As the COVID-19 pandemic continues to rage on for almost 3 years now, the in-home care industry has drastically changed. The world has never experienced something quite like the coronavirus pandemic, so there were many new challenges that presented themselves to in-home caregivers. It also worsened other existing challenges within the industry. Citizens in today’s society are living longer and are also wanting to stay at home for longer (instead of being put in a senior care facility), which has caused an ambulatory shift in the industry. This shift has taken place to offer alternatives to patients in a time of need, especially since the healthcare system has faced a shortage of both beds and staff.

Are In-Home Health care Workers Overlooked?

Within the home care sector, there has been a high job turnover regardless of the pandemic, but COVID-19 has definitely made this much worse. Being an in-home caretaker is plagued by long work hours, low minimum wage, and limited opportunities for career advancement. Since home care workers were also not being recognized as “essential workers,” they lacked access to necessary protective equipment, testing, and vaccines. With home care workers worried about contracting and transmitting COVID-19 to and from their patients, many felt uncomfortable going to work. As a result, infection prevention slowly became a top priority. While home-based care is critical to the well-being of older adults, people with disabilities, and those with chronic illness, it is important to also think about the well-being of the staff that is aiding them during this trying time.

Home care has become a booming industry in the United States and offers a solid alternative to traditional facility-based health care. Despite this, home health care is often overlooked as part of the health care system as a whole. When older adults are discharged from the hospital with a care plan in place, hospital readmissions have been shown to be reduced by more than 20% in comparison to patients without discharge plans. In the same study, researchers discovered that 94% of COVID-19 survivors who received home-based care after their hospital stay for an entire month were discharged from the program and had also shown improvements in functional status and in symptoms as well. The healthcare industry used earlier influenza outbreaks to figure out how to cope with the COVID-19 pandemic.

What is the Future for In-Home Care?

The U.S. Bureau of Labor Statistics has projected that the demand for home health and personal care aides will grow 34% between 2019 and 2029, which is a much faster rate of growth compared to other occupations. With this type of growth combined with the lack of employees who want to work in the home health care industry, the burnout of the ones picking up the slack is very apparent and the situation is becoming more dire. A study conducted by Rutgers University, in conjunction with the National Institute’s of Health Initiative for Rapid Acceleration of Diagnostics in Underserved Populations, found that in-home care workers were reluctant to test for COVID-19 or to report positive results due to the fear of loss of income when required to isolate at home for up to two weeks.

This same study also highlighted the previously unknown benefits of in-person interactions between healthcare workers and their patients that were not discovered until they were no longer accessible. For example, in-home health care workers can help non-English speakers make appointments. They also have the advantage of seeing what the patient’s home looks like, so they can pick up on dangerous signs of something as serious as domestic violence or something as small as lead in paint.

Just like the people that they treat, in-home health care workers are often also members of vulnerable populations. Since many in-home workers are women of color, and it has been found that COVID-19 causes higher rates of infection and death in racial and ethnic minorities, they are very much putting themselves and their families at risk by continuing to care for their patients. Through in-depth interviews with 33 unionized home care workers (64% Black/African American, 18% Latinx/Hispanic, and 97% women) across New York, Sterling et al was able to identify the perils these workers face as essential workers who are not treated as such. These women all faced similar issues of feeling invisible despite being considered essential workers.

How Has the Government Handled In-Home Care During the Pandemic?

Working with the Administration and Congress, the Partnership for Quality Home Healthcare released a set of recommendations for expanding home health care under current federal regulations and have also suggested specific policy changes to address these problems. Established in 2010, the Partnership for Quality Home Healthcare works in collaboration with government officials to ensure accessibility of home healthcare services for all Americans, in addition to protecting the rights of the employees as well. They have recommended that in-home care providers should have access to the provider relief funds, be allowed to use telephonic and telehealth visits as needed, should have flexibility on physician signature requirements, and should have access to personal protective equipment and vaccine access prioritization.

In March 2022, the Department of Health and Human Services (HHS) announced that they would make more than $413 million in Provider Relief Funds (PRF) payments to over 3,600 providers across the nation. This is the fourth installment of payments, which has totaled to about $12 billion distributed to over 82,000 providers in all 50 states. Even though this is a positive step forward, essential workers are still struggling. In June of the same year, dozens of essential workers in New Jersey delivered a letter to state legislators demanding hazard pay funding.  While they have been recognized through verbal affirmations, this will not pay the bills and does not reduce the risk essential workers take everyday to help keep our country afloat during the never-ending pandemic.

Even though the COVID-19 pandemic has slowed down, it is still affecting every aspect of daily life. The pandemic has further perpetuated long-standing problems within the in-home care industry, but has also helped to reveal many invisible challenges these workers have been facing as well. Over 7 million older Americans are estimated to require care within their home due to cognitive, social, or functional limitations. It is time to use the pandemic as an opportunity to spur change within the in-home medical care occupation by showing workers that they are valued through more than just words, but by investing in their health and financial security.

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