Barron\'s - April 6 2020

28 BARRON’S April 6, 2020

L

indsay Asherman’s job has

never been easy. The 27-

year-old single mother of

two is a hospice aide in San

Antonio. She cares for up to

seven dying patients a day.

Now, the pandemic

sweeping across the country has made

Asherman’s challenging profession all

but impossible and strained her pre-

carious finances. Over the past couple

of weeks, she has been barred from

seeing about 40% of her patients, as

nursing facilities and family members

turn away outside aides to minimize

potential exposure to the coronavirus.

When she does see patients, she has to

do something that seems unnatural to

a caregiver accompanying patients

through their final days: keep her dis-

tance. “It’s hard for me to sit there and

not cuddle up next to them and give

them a hug,” she says.

Adding to the stress: When she

doesn’t see patients, she doesn’t get

paid, and she has no safety net if she

gets sick and can’t work. She needs

every penny of her $16-an-hour wages

to cover basics like child care and ex-

tra meals for her kids while schools

are closed. She drives around the city

to see patients, raising the odds of

exposure to the virus, but she has no

health insurance and no emergency

fund to draw on. “I wash my hands all

the time,” she says, “and keep hand

sanitizer in my pocket.”

An army of 4.5 million direct care-

givers is confronting an invisible en-

emy. This direct-care workforce in-

cludes nursing assistants in nursing

homes and assisted-living facilities,

home health aides, and hospice aides.

They are the cornerstone of care for

older Americans, helping millions of

elderly or disabled adults bathe, dress,

eat, and get through the day. While

much of America hunkers down at

home, they’re at the forefront of the

U.S. health-care system, wondering if

they’re exposing themselves, their

families, and their patients to a pan-

demic.

In return, they get low wages,

sparse benefits, and heavy workloads.

In 2018, the median direct-care

worker earned $12.27 an hour, an

inflation-adjusted increase of just

three cents from 2008, according to

research and consulting group PHI.

Decades of experience don’t necessar-

ily bring higher pay. After nearly 30

years as a nursing assistant, 63-year-

old Mary McClendon makes just $13

an hour. “There’s no such thing as a

banking account,” says McClendon,

who works at a nursing home in

Detroit. “We work paycheck to

paycheck.”

Training and career-development

opportunities can be scant. Home

health aides and nursing assistants

whose employers are Medicare-

certified typically must have at least 75

hours of training, but personal-care

aides helping older adults in their

homes don’t have to meet this federal

standard. (Requirements vary by state.)

About 15% of direct-care workers

live in poverty, while 44% live in low-

income households, according to PHI.

Many work multiple jobs, increasing

the potential of virus exposure for

themselves and their patients. Often,

they have no paid sick leave, and one

out of five nursing assistants working

in nursing homes are single parents,

according to PHI, facing additional

pressures as school districts extend

closures.

Even before the coronavirus came

along, the risks and demands of the

job were daunting. The average nurs-

ing assistant in a nursing home, for

example, cares for 12 residents at a

time and is injured three times more

frequently than the typical American

worker, according to PHI.

That job description doesn’t attract

any surplus of applicants. There’s a

chronic shortage of direct-care work-

ers, made acute by the current crisis,

according to many of those working in

the field.

“Workforce is our No. 1 issue. We

cannot find enough people,” says Kim-

berly Green, chief operating officer of

Diakonos Group, which operates 20

long-term-care facilities in Oklahoma.

“At one of my buildings, we had like 13

openings the other day,” she says. The

level of vacancies is unusual. “I’m

getting more and more calls every

day,” she says, from staff members

who are “tired, scared, overloaded,

and overwhelmed.”

Green in mid-March made a public

appeal for help. “I went on TV and

“There’s

no such

thing as

a banking

account.

We work

paycheck

to

paycheck”

Mary McClendon,

nursing assistant Nick Hagen

The Perils of

Working on

The Front

Lines of Care

The direct-care workforce at the

forefront of the U.S. health-care system

gets low wages, sparse benefits, heavy

workloads—and exposure to coronavirus

By ELEANOR LAISE

Mary McClendon

stands outside the

nursing home in

Detroit where she

works as a nursing

assistant.

April 6, 2020 BARRON’S 29

said, ‘You want a job? We have jobs,’ ”

she recalls. The company will provide

“on-the-job training” for new hires

who want to be nursing aides. The

new employees can start as hospitality

aides, she says, answering call lights

and getting blankets for residents, and

receive on-site training in bathing,

dressing, patient transfers, and other

nursing-aide responsibilities.

The nursing-home industry says

it’s fighting for flexibility to help facili-

ties staff up quickly. “Quality care

begins with our direct caregivers, and

we have seen their extraordinary com-

mitment to our seniors during this

pandemic,” Dr. David Gifford, chief

medical officer at the American

Health Care Association, a nursing-

home industry group, said in a state-

ment. The group has urged federal

and state governments to waive licens-

ing requirements that could prevent

health-care professionals from work-

ing across state lines, as many have in

recent weeks. The industry is also

advocating for “rapid training of un-

employed individuals to help with

basic tasks,” Gifford said, “so nurses

and aides can concentrate on the sick

residents, and we can potentially ad-

dress any shortages due to employees

needing to stay home.”

As the crisis intensifies, dwindling

supplies of masks and other protective

gear are amplifying direct-care work-

ers’ frustrations.

Last month, McClendon’s employer

told staff members that if they wanted

to wear masks around the nursing

home, they’d have to buy their own,

she says. “Why would we have to go

out and buy masks for the facility

when we are working here?” asks

McClendon. The nursing home

“should supply us with everything we

need.” Just over a week later, the SEIU

Healthcare Michigan union said that

workers at McClendon’s facility, Am-

bassador Nursing and Rehabilitation

Center in Detroit, were reporting sev-

eral coronavirus cases among staff

and a resident at the nursing home.

The facility, which is part of the Villa

Healthcare chain, didn’t respond to

requests for comment. Villa Health-

care didn’t respond to requests for

comment.

McClendon, meanwhile, says she’s

“very worried” about her own poten-

tial exposure to the coronavirus. On a

scale of one to 10, she says, “I’d give

youa50.”

Home health aides may be at a par-

ticular disadvantage when it comes to

getting protective equipment. In a

recent survey by the Home Care Asso-

ciation of New York State, nearly 70%

of providers said they don’t have ac-

cess to adequate personal protective

equipment. “We have been on the bot-

tom of the totem pole” for procuring

supplies, says Amy Champagne, di-

rector of clinical operations for the

Medical Team, a home health agency

based in Reston, Va., while hospitals

and other facilities get top priority.

“We need to remain calm and can’t

overuse supplies,” she says. The com-

pany is telling workers, “Don’t double-

glove when you don’t need to double-

glove. Don’t wear gowns when you

don’t need to.”

The age and occupation of older

direct-care workers increase their

risk. People 55 and older account for

23% of the direct-care workforce, ac-

cording to PHI. Josefa Guardian, 79,

earns $10 an hour as a home-care

attendant in Hebbronville, Texas.

Finding basics like bread and drink-

ing water has become a challenge in

the small town, Guardian says, and

onedayinlateMarchshewenttofive

different stores trying to get enough

food for her patients. Guardian has

diabetes, which can increase the odds

of serious complications from the

coronavirus, and when she’s not at

work, she stays home with her 82-

year-old husband, she says. As a part-

time worker, she has no paid sick

leave or vacation time. Her children

want her to quit, she says, but “I don’t

like to watch TV all day.” She and her

husband are scared, she says, “but

we’re very, very careful.”

Lack of paid sick leave, combined

with potentially unpaid periods of

self-isolation due to coronavirus expo-

sure, can be financially devastating for

direct-care workers. Only about 35%

of direct-care workers who take time

off for family care or medical reasons

qualify for paid leave, according to

PHI. Ashley Nixon, 32, a nursing as-

sistant at a nursing home in Collins-

ville, Okla., was recently forced to stay

home for two weeks without pay be-

cause a member of her household had

traveled to Florida—raising fears of

coronavirus exposure.

“I was thinking, ‘How am I going to

pay my bills?’ ” says Nixon, who also

lost income from her second job,

working in a special-education class-

room, when the schools closed. “I’ve

been on a spending freeze,” she says,

cutting her weekly grocery budget in

half, to $50, and giving up her daily

indulgence—a frozen Dr Pepper from

the convenience store.

On top of the physical and financial

stress, direct-care workers are shoul-

dering the emotional burden of their

patients’ isolation, as communal activ-

ities are canceled and visitors are kept

at bay. They’re connecting patients to

their families on video calls, asking

residents to write messages for loved

ones on whiteboards, and monitoring

families as they commune through

panes of glass. Emily Phillips, a nurs-

ing assistant in Collinsville, cares for a

resident whose husband, a regular

visitor, now has to stand outside the

window. “They can talk a little bit, but

it’s mostly just to look at each other

and see that they’re OK and know

they love each other,” she says. “You

want to just let him in the door. But

we know that it’s very unsafe.”

For workers and advocates who

have long raised concerns about facil-

ity understaffing, the heartbreak is

mixed with bitterness over all of their

unheeded warnings. “It’s sad. We’ve

been crying for much too long now for

help, and it takes the coronavirus to

get attention,” says Francine Rico, a

nursing-home nursing assistant in

Chicago and member of the executive

board of the SEIU Healthcare Illinois

Indiana union. For nursing assistants

trying to care for 13 or 14 residents at a

time, she says, “everything you do,

you’re in a hurry.” But “for 99% of

these residents, this is their final rest-

ing spot, and they should leave this

world with dignity and respect.”

For years, “everybody talked about

how the baby boomers were aging and

they were going to really tax the long-

term care industry, yet we’ve not been

able to get anybody to act on any mea-

sures to ensure there are more” nurs-

ing assistants, says Lisa Sweet, chief

clinical officer at the National Associa-

tion of Health Care Assistants. “Then

you throw a pandemic into the mix,”

she says. “I’m really kind of angry

right now.”

What is the breaking point for

direct-care workers in the teeth of the

pandemic? The nursing-home indus-

try says that some workers, at least,

are undaunted. “We have seen staff

come to work even when Covid is in

the building and masks and other

supplies are low or unavailable,” says

the American Health Care Associa-

tion’s Gifford.

But even in the face of dismal eco-

nomic prospects, some workers are

giving notice. At the Medical Team,

roughly 5% of workers have quit, says

Champagne. At Diakonos, Green ex-

pects to lose more staff as the crisis

drags on.

As for Asherman, the hospice aide

in San Antonio, she’s mulling alterna-

tive career paths. “There’s not a lot

that’s open,” she says. “I thought

about Amazon. They need people.”B

“I’m getting

more and

more calls

every day”

from staff

members

who are

“tired,

scared,

overloaded,

and over-

whelmed.”

Kimberly Green,

Diakonos Group

Josh Huskin

Josefa Guardian,

a home-care

attendant, picks up

a prescription for

one of her patients

at a pharmacy in

Hebbronville, Texas.