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Geriatrics

Extreme Vulnerability of Home Care Workers During the COVID-19 Pandemic—A Call to Action

Educational Objective
To understand the risks Home Care Workers face during the COVID-19 pandemic

1 Credit CME

JAMA Internal Medicine

Published Online: August 4, 2020

Invited Commentary

Article Information and Disclosures

Theresa A. Allison, MD, PhD^1,2;

Anna Oh, PhD, MPH, RN²;

Krista L. Harrison, PhD^1,3

Author Affiliations

¹Division of Geriatrics, Department of Medicine, University of California, San Francisco
²Geriatrics, Palliative and Extended Care Service Line, San Francisco VA Health Care System, San Francisco, California
³Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco

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Coronavirus disease 2019 (COVID-19) has been identified in more than 14 000 US nursing homes and other long-term care settings.¹ More than 316 000 residents and staff members have contracted COVID-19, and they account for 57 000 of more than 140 000 deaths in the US.¹^,2 Despite our recognition of the higher mortality rates among older adults and higher overall rates of disease among nursing home staff,³ we still know little about the risks and experiences of workers who provide help and care to older adults who live at home. Home health aides, personal care aides, and home attendants (hereafter referred to as home care workers⁴) are members of a vulnerable population within health care delivery. Underpaid and overwhelmingly women of color, they shoulder the responsibility for hands-on assistance with bathing, toileting, dressing, and housekeeping for vulnerable older adults in the home.⁵ Home care workers are essential to the health of more than 7 million older adults who require care in the home.⁶^,7

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Article Information

Corresponding Author: Theresa A. Allison, MD, PhD, Division of Geriatrics, Department of Medicine, UCSF, 3333 California St, San Francisco, CA 94121 (theresa.allison@ucsf.edu).

Published Online: August 4, 2020. doi:10.1001/jamainternmed.2020.3937

Conflict of Interest Disclosures: Drs Allison and Harrison reported receiving grants from the National Institute on Aging during the preparation of this article. No other disclosures were reported.

Disclaimer: The opinions reflected in this commentary are those of the authors and do not reflect the opinions of the San Francisco VA Health Care System or the University of California.

References

Almukhtar S . More than 40% of U.S. coronavirus deaths are linked to nursing homes. New York Times. Updated July 20, 2020. Accessed July 20, 2020. https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html

Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in the U.S. Accessed July 20, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

McMichael TM , Currie DW , Clark S , et al; Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team. Epidemiology of COVID-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005-2011. doi:10.1056/NEJMoa2005412 PubMed Google Scholar Crossref

PHI. It’s time to care: A detailed profile of America’s direct care workforce. Published January 21, 2020. Accessed June 1, 2020. https://phinational.org/resource/its-time-to-care-a-detailed-profile-of-americas-direct-care-workforce/

Bercovitz A , Moss A , Sengupta M , Park-Lee EY , Jones A , Harris-Kojetin LD . An overview of home health aides: United States, 2007. Natl Health Stat Report. 2011;34(34):1-31.PubMed Google Scholar

Reckrey JM . COVID-19 confirms it: paid caregivers are essential members of the healthcare team. J Am Geriatr Soc. 2020. Published online May 20, 2020. doi:10.1111/jgs.16566 PubMed Google Scholar

Ornstein KA , Garrido MM , Bollens-Lund E , et al. Estimation of the incident homebound population in the US among older Medicare beneficiaries, 2012 to 2018. JAMA Intern Med. 2020;180(7):1022-1025. doi:10.1001/jamainternmed.2020.1636 PubMed Google Scholar Crossref

Sterling MR , Tseng E , Poon A , et al. Experiences of home health care workers in New York City during the coronavirus disease 2019 pandemic: a qualitative analysis. JAMA Intern Med. Published online August 4, 2020. doi:10.1001/jamainternmed.2020.3930 Google Scholar

New York Times. New York City coronavirus cases map and case count: cases by zip code. Accessed June 24, 2020. https://www.nytimes.com/interactive/2020/nyregion/new-york-city-coronavirus-cases.html

Congress.gov. H.R.6305-Coronavirus Relief for Seniors and People with Disabilities Act of 2020: 116th Congress (2019-2020). Accessed July 16, 2020. https://www.congress.gov/bill/116th-congress/house-bill/6305?overview=closed

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.