in terms of attention and protection," said Robyn Stone, senior vice president for research at LeadingAge, which represents not-for-profit long-term care providers.
Some LeadingAge members are setting up child care facilities for their employees, she said. In addition, her association is developing an online training program for nursing home and health home aides on COVID-19 safety protocols, which can be viewed in short modules on cell phones. That's intended to combat these workers' fears about contracting the virus at work and spreading it to their families.
Some unions are even pushing for hazard pay for people who continue coming to work despite the risk of infection. "Our housekeepers are on the front lines sanitizing rooms to make sure they are safe," Igoe said. "Without these workers, we won't be able to get ahead of this epidemic."
Nursing home and home care aides, who dress, bathe, and feed many elderly and disabled people every day in facilities and homes, are at particular risk of catching and spreading the virus. There are anecdotal reports of more care aides not coming to work, and of facilities and agencies scrambling to provide care to patients.
"There's no social distancing or hands-off way to do this work," said Stephen Campbell, a policy analyst at PHI, a long-term care research group. "These workers may have comorbidities of their own and fear for their lives."
State hospital associations in California and Washington, which are hotspots for the pandemic, declined to comment for this article.
The Healthcare Association of New York State, another hotspot, said New York healthcare facilities have focused on educating all staff on infection control practices.
"The health and safety of absolutely everyone who works in our hospitals—cleaning crews, clinicians, security guards and technicians—remain hospitals' top priority," said Bea Grause, the association's president. "You can't care for patients unless everyone in a hospital can do their part."
Dale Ewart, executive vice president of SEIU Local 1199 in Florida, said there's a dangerous shortage of N95 masks, particularly in nursing homes. In some facilities, workers have started wearing bandanas over their faces. He doesn't blame the hospitals or nursing homes, though.
"We've not taken action as a nation to make sure healthcare workers who are literally placing their lives on the line are given adequate protection," Ewart said. "It's not a problem that employers can solve. Only the states and the national government can resolve it."
Unions say it's vital for these non-professional workers to have adequate paid sick time and family leave if they are exposed to COVID-19, so they can make the right decision about staying home and not exposing their vulnerable patients to the virus. In California, the state's 380,000 public home care workers qualify for only eight hours of sick leave per year.
The Families First Coronavirus Response Act recently passed by Congress granted workers sick pay and paid family leave but allowed exemptions for businesses with fewer than 50 employees as well as for employees of healthcare providers. It's not clear whether the U.S. Department of Labor will consider nursing homes or home care agencies for exemptions, though some organizations are seeking it.
"We want to ensure that our workers, who are really low wage, don't have to make the tough choice between going to work sick and not getting paid," said April Verrett, president of SEIU Local 2015, which represents 400,000 home health and nursing home workers in California.
She argued that the coronavirus crisis has highlighted the inadequacies of the nation's healthcare system, particularly the long-term care system, in terms of support, training, and development of the workforce.
There already was a dire shortage of direct care workers in long-term care. But the pandemic could create a crisis in availability of services for elderly and disabled people who can't function without assistance in their daily living activities.
What's needed, Verrett and other experts say, is better pay, training and benefits including health insurance, as well as stronger recruitment efforts for direct care workers.
"We need to get busy about making reforms that are necessary to meet the needs of the workforce and demands of baby boomers who will require these services," Verrett said.