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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

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
1.
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
2.
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
3.
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 PubMedGoogle ScholarCrossref
4.
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/
5.
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.PubMedGoogle Scholar
6.
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.16566PubMedGoogle Scholar
7.
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 PubMedGoogle ScholarCrossref
8.
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.2020.3930Google Scholar
9.
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
10.
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
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