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| Navigating Home Care During the Pandemic | Navigating Home Care During the Pandemic |
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| In March, Amy Carrier asked one of the two women who provided home care for her mother to stop coming to work. | In March, Amy Carrier asked one of the two women who provided home care for her mother to stop coming to work. |
| Her mother, 74, has Alzheimer’s disease and lives with her in Corvallis, Ore. To protect her from the coronavirus, “it was clear that I needed to lock down my house,” said Ms. Carrier, 45, a foundation executive. She allowed one helper, who lived with only an adult daughter, to continue helping her mother bathe, take walks and play puzzles and games. | Her mother, 74, has Alzheimer’s disease and lives with her in Corvallis, Ore. To protect her from the coronavirus, “it was clear that I needed to lock down my house,” said Ms. Carrier, 45, a foundation executive. She allowed one helper, who lived with only an adult daughter, to continue helping her mother bathe, take walks and play puzzles and games. |
| But the other aide has a household of six, including four teenagers, and was visiting other clients’ homes. “There’s too much chance of exposure,” Ms. Carrier decided. When she explained that to her employee, she said, “she totally understood, and she wanted to be home with her family, too.” At least, because Ms. Carrier hires and pays caregivers legally, the worker is receiving unemployment benefits. | But the other aide has a household of six, including four teenagers, and was visiting other clients’ homes. “There’s too much chance of exposure,” Ms. Carrier decided. When she explained that to her employee, she said, “she totally understood, and she wanted to be home with her family, too.” At least, because Ms. Carrier hires and pays caregivers legally, the worker is receiving unemployment benefits. |
| Home Care Partners, a nonprofit agency serving the Washington, D.C., area, said that about 20 percent of its clients, primarily low-income older adults, had suspended their service. | Home Care Partners, a nonprofit agency serving the Washington, D.C., area, said that about 20 percent of its clients, primarily low-income older adults, had suspended their service. |
| Those aides who are still working face arduous conditions. “They have a higher level of risk, because they’re going into a number of different homes,” said Marla Lahat, the executive director. “They’re often traveling on public transportation, which is severely curtailed here in D.C.” | Those aides who are still working face arduous conditions. “They have a higher level of risk, because they’re going into a number of different homes,” said Marla Lahat, the executive director. “They’re often traveling on public transportation, which is severely curtailed here in D.C.” |
| Acquiring protective equipment, for workers accustomed to hand-washing and gloves but not to masks, proved difficult and expensive. “Hospitals and nursing homes were the priorities; we weren’t,” said Ms. Lahat, who eventually had to buy sanitizer from repurposed distilleries. “It’s been totally disruptive.” | Acquiring protective equipment, for workers accustomed to hand-washing and gloves but not to masks, proved difficult and expensive. “Hospitals and nursing homes were the priorities; we weren’t,” said Ms. Lahat, who eventually had to buy sanitizer from repurposed distilleries. “It’s been totally disruptive.” |
| Much of the attention to the toll Covid-19 has taken on older adults has rightly focused on long-term-care facilities. Their residents and employees account for almost 40 percent of the nation’s deaths, according to an updated New York Times analysis. | Much of the attention to the toll Covid-19 has taken on older adults has rightly focused on long-term-care facilities. Their residents and employees account for almost 40 percent of the nation’s deaths, according to an updated New York Times analysis. |
| But far more Americans — nearly six million, by one estimate — rely on paid home care than live in nursing homes and assisted living combined. | But far more Americans — nearly six million, by one estimate — rely on paid home care than live in nursing homes and assisted living combined. |
| Already among the nation’s fastest-growing job categories, personal care and support at home can help older adults age in place — as almost all prefer, surveys repeatedly show — and prevent or delay institutionalization. (This sector, also called personal care, is distinct from home health care, which Medicare covers after hospitalization.) | Already among the nation’s fastest-growing job categories, personal care and support at home can help older adults age in place — as almost all prefer, surveys repeatedly show — and prevent or delay institutionalization. (This sector, also called personal care, is distinct from home health care, which Medicare covers after hospitalization.) |
| Such aides — almost 2.3 million of them, according to the research nonprofit P.H.I. — help with everyday nonmedical needs like bathing, dressing and using the toilet; they may prepare meals, do light housekeeping and remind clients to take their medications. | Such aides — almost 2.3 million of them, according to the research nonprofit P.H.I. — help with everyday nonmedical needs like bathing, dressing and using the toilet; they may prepare meals, do light housekeeping and remind clients to take their medications. |
| Even when consumers pay $22.50 an hour (the national average, according to an annual survey by Genworth), a daily four-hour visit costs far less per month than a residential facility and may allow family caregivers to keep their jobs. | Even when consumers pay $22.50 an hour (the national average, according to an annual survey by Genworth), a daily four-hour visit costs far less per month than a residential facility and may allow family caregivers to keep their jobs. |
| When governors issued shutdown orders across the country this spring, they exempted home care aides as essential workers. “Home care workers can’t socially distance,” said April Verrett, the president of SEIU Local 2015, which represents nearly 400,000 home care aides in California. | When governors issued shutdown orders across the country this spring, they exempted home care aides as essential workers. “Home care workers can’t socially distance,” said April Verrett, the president of SEIU Local 2015, which represents nearly 400,000 home care aides in California. |
| But as with so many other parts of the health care system, the pandemic has spotlighted weaknesses and dilemmas. | But as with so many other parts of the health care system, the pandemic has spotlighted weaknesses and dilemmas. |
| Even more than nursing home employees, home care workers are poorly paid hourly workers (average wage in 2018: $11.52 an hour, according to P.H.I.) and often lack health insurance; half rely on some form of public assistance. | Even more than nursing home employees, home care workers are poorly paid hourly workers (average wage in 2018: $11.52 an hour, according to P.H.I.) and often lack health insurance; half rely on some form of public assistance. |
| Analyzing federal data, P.H.I. researchers found that, from 2012 to 2017, only one in five home care workers who needed time off for medical or family reasons could take paid leave. | Analyzing federal data, P.H.I. researchers found that, from 2012 to 2017, only one in five home care workers who needed time off for medical or family reasons could take paid leave. |
| Unsurprisingly, among the for-profit agencies and franchises that employ most home care workers — leaving aside the uncountable private hiring arrangements known as the gray market — turnover nears 70 percent annually, said Vicki Hoak, the executive director of the Home Care Association of America. | Unsurprisingly, among the for-profit agencies and franchises that employ most home care workers — leaving aside the uncountable private hiring arrangements known as the gray market — turnover nears 70 percent annually, said Vicki Hoak, the executive director of the Home Care Association of America. |
| “If you don’t have the heart for this, you’ll go work in retail and get paid just as much,” she added. | “If you don’t have the heart for this, you’ll go work in retail and get paid just as much,” she added. |
| Now, both workers and clients have more cause for worry. | Now, both workers and clients have more cause for worry. |
| “Home care workers are probably unknowingly involved in the transmission of Covid-19, especially when they’re not equipped with sufficient P.P.E.,” or personal protective equipment, said Dr. Nathan Stall, a geriatrician and researcher at the University of Toronto and a co-author of a recent article on home care. | “Home care workers are probably unknowingly involved in the transmission of Covid-19, especially when they’re not equipped with sufficient P.P.E.,” or personal protective equipment, said Dr. Nathan Stall, a geriatrician and researcher at the University of Toronto and a co-author of a recent article on home care. |
| Not only do many home care workers serve several clients each week, increasing their exposure, but to piece together a living, they may simultaneously work for several agencies or for nursing homes, or hold outside jobs. One aide at Home Care Partners cleans hotel rooms at night. | Not only do many home care workers serve several clients each week, increasing their exposure, but to piece together a living, they may simultaneously work for several agencies or for nursing homes, or hold outside jobs. One aide at Home Care Partners cleans hotel rooms at night. |
| Those conditions increase infection risks, and not only for their frail older clients. Almost a third of home care workers, a heavily female work force, are themselves over 55, and most are black or Hispanic, groups that have proved particularly vulnerable to Covid-19. | Those conditions increase infection risks, and not only for their frail older clients. Almost a third of home care workers, a heavily female work force, are themselves over 55, and most are black or Hispanic, groups that have proved particularly vulnerable to Covid-19. |
| Protective equipment has proved hard to acquire, however. With hospitals and nursing homes scrambling for supplies, “this was the forgotten sector,” Dr. Stall said. | Protective equipment has proved hard to acquire, however. With hospitals and nursing homes scrambling for supplies, “this was the forgotten sector,” Dr. Stall said. |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| Even when employers secure it, “how do you get equipment to 400,000 people at 400,000 work sites?” Ms. Verrett said, referring to her membership. “It’s been challenging, to say the least.” | Even when employers secure it, “how do you get equipment to 400,000 people at 400,000 work sites?” Ms. Verrett said, referring to her membership. “It’s been challenging, to say the least.” |
| Researchers expect the demand for home care to increase sharply as the population ages. Already, older people preparing for previously postponed elective surgery or recovering from Covid-19 will want or need care at home. These days, moreover, “a lot of people justifiably have fears of entering nursing homes,” Dr. Stall pointed out. | Researchers expect the demand for home care to increase sharply as the population ages. Already, older people preparing for previously postponed elective surgery or recovering from Covid-19 will want or need care at home. These days, moreover, “a lot of people justifiably have fears of entering nursing homes,” Dr. Stall pointed out. |
| Recruiting aides who won’t decamp for fast-food jobs will require employers to offer higher wages and benefits like paid sick leave, perhaps through full-time positions. | Recruiting aides who won’t decamp for fast-food jobs will require employers to offer higher wages and benefits like paid sick leave, perhaps through full-time positions. |
| Aides will also need more education — “a huge issue for this work force even before Covid,” said Dr. Madhuri Reddy, a geriatrician with Hebrew SeniorLife in Boston and a co-founder of a tech company that trains home care aides. | Aides will also need more education — “a huge issue for this work force even before Covid,” said Dr. Madhuri Reddy, a geriatrician with Hebrew SeniorLife in Boston and a co-founder of a tech company that trains home care aides. |
| With no federal standards for training or licensing aides, home care operates under a hodgepodge of state requirements — or lack thereof. Thirty-five states set no requirements for home care aides, Dr. Reddy said. | With no federal standards for training or licensing aides, home care operates under a hodgepodge of state requirements — or lack thereof. Thirty-five states set no requirements for home care aides, Dr. Reddy said. |
| “We license people who cut our hair, but not the people who care for our moms?” Ms. Hoak said. Greater professionalization could promote workers’ stature, their income and their ability to care for elderly and disabled clients. | “We license people who cut our hair, but not the people who care for our moms?” Ms. Hoak said. Greater professionalization could promote workers’ stature, their income and their ability to care for elderly and disabled clients. |
| “We don’t get the respect and help that doctors and nurses do, but we’re on the front lines, too,” said Jennifer Washington, who cares for three clients in their 60s in Oakland, Calif. (One is her mother, as California’s Medicaid-supported state program permits.) | “We don’t get the respect and help that doctors and nurses do, but we’re on the front lines, too,” said Jennifer Washington, who cares for three clients in their 60s in Oakland, Calif. (One is her mother, as California’s Medicaid-supported state program permits.) |
| Early in the pandemic, Ms. Washington, 43, a home care worker for 20 years and an SEIU Local 215 member, stayed home for a couple of days. Although diabetes and kidney disease increased her own vulnerability to the virus, she worried more about infecting her mother or carrying illness home to her two children. | Early in the pandemic, Ms. Washington, 43, a home care worker for 20 years and an SEIU Local 215 member, stayed home for a couple of days. Although diabetes and kidney disease increased her own vulnerability to the virus, she worried more about infecting her mother or carrying illness home to her two children. |
| But her clients, virtually housebound, weren’t exposed to others, she reasoned. And without her assistance with showering, grocery shopping, banking, laundry, meals and simple companionship, they would be alone; their already fragile health might suffer. “They’re kind of like family now,” she said. | But her clients, virtually housebound, weren’t exposed to others, she reasoned. And without her assistance with showering, grocery shopping, banking, laundry, meals and simple companionship, they would be alone; their already fragile health might suffer. “They’re kind of like family now,” she said. |
| So, buying her own masks and gloves, she resumed her $14-an-hour visits. “They needed the help,” Ms. Washington said. “They didn’t have any other support. I had to do my job and pray for the best.” | So, buying her own masks and gloves, she resumed her $14-an-hour visits. “They needed the help,” Ms. Washington said. “They didn’t have any other support. I had to do my job and pray for the best.” |
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