Don’t forget home care workers

AS WE WAIT for a final plan on who should be the first to receive limited supplies of COVID-19 vaccines, there is general consensus that health care personnel who are likely exposed to or treat COVID-19 infected people should be at the front of the line.

This group includes frontline workers at hospitals, long-term care facilities, and emergency medical services, as well as those involved in offering vaccinations to people. But one group that appears to have been at least slightly overlooked so far is home health and home care workers who care for seniors and disabled people in their homes.

1199SEIU Massachusetts, the local arm of the national Service Employees International Union, which represents these workers, is pressing the Baker administration to include its members along with other frontline health care workers. These home health and care workers are not well connected politically. They are overwhelmingly women and the majority are people of color. Many are also recent immigrants from Haiti, Africa, and elsewhere.

When I first became active in the Greater Boston Interfaith Organization, I discovered caregivers and their patients have a very symbiotic relationship when it comes to each other’s well-being—and, if energized to work together, they can achieve some impressive results.

Some 15 years ago, GBIO heard from its Haitian Church members many different stories of mistreatment from those who worked as certified nurse assistants at many of the nursing homes in Eastern Massachusetts.  These workers not only struggled with poor wages and limited benefits, but suffered as well from some oppressive workplace practices.

But when GBIO got involved and advocated successfully for then-attorney general Tom Reilly’s office to strongly warn the nursing home industry about potential legal violations, the collective understanding was that while we were fighting against labor and civil rights violations affecting these workers, we were also trying to protect the frail elders and disabled people who these certified nursing assistants were caring for at these skilled nursing facilities.

Fast forward to now: whatever connection there has been over the years between poor treatment of lower-paid caregivers and its attendant impact on the people they care for, COVID-19 has only magnified the realities flowing from such a relationship.

While it is true in the hospital setting as well, the symbiotic relationship between front line worker and patient is perhaps most intense in the long-term care context.  Whether it is in a skilled nursing facility or a patient’s home, front-line certified nursing assistants and home health and home care aides’ abilities to obtain and use personal protection equipment, practice effective infection control practices, or secure COVID-19 vaccination when it becomes available are all key elements that are not only supportive of worker health but essential to their patients’ health and well-being.

The state sadly seems to have a regulatory blind-spot for the home care industry, but that may be changing. Last week, with the urging of 1199SEIU, the Legislature passed a budget with a provision creating a special commission to study and make recommendations for statewide licensing for home care agencies.  It’s hard to believe but Massachusetts currently does not require a home care agency to be licensed, certified, or even registered in order to offer home care services.   Ensuring minimum health and safety standards and fair treatment of workers—including their health protection–seems to be essential worker protections that could flow from this Special Commission’s recommendations for licensure standards.

1199SEIU’s 70,000 frontline healthcare workers have experienced firsthand the challenges of the COVID-19 pandemic; not only as caregivers and support staff, but also \seeing the disproportionate impact of COVID-19 on people from their own neighborhoods and communities.  They perhaps know as well as anyone that worker protection from COVID-19 infection, fair and reasonable staffing requirements in hospitals and nursing homes, and sufficient oversight of the agencies that offer services and programs relied upon by homebound seniors and people with disabilities, are all good and important things to assure that both vulnerable patients and caregivers alike have the best chance of surviving the pandemic and living as healthful and productive life as possible.

Paul A. Hattis is a recently retired associate professor at the Tufts University Medical School.