Home health workers care for America’s most vulnerable – and they do it without PPE

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As the coronavirus epidemic continues to flood hospitals in the United States, governments, businesses and communities have taken action to provide overcrowded emergency personnel with personal protective equipment (PPE). But for the more than 3.2 million home health workers who care for more than 8.3 million people in the United States, access to PPE remains relatively rare.

“I buy [the masks] myself, “said Stephanie Williams, a 58-year-old homeworker in Philadelphia, where more than 1,850 people were infected and at least 13 people died from coronavirus. I have to use the same masks for my clients. I pay out of my own pocket and I just can’t afford it, especially on a daily basis, “she added.

According to Johns Hopkins, more than 7,000 people in the country have died from coronavirus. The majority of infected and deceased people are 65 and older, according to the Centers for Disease Control. This demographic represents 22.7% of the U.S. population and is the most likely to need home health care, according to the Census Bureau.

Williams, who works for two different agencies and is represented by the United Home Care Workers of Pennsylvania, cares for three clients each week, including his mother. As part of providing home health care, Williams helps clients with daily chores such as eating and bathing and runs errands on their behalf, putting herself and her clients at risk of contracting. coronavirus in grocery stores, pharmacies and other public spaces.

Even reaching patients is risky. She has to take two buses to get to her first patient of the day – a disabled elderly man – at 9 a.m. She said the Market-Frankford line, commonly known as “El”, was no longer safe. She used to spend time commuting on the train, but another caregiver from her union jumped on the train on Wednesday.

Williams said she did not receive a risk premium for the conditions.

“The only thing I know is that they tell us that if we feel that we are not safe, they organize unemployment or we can use our PDF [paid time off] time, “said Williams.

Williams received PPE – hand sanitizer and gloves – from an agency. She said the agency and the union said they would provide masks soon.

Philidelphia has the most cases of coronavirus in Pennsylvania. The State Department of Health told CBS News that “home health workers are among those we consider when we distribute PPE, balancing their needs with the needs of our health workers and health workers. First line “.

“We strive to distribute PPE to our hospitals, long-term care facilities, clinics, home health agencies, etc. across the identified need areas, as well as through individual problems as they arise, “they said. But when CBS News asked for clarification on the amount of PPE provided to each sector, the ministry said, “We are not providing this level of data at this time. “

For now, Williams is paying for her protection herself. She said that surgical-type masks cost about $ 2 each and that N95 masks cost about $ 6 each. Ideally, she would have three new masks per day – one for each patient and one for travel.

Matthew Yarnell, president of SEIU Healthcare PA, said he spoke to home care workers every day “who are working without adequate protection and are putting their lives at risk to care for the most vulnerable in this pandemic”.

“The slowness of the Trump administration’s response to the PPE shortage is an insult to all of them,” said Yarnell. “Homeworkers should not be forced to reuse or dispense with PPE. A federal response is required in a situation like this, which is why it is so important that the President use the Defense Production Act to reuse US manufacturing to produce N95 masks. , coats, gloves and other PPE. “

David Causby, President and CEO of Kindred at Home, the country’s largest home, palliative and community care provider, told CBS News that when the coronavirus epidemic started, they been able to get “maybe hundreds” of N95 dresses and masks from a few. States. The company has approximately 80 offices in more than 40 states. They serve approximately 120,000 patients who currently do not have coronaviruses.

“We have received nothing from FEMA or the federal government. We continue to be in touch with them daily, trying to explain the critical nature of the home care situation and the need for home care organizations to climb the supply ladder, but we have not had no success or received nothing to date. “

The agency is now about 30% of its original supply, Causby said, and getting more PPE for their home health care workers has “become more difficult.”

“We have worked with vendors to try to source from China,” he said, “but we just found out this week that all of our orders that had been placed and confirmed, that the Chinese government seized these supplies. I ‘I don’t know what they’re going to do with these supplies, but the orders we had received have now been canceled. “

The CDC recommended that face masks be prioritized “during activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable”. Williams has this extended contact with each of her patients – but she can only afford one clean mask a day while living on her hourly wage of $ 11.

Thousands of home health care workers find themselves in a similar situation, according to the nonprofit home health care organization PHI International. In a PHI report published in 2020, they found that 15% of workers, who are mainly people of color, live in poverty and 44% live in low-income households. More than 40% depend on public aid.

“I’m afraid for myself … We are here. We go to people’s homes and they trust us to be OK. We deserve proper dresses and masks, ”said Williams. “We deserve the right equipment, as do the rest of the healthcare workers. “

Marina Sapountzi.jpg
Marina Sapountzis, 51, helps care for a 96-year-old woman

Courtesy of Marina Sapountzi

Marina Sapountzis, 51, helps care for a 96-year-old woman five days a week in Queens, New York, who is dependent on a catheter. She said she was “lucky” that her patient’s family provided PPE, since most families do not pay for these supplies.

There are more than 51,800 cases of coronavirus in New York.

“Many homecare assistants float from home to home, from place to place, from job to job, every day, and do not have a stable patient, but go back to work where they are needed, “she told CBS News. “This puts them at higher risk for viral and bacterial transmission and makes them more vulnerable to a much higher exposure rate than having a single patient to care for. “

Since New York Governor Andrew Cuomo announced an executive decree called Matilda’s Law that forces vulnerable populations to stay in their homes and limits who can visit them, adequate home health care and protection have become more essential.

“Some patients have heart problems, a stroke, respiratory problems, oxygen tanks,” said Sapountzis. “They can vary in age, they could be in an accident. “

Even for home caregivers like her who have only one patient a day, Sapountzis said PPE was important because of various other sources of contact. With his two school-age children and three adult children living at home, Sapountzis’ husband, a taxi driver, is diabetic.

The New York Department of Health would not tell CBS News how they allocate PPE between the healthcare sectors.

“The Department remains committed to sending PPE to home care agencies in need, but we urge all health entities to keep the supplies,” they said. “We regularly communicate this message to healthcare providers. “

Jason Kidushim, executive vice president of operations for Alliance Homecare, an agency with about 400 home health care workers currently caring for patients in New York, told CBS News that his agency also had no been able to get supplies from state or federal governments.

And the price for getting new supplies, Kidushim said, has gone up dramatically. He said the cost of a glove box has increased by about 500% and that the three-ply masks, which cost around 20 cents each, now cost $ 4 or $ 5. They saw N95 masks sold at $ 12 each.

To deal with the pandemic, Alliance asked workers to bring a change of clothes to patients’ homes and provided disinfectants to wipe surfaces, as well as three-ply masks.

“There is not really enough supplies for us to last until the crisis ends,” said Kidushim. “We have seen a huge increase in potential customers who have specifically tested positive or are recovering from [coronavirus], or have been turned away from the hospital system because their symptoms are not severe enough. “

He added that “small regional players” like Alliance will be necessary to “alleviate this pressure and this constraint for hospitals a lot.”

“I think it is not known how many seniors live in isolation and how many are likely to receive routine visits from family members who cannot do this at the moment,” he said. “At the end of the day, we have a responsibility to protect our employees. … Some of these home health aides are at risk just as much as anyone else. “

In Penobscot County, Maine, where there are 16 confirmed cases of coronavirus, home health worker Athena Diligenti received no masks or other PPE from her agency.

According to the US Census Bureau, those who are 65 or older make up more than 20% of the population and Diligenti cares for a 92-year-old woman in a retirement community in Orono.

“There are gloves in the retirement home where my client lives, but otherwise I just took my own precautions and being very aggressive in washing my hands,” she said. “I wash my hands about 20 times a day. “

The CDC has recommended that nursing homes have face masks, gowns, gloves and eye protection for those providing care. They also suggested implementing sick leave policies that are “non-punitive, flexible and consistent with public health policies that allow sick health care professionals to stay at home.”

Coronavirus is now the second leading cause of death in the United States and the third leading cause of death in assisted living centers, but Diligenti, 24, said his agency had never provided him with PPE or sick leave paid.

The only additional precautions that have been taken are by the retirement community itself – they have limited social gatherings and visitors – but there are still several healthcare professionals in and out of patient rooms throughout the week.

After the coronavirus epidemic at the Life Care Center in Kirkland, Washington, the CDC determined that “once COVID-19 has been introduced into a long-term care facility, it can lead to high attack rates among residents, staff and visitors “and that public health measures for health staff are” essential “.

But Williams said his biggest concern right now was that officials hadn’t taken this to heart and had forgotten the health workers who care for people outside the hospital.

“There are a lot of things to think about. I’m not just going out as I’m just going to work, ”she said. “It’s ugly, it’s really ugly, and it shouldn’t be like that. “



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