In 2019, I wrote about my mother-in-law’s struggles with isolation after losing her husband of 61 years. As you can imagine, the pandemic has only made this challenge more difficult.
Adding to the challenge of 2020 were two injuries she experienced, first a spinal compression fracture in January and a pelvic fracture after a fall in May. Both left her in need of constant care, which family members alone have been unable to provide. Fortunately, she has been able to afford—although not easily afford—the help of in-home caregivers.
As the Bureau of Labor Statistics (BLS) notes, this occupation is growing as our population ages and more people will need help with basic needs. However necessary and important home health aides are, their pay is somewhat low. According to BLS data, the median income hovers around $25,000 a year, or approximately $12 an hour. In high-housing cost cities like Los Angeles, it is hard to get by on this amount. (In 2020, the average rent in Los Angeles for a one-bedroom apartment is estimated to be about $2,500 per month, more than the median monthly income of a caregiver.)
My colleague, sociologist Rhacel Salazar Parreñas, has written about the challenges caregivers face in The American Prospect. Often older themselves, most lack the resources to retire and must continue working, despite the toll it can take on them physically. She interviewed one woman who had a patient fall on her, fracturing her femur, for which she received no compensation. Parreñas describes how this home health aide lacked other basic economic protections:
[She] never received any sort of employment or state benefits for her labor, including unemployment, medical insurance, or a pension. This is despite the fact that she is a citizen, and the fact that the U.S. government requires employers who pay household workers at least $1,900 in annual cash wages to deduct Social Security and Medicare taxes.
The informal nature of her employment has clearly worked against her. One employer even deterred her from accruing sufficient credit to later qualify for Social Security benefits by discouraging her from paying taxes.
The low pay means that many health aides must work in multiple locations to try and make ends meet. This has been particularly problematic during the COVID-19 crisis, as working in multiple eldercare facilities contributes to the spread of the disease, particularly among the most vulnerable populations.
For older home health aides, working with the elderly might mean aging alongside a patient, with little likelihood of pay increases, benefits, or retirement pay, as Parreñas found. And yet, they are expected to be loyal and remain with long-time clients and develop personal relationships with those they care for.
My mother-in-law is on a fixed income, like many older individuals. Paying for round-the-clock care after her second injury cost about $5,000 a week, a huge expense that was a stretch for her, but kept her out of a nursing home during the spring COVID-19 surge. Her caregivers came from an agency, which screened and scheduled caregivers, and who of course were paid only a fraction of the hefty agency fee.
While she was happy to be at home, out of the hospital, and away from a nursing home, the merry-go-round of caregivers was a concern during the pandemic. How many other patients were they caring for? In effect, she was exposed to every caregiver’s other patients and to every other patients’ caregivers.
Not all the home health aides wore masks consistently, and during one visit to drop off groceries I noticed a caregiver rubbing her eyes and nose without washing her hands. Another caregiver regularly shared food from large family gatherings, which she apparently continued to hold despite the pandemic. Another regularly traveled out of state to visit her daughter.
Fortunately, my mother-in-law has not gotten the virus and her health has improved enough so that now she has just one caregiver come by for a few hours a week. She met this caregiver through her prayer group, which by March had moved to an online platform she wasn’t comfortable using, so being able to maintain this social connection has been valuable for her.
I am still concerned about her exposure to even one caregiver. Although this caregiver does not work for an agency, and instead lives nearby in the home of another client, she is still one other possible COVID contamination link.
The pandemic has exposed weaknesses in the eldercare system, which are likely to become more significant as our population ages. Not only are older individuals more likely to need home care, but as caregivers age they are likely to struggle physically and financially themselves.
We are caught in a double-bind: paying even low wages for home health aides can be very difficult for those on a fixed income, but surviving on those wages can even more difficult for those who expend their physical and emotional energy caring for our aging population. What might be done to address this growing problem?