Sandra Sherwood was feeling a little run down when she showed up to work on Wednesday, March 25.
And no wonder. She’d been working for three weeks without a day off as a personal care provider in the homes of elders and people with disabilities, and in nursing homes. Sherwood works 40 to 68 hours per week for two home care agencies; that’s just what it takes to stitch together a living at minimum wage.
At the Center at Park West, a skilled nursing facility in Pueblo, staff took her temperature before letting her in: 99.8. Sherwood was about to turn around and go home, she said, but was told to stay; she didn’t technically have a fever.
Sherwood, 58, spent the day caring for an elderly woman with memory and balance issues, helping her to the bathroom and with other tasks. Sherwood didn’t have a mask—just gloves.
And then on Thursday, Sherwood woke up with a high fever, body aches, a bad sore throat and a cough. Her doctor recommended that she get tested for COVID-19.
Home care providers are essential workers, unable to stay away from their jobs as a global pandemic picks up pace in Colorado. But many of them receive pay that is punishingly low, work without personal protective equipment—or buy their own, if they can even find it—and rarely have access to paid sick leave.
Working in the facilities that are vulnerable to COVID-19 outbreaks in Colorado and across the country, their lack of access to basic protections may prove deadly. In other states, nursing homes have become incubators for the virus. In Seattle, employees lacking access to protective gear or hand sanitizer spread the virus from place to place, according to the Centers for Disease Control and Prevention (CDC).
“During this COVID-19 outbreak, our workers are still on the front lines providing care for their clients,” said Melissa Benjamin, lead organizer for Colorado Care Workers Unite, which advocates for better pay and working conditions for home care workers. “We know [hospital workers] don’t have the necessary equipment. Neither do our home care workers. They go into homes with immune-compromised people, our aging population—a very vulnerable population—to take care of them.”
There’s no national or state policy that gives home health agencies or people who hire care providers priority access to protective gear. Home health agencies say they are doing the best they can to retrain caregivers in infectious disease prevention, and to provide the proper protective equipment.
Brian Arant is the owner of Visiting Angels of southern Colorado, the agency that employed Sherwood to work at the nursing home in Pueblo. He said he has been scouring potential sources for hand sanitizers and protective gear. He found a case of hand sanitizer at Home Depot. And through the national corporate headquarters of Visiting Angels, Arant hopes to have masks to offer his staff members in another two weeks or so. In any case, he said, the CDC hasn’t recommended the use of masks for people who aren’t sick. (The CDC amended its recommendation shortly after we spoke.)
Many agencies, Visiting Angels among them, are refusing to send their staff to homes of people with respiratory issues, and telling their employees not to work if they are sick. At the same time, many nursing homes have restricted access to visitors, including caregivers, to stem the spread of the virus.
But the insidious nature of the coronavirus, which can be spread even when people are asymptomatic, makes it particularly difficult to control whether staff members are picking up the virus at their jobs, or spreading it to others.
In Sherwood’s case, everyone seemed to be following the rules. Visiting Angels tells employees to call them if they have a temperature of 99.9 or higher. Arant said he chose that number to be safe despite its being several tenths of a degree lower than what the CDC considers a fever, at 100.4.
“I have to go by what the medical experts are saying,” said Arant. “If they’re telling me fever is the main indicator, that’s what I go by.”
He added that he didn’t know Sherwood was not feeling well when she went to work on March 26. The Center at Park West didn’t respond to calls for comment on this story.
In other cases, care providers don’t know that they’ve been exposed to someone with the coronavirus until later. Ken Jenson, the owner of Amada Senior Care of Colorado, Sherwood’s other employer, said he sent two staff members into self-isolation after a man they attended to was later hospitalized with COVID-19.
When I spoke with them, Visiting Angels and Amada said their employees have access to paid sick leave during the coronavirus pandemic. But Sherwood said she hadn’t been expecting to be paid for any time off.
With a shifting set of rules affecting who qualifies for paid sick leave and under what circumstances during the coronavirus epidemic, it can be hard for employees to know what to expect. Most are hourly workers unaccustomed to receiving paid sick leave.
New state and federal laws intended to offer paid sick leave during the coronavirus crisis have important loopholes that leave out many caregivers. The Families First Coronavirus Response Act, the federal law aimed at providing sick leave for employees affected by COVID-19, does not apply to people working in nursing homes or to home health care providers. Many employers are interpreting this to mean that people who provide non-medical care in homes are exempt from paid sick leave requirements, too, following guidance from the National Association for Home Care & Hospice, a Washington, D.C.-based trade association, Home Health Care News reported.
Colorado law that went into effect during the state of emergency that started in March does mandate paid sick leave for home health care workers and nursing home staff. But this requirement only covers four days for suspected cases of the coronavirus.
People who hire care workers directly have long-standing prohibitions on paying them sick leave, under rules that govern use of the Medicaid funds that pay for this work, according to Julie Reiskin, executive director of the Colorado Cross Disability Coalition, a Colorado Trust grantee. The organization has long advocated for the rights of the care providers who work closely with the disability community, knowing that their welfare is deeply connected.
The highly contagious coronavirus sweeping through the country holds particular risks for people with disabilities—who are more likely to become severely ill, to be hospitalized and to die. There’s never been a better illustration of why worker protections also protect the rest of the community, said Reiskin.
“If this doesn’t get our country to pay sick leave for everyone, I don’t know what will,” said Reiskin. She called federal rules excluding home health aides from paid sick leave requirements during the coronavirus crisis shortsighted.
“Home health aides can’t social-distance,” said Reiskin. “If someone is picking you up, giving you a shower, physically putting you in a bed—you can’t do that from six feet apart.”
Workers often travel from home to home and facility to facility, increasing the risk of contagion. Sherwood, for instance, covers an area of hundreds of miles, from Monument to Walsenburg, and from Salida to Rocky Ford. She sees between one and 10 clients a week, between the ages of 65 and 102.
Reiskin said the lack of protective gear for home health aides is putting them and the people they care for at risk.
“Of course, hospitals are going to get [personal protective equipment] first, and first responders. I don’t have a problem with that,” said Reiskin. “But those of us that employ workers need to be able to get the equipment, and right now we’re not able to.”
At the same time, care workers who work for agencies are often told only minimal details about the people they’re attending before showing up to care for them. Jamie Gruss, a care provider in Colorado Springs, said that while working for other agencies in the past, she had attended people who were HIV-positive or had hepatitis, without knowing it until later. Gruss said she buys her own masks and gloves to use at work.
With the coronavirus spreading in Colorado, this lack of disclosure combined with the lack of protective gear has left workers on edge.
“Doctors are all strapped up going in and dealing with these patients,” said Brenda Lozada, a home care provider in Aurora. She has been working in the industry for 16 years—finally landing a higher-paying job as an independent contractor that she supplements with lower-paid agency work. “If you guys want us to do this, why not have us in full armor?”
Care providers are also worried about bringing germs home to their own families. Gruss lives with her three children and a newborn grandchild, born premature in early March. The household depends on income from Gruss’ job and that of her son, who works at King Soopers. The nursing assistant says she steps into the shower, trying her best not to touch anything, as soon as she gets home; so does her son.
When Gruss got sick with a fever she attributed to a sinus infection in late March, her employer told her to wait it out at home for four days with pay; a doctor said she wouldn’t be able to access a test for COVID-19, even if she suspected it.
Colorado Care Workers Unite has lobbied for a small statewide pay raise for home care workers, set to come into effect in July. For now, many receive minimum wage, which in Colorado is $12 per hour as of Jan. 1. At a time when schools are closed and thousands of Coloradans have lost their jobs, home care workers are particularly anxious about losing work.
“Many of them are single mothers,” said Benjamin. “This is their only source of income.”
Denver home care worker Corletta Hithon-Davis (whom we featured in a 2018 story) lost her job when the governor issued a stay-at-home order for the state. Though home care workers are considered essential workers, the clients she was working for decided that it was safer for her to stay away.
“I’m kind of so depressed that I don’t know what to do,” said Hithon-Davis. With the state unemployment website jammed with applicants, she’s been unable to access unemployment benefits.
“I’m going to be short on my rent because I had to buy groceries… . I literally almost cried in the grocery store because I could not afford the cleansers, the extra groceries,” she said. “I don’t know if I’m going to be on someone’s couch again. I can’t go through that again.”
Still, the prospect of going out during the coronavirus pandemic and looking for a job was an even scarier thought. On March 30, Hithon-Davis was facing the prospect of homelessness and had just three days of food remaining.
“I’m staying in, where I’m safe,” she said. “Praying this will end.”
Sherwood, too, was unsure how she’d make rent or pay for the 14 days of her self-isolation. She was worried, too, that speaking out would put her job at risk. (Arant, of Visiting Angels, said her job was safe.) But above all, she was worried about surviving the pandemic. On April 2, she was still sick at home and awaiting the results of a COVID-19 test.
“I believe in God, and I believe that when God’s ready, he’ll take me,“ she said. “But I don’t want to push the envelope, either.”
Later that day, one of her prayers was answered: She had tested positive for the flu.