Home care workers are on the frontlines of the coronavirus crisis. But for many of these caregivers, the outbreak has only exacerbated the ongoing workforce challenges associated with the in-home care space.

“The coronavirus crisis has exposed the holes in the safety net and the deep inequities that direct-care workers face,” Robert Espinoza, vice president of policy at PHI, told Home Health Care News. “This includes compensation, job benefits and adequate recognition in the health care system.”

New York-based PHI is a direct-care workforce advocacy organization.

Among the challenges they face, many in-home caregivers aren’t being given adequate personal protective equipment (PPE). That’s true despite the fact they’re considered essential workers and a key cog in the machine battling the COVID-19 virus.

A lack of PPE isn’t necessarily a knock on the home care companies caregivers work for, but rather a reminder of how hard it is for health care organizations to secure supplies, in general. Nearly 80% of home care organizations currently face a shortage of masks and hand sanitizer, a recent survey conducted by the Home Care Association of America (HCAOA) found.

“What we are seeing all over the country is nursing homes and home care agencies saying that they aren’t getting enough [PPE],” Espinoza said. “And the workers, knowing that they don’t have the equipment, are increasingly choosing not to risk their health or their clients’ health.”

Of the roughly 1,200 respondents that took part in the HCAOA survey, more than 60% said they’ve had employees calling off as a result of the coronavirus outbreak.

In all likelihood, that trend is one that will persist for the foreseeable future.

“The challenge with this moment is that it feels unprecedented,” Espinoza said. “It’s unclear how long it will last and how long the virus will remain a threat in our communities. Workers, in choosing not to go to work, might, in essence, be saying they’re not going back until this crisis is in a better place. And that could be months.”

Of the 1,200 respondents in the HCAOA survey, about 20% said they’ve had employees with COVID-19 symptoms.

Caregivers calling off work is obviously disruptive for in-home care providers. But several months away from work could also potentially create serious financial challenges for caregivers themselves, many of whom are already living from paycheck to paycheck, according to Espinoza.

Overall, roughly one in six U.S. caregivers live in poverty, according to data from PHI.

“Wages are about $12 an hour,” Espinoza said. “Many caregivers live in or near poverty. A lot of them don’t have access to paid leave or child care around the country. If they get sick, they don’t have a safety net. It’s informing their ability to be part of this workforce and their employers are scrambling.”

On the federal level, there were a handful of legislative efforts that sought to address caregiver pay introduced earlier this year. For example, the Home- and Community-Based Services (HCBS) Infrastructure Improvement Act — S. 3277 — was introduced into the U.S. Senate in February by Bob Casey, a Democrat from Pennsylvania.

Among other things, the bill would allow states to fund potential wage and benefits increases for home-based caregivers. The bill has seen no major movement since its introduction, however.

Over the years, home care providers have frequently struggled to recruit and retain caregivers, a problem partly linked to low wages. In 2018, the average home care industry turnover rate surged to an all-time high of 82%, according to Home Care Pulse.

During the coronavirus outbreak, a lack of workers leaves the care of older adults in a precarious spot, according to Espinoza.

“What’s going to happen to clients if employers don’t have a backup plan,” he said. “For years, PHI and others have advocated for focusing on the growing workforce shortage in home care. We were seeing high turnover rates and employers struggling to recruit and retain workers. Now, the workforce shortage that has been years in the making is rearing its head — and that is frightening.”

Now more than ever, providers should be asking caregivers what their challenges are and what they need to stay active in the home care workforce during this critical moment, according to Espinoza.

“Maybe it’s additional supports, such as help with child care,” he said. “Maybe they need help with transportation or other benefits that the provider may be able to offer in that realm. Providers need to be creative with their scheduling. Maybe there’s a way to maximize caregiver’s schedules and allow that flexibility that workers often need.”

A few home care companies already offer their caregivers transportation help. One company, Alliance Homecare, reimburses its caregivers for the cost of taxis and private rides, for example.

Overall, Espinoza believes that the coronavirus outbreak will transform the home care industry for years to come.

“It’s brought serious and much needed attention to … developing a strong pipeline [of workers],” he said. “When a crisis like this hits, and we don’t have enough workers, we must quickly recruit new people into this sector.”

The crisis has also put a spotlight on the financing of home care.

“Nursing homes, home care agencies and the direct-care workforce have long been underfunded and under-resourced, so they’re not prepared to deal with a crisis when it hits,” Espinoza said.