NY Home Health Workers Report Personal Risks During COVID-19 Pandemic

By Lisa Rapaport

August 07, 2020

(Reuters Health) - Home health care workers in New York City report feeling invisible and at personal risk during the COVID-19 pandemic, a small study suggests.

Researchers performed a qualitative analysis of results from semi-structured interviews with 33 home health care workers in New York City between March and April of 2020. Participants' mean age was 47.6 years and all but one were women. Most were Black (64%) or Hispanic (18%).

Several themes emerged from interviews with these front-line essential workers, including participants' sense that they were at heightened risk for virus transmission, that they received inconsistent amounts of supplies, training, and information from home health agencies that employed them, that they relied on support from outside of these agencies, and that they felt forced to make challenging trade-offs between their work and personal responsibilities.

"We found that despite providing essential, day-to-day personal and medical care to older adults and those with chronic conditions, home health care workers generally felt invisible to society at large," said lead study author Dr. Madeline Sterling, an assistant professor of medicine in the Division of General Internal Medicine at Weill Cornell Medical College in New York City.

"They faced increased risks to their physical, mental and financial well-being during COVID-19, which exacerbated many of the inequities they face as a marginalized workforce," Dr. Sterling said by email.

Participants had a mean of 10.9 years of experience as home health workers and 22 (67%) had at least some college education.

Four (12%) said they had been ill with confirmed or suspected COVID-19 infections during the study period and that they had stopped working as a result.

The majority of patients they cared for had multiple chronic conditions that made them high risk for COVID-19, and these conditions often had symptoms like a cough or shortness of breath that were similar to symptoms of COVID-19.

Home health workers worried that they might infect their home-bound patients, and often took on additional duties like getting groceries or going to the pharmacy to help patients avoid exposure to the virus in the community. Doing this, however, made home health workers feel that they took on added personal risk for contracting the virus, which they might spread to their own families or to their patients.

Workers often reported being one of many caregivers in patients' homes at once, adding to their concerns about infection.

Many workers also said agencies didn't provide adequate supplies of PPE, and that they bought these supplies themselves or got donations from family or friends to try to keep safe on the job. Often, they got more information about COVID-19 from Facebook or local news than from their employers.

Workers also felt conflicted about whether to keep caring for patients who contracted COVID-19, exposing themselves to the virus. And workers feared encounters with new patients during the pandemic because they didn't know what level of risk they might encounter with a new situation.

Beyond this, workers also said they struggled to balance the need to keep their jobs to maintain financial security against the risk of contracting COVID-19 at work.

Results from the small, qualitative study may not be generalizable to other home health workers, particularly outside of New York City, the study team notes in JAMA Internal Medicine.

Even so, the results highlight numerous challenges that might be experience both by paid home health care workers and by unpaid family caregivers helping house-bound patients during the pandemic, said Dr. Theresa Allison, co-author of an editorial accompanying the study and a professor in the division of geriatrics at the University of California San Francisco.

"The results are important for our home care workers, who from this study appear to be at high risk of contracting COVID-19, for the older adults they support, who have among the highest mortality rates, and for the entire health care system, because avoiding COVID-19 in high risk groups will reduce the number of people needing hospitals and emergency rooms," Dr. Allison said by email.

SOURCE: https://bit.ly/3fttxNr and https://bit.ly/30tE0Ei JAMA Internal Medicine, online August 4, 2020.