As COVID-19 cases continue to rise, so has the national conversation surrounding hazard pay for essential front-line workers.
Since the coronavirus outbreak began, in-home care workers have helped lead the charge on care delivery, often putting their health and wellness at risk. To reward those workers and encourage them to keep on fighting, many home-based care providers have called for hazard pay — and help to finance it.
“It’s about the risk people are taking by going into someone’s home,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News. “While those risks can be mitigated, by way of appropriate protective equipment, training and everything else, the risk is still there. Risk itself, generally, deserves financial support — and not just a pat on the back.”
To some extent, home-based care workers may be safer compared to their peers in hospital or nursing homes, though many actually help staff those settings as part of their jobs. At the same time, in-home care organizations have been largely excluded from personal protective equipment (PPE) relief efforts, forcing providers to scramble for supplies and, at times, to improvise.
“In the home- and community-based setting, access to personal protective equipment is one of the biggest challenges that we have had to deal with from the onset of the COVID-19 crisis,” Jennifer Sheets, president and CEO of Caring Brands International and Interim HealthCare Inc., previously told HHCN.
Hazard pay isn’t just about rewarding workers, however.
Especially for in-home care providers working on the non-medical side, additional pay can mean the difference between retaining their workers or having to compete with new unemployment benefits, according to Dombi.
“Among home care aides, the compensation is low, to begin with,” Dombi said. “Since the federal supports are out there now, paying as much as a $600 add-on unemployment compensation, individuals in that home care-worker class can make more money by not working. We do not want to incentivize not providing care.”
While there has been a lot of chatter about hazard pay policies, there have only been a few noteworthy legislative efforts on the federal level.
Last month, Senate Democrats revealed a proposal — the Heroes Fund — that sought to offer a $25,000 bonus to all front-line workers. That total would roughly translate to an additional $13 per hour for workers since the start of the public health emergency.
The proposal also sought to set aside a one-time payment of $15,000 to attract new workers into essential fields.
“The Heroes Fund was a purely Democratic move,” Dombi said. “Part of the reason it has had limited traction, so far, is because it’s a Democrat-only measure. That doesn’t mean that it can’t become bipartisan.
On Tuesday, House Democrats then officially introduced the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. The legislation is a sweeping stimulus package that earmarks $200 billion in funds for essential worker hazard pay.
Another notable hazard pay effort came from Sen. Mitt Romney (R-Utah). Earlier this month, Romney revealed his Patriot Pay proposal, which calls for a temporary pay bump — up to $12 hourly — for certain workers.
“In concept, Romney’s plan is similar, providing financial rewards to front-line first responders and caregivers,” Dombi said. “But it has some elements to it that probably won’t be embraced by home care employers, in that it makes them pay a portion of it. They don’t have [that money], that’s why the wages were low in the first place.”
Moving forward, there may be other proposals that address hazard pay.
But so far, nothing has materialized publicly. The White House also has an interest in considering rewards for front-line workers, but it’s still early days in those discussions, according to Dombi.
“It’s probably not at the point where it has gelled enough,” he said. “That doesn’t mean that it’s fallen by the wayside or gone for good. There wasn’t even recognition of what it meant to be a front-line worker when some of these stimulus efforts first started happening. So there’s an evolution of support that’s developing.”
In addition to NAHC, organizations such as the Home Care Association of America (HCAOA) have been active when it comes to advocacy for both providers and their employees.
“Our most recent advocacy efforts are around [asserting] that we are on the employee’s side,” Emma Dickison, president of HCAOA’s board of directors, told HHCN. “We recently started a campaign and have sent over 1,900 messages to 360 recipients in Congress from our membership. This is about helping our representatives understand the important role that private-duty home care plays and making sure they are included in the benefits.”
In addition to her role at HCAOA, Dickison serves as CEO and president of Home Helpers. Cincinnati-based Home Helpers is an in-home care franchise company that has more than 300 locations around the country.
While providers may be eager to see hazard pay efforts move forward, they are not lying in wait. Many have been proactive about coming up with incentives for caregivers working in the field themselves.
Some have even used the Paycheck Protection Program (PPP), a loan program for small businesses made available through the CARES Act, to fund hazard pay for caregivers.
“We are hearing some wonderful examples across the country of how employers are utilizing that program to do exactly what it was designed to do, which is keep people employed and on the job,” Dickison said. “There’s a number of ways we’ve seen it being done, through increases on a temporary basis or through bonuses.”
Outside of home-based care, there have been reports of companies walking back hazard pay. Kroger Co., Target Corp. and Amazon.com Inc. have plans to eliminate additional compensation for employees, according to reports from Time magazine.
Without federal help, financing hazard pay may not be sustainable for in-home care providers in the long term, industry experts say.
“Absence of government support, the money will have to come from the home care companies themselves,” Les Levinson, co-chair of the health care transactions practice at legal firm Robinson & Cole, told HHCN. “They’re either going to get it from their cash reserves or other sources of capital if they have lines of credit to tap.”
For home care, a sector dominated by small businesses, financing hazard pay may have a negative impact on agencies’ margins, according to Levinson.
“Many home care companies are feeling the pinch during the pandemic,” he said. “If their revenue side is going down and the cost side is going up … their margins are going to get squeezed.”
Home health providers who have seen their admissions take a dip during the COVID-19 emergency may be in the same boat, according to Levinson. That said, larger companies may ultimately fare better.
The Pennant Group Inc. (Nasdaq: PNTG) is among the larger home health providers that have implemented a “hero pay” policy.
“They are certainly in a better position to deal with greater costs than smaller providers, for obvious reasons,” Levinson said. “They are better capitalized, maybe they have preserves in their credit facility that are untapped, but they may run into the same issues.”