America’s neglect of older people extends to the people who care for them at home.
The home health aides and certified nursing assistants who work in long-term care facilities and private homes are usually paid no more than the minimum wage and given few, if any, benefits. Their salaries are drawn from public Medicaid funds, through a labyrinthine arrangement of state-by-state block grants, health insurers and private contractors. Medicare, despite its association with seniors, does not cover long-term care.
These front-line workers, mostly Black and immigrant women, have become victims and vectors of the pandemic. More than 54,000 Americans living or working in long-term care have died of the coronavirus, representing 40 percent of all Covid-19 fatalities, and a disproportionate number of those deaths have occurred in facilities serving nonwhite patients.
These figures should scandalize, but they may be an undercount. While concentrations of deaths in nursing homes have made the news across the country, from Hawaii to Illinois to Louisiana, there is no parallel accounting in private residences, where more than 2.3 million aides help seniors and people with disabilities.
The home health aides and nursing assistants I have interviewed since May, mostly in New York, relay terrifying stories.
Direct caregivers are so poorly paid that they often have to accept whatever shifts are offered, shuttling between private residences, assisted-living units and nursing homes.
To contain the spread of the virus, wouldn’t aides need hazard pay and extra protective equipment, private transportation and temporary lodging? No one seemed to have an answer, and aides proceeded to work in fear.
Their employers, despite claiming to do the best they could, were in fact mobilizing lobbyists to shield themselves from litigation: The nursing-home industry has tried to limit its liability in more than 20 states and is pushing for nationwide relief in Congress.
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