Heading into a third year of the pandemic, 19.7% of healthcare support workers say they have faced food insecurity in the previous month, a study found. Compare that to a 6.6% food insecurity rate among all healthcare workers.
The problem is the worst in nursing homes, where 22.7% of healthcare support workers, people who work as aides and assistants, reported lacking access to enough food, the study published this fall in Health Affairs showed.
Healthcare workers have often been missed in conversations about food access because previous studies and interventions have focused on the general population, said Mithuna Srinivasan, principal research scientist at NORC at the University of Chicago and an author of the study on healthcare worker food insecurity.
"The gap in that research is that it was all focused on patients' food insecurity," Srinivasan said. "Nobody asked the questions from the standpoint of healthcare workers themselves."
Many workers in these positions make too much money to qualify for federal assistance like SNAP but not enough to adequately provide for their families, Srinivasan said. Or their hours are inconsistent, meaning they could qualify one month but not another, she said.
Joe Pecora, vice president of Home Healthcare Workers of America, a union representing about 32,000 home healthcare workers mostly around New York City, said a lot of members live in poverty, despite holding healthcare jobs
"We experience a lot of insecurity — food insecurity, clothing insecurity, paying the rent insecurity — mainly due to an embarrassment by society by how underpaid and undercompensated they are," Pecora said.
Once the pandemic was declared an emergency, the union was allowed to let workers start using their pre-tax flex cards, called pandemic relief cards, for food, Pecora said.
"We saw this as an opportunity to put food on the table for our members," Pecora said. "That was a huge benefit. That put money right into pockets."
The workers represented by his union have about a 20% annual turnover, Pecora said. They are 95% Black women who make around $15 per hour, he said.
"They went to higher paying jobs at Amazon or Walmart or even some fast-food chains to make more money and not have the same amount of physical or mental stress," Pecora said.
The healthcare industry as a whole is already clamoring for workers, and the long-term care sector has especially struggled, as one characterized by low wages and physically and emotionally draining work.
Nursing homes have had to close their doors over staffing, and the National Guard has been sent to help others remain open. The nursing home sector shed about 8,400 jobs in November and has been in a downward spiral since the start of the pandemic. In home care, facilities are wrangling with never-ending waiting lists, unable to take on new clients without more staff.
"What we're seeing is many employers simply can't fill the jobs they have open. We've heard stories of nursing homes closing. What happens to those residents? It's catastrophic," said Robert Espinoza, vice president of policy at PHI. "This is a problem that's going to worsen unless we improve direct care jobs."
The American Health Care Association/National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living facilities across the U.S., said long-term care providers are "focused on solutions that would help attract and retain" workers.
"During the pandemic, we've heard of providers offering food pantries so employees can easily access free groceries, provide meals for employees and cover other needs, such as transportation, to help employees direct their pay to other necessities," AHCA/NCAL said in an emailed statement.
But providers are hamstrung by low Medicaid reimbursement rates and need lawmakers to intervene, AHCA/NCAL said.
"Long-term care providers cannot solve issues like food insecurity all on their own. We need policymakers and stakeholders working together to solve these major societal challenges," AHCA/NCAL said.
Srinivasan said one option other than directly raising wages to reduce food security of direct-care workers is for employers to offer benefits packages that maximize take-home pay. That could mean creating a sliding scale for health insurance premiums based on wage levels. Or employers could offer other types of assistance, such as childcare support or housing and transportation assistance, that would help workers save money that could be redirected to food, she said.
"A low-income individual does not experience these needs in isolation," Srinivasan said.