Editor’s note: The elderly and those recovering from surgeries are among the most vulnerable to becoming seriously ill as a result of COVID-19. An army of 3.5 million home care aides are responsible for taking care of them and others who need help, whether in homes or assisted care facilities. Marc Cohen, Robyn Stone and Christian Weller, gerontology and public policy researchers at the University of Massachusetts Boston, have been studying this group and explain who they are – as well as their vulnerabilities.

1. What do home care aides do?

Home care aides are a crucial part of our health care system for people who need extra help. They play a critical role in helping address and manage the potentially catastrophic impacts of the current pandemic on seniors and those living with disabilities.

Most aides help people in their homes. But many – called certified nursing assistants – also work in assisted living facilities and nursing homes.

Next to family members and other unpaid caregivers, they provide the vast majority of hands-on assistance to these vulnerable populations. Their work includes help with personal tasks such as cooking, eating, bathing and toileting. It also includes assistance with running errands, such as going shopping and taking people to the doctor.

In addition, such aides are the “eyes and the ears” of the health care system, often observing subtle changes in condition that assist other health care professionals in the management of chronic illnesses and functional decline. They are also an important source of emotional support for care recipients and their families.

For those receiving care at home, the presence of a consistent visit from a home health aide can mean the difference between aging in place and having to move to an institutional setting. The support provided by aides in both home and institutional settings may also help keep people from having to make unnecessary trips to the emergency department or be admitted to a hospital unnecessarily – something particularly important at this time of crisis.

2. Who are the people providing this care?

Our current research project – in collaboration with economic research consultant Beth Almeida – involves trying to understand the link between the economic status of home care aides and labor force shortages in this sector.

Analyzing data from the Bureau of Labor Statistics, we found that aides are on average 43 years old and have more than two decades of work experience. Almost half have at least some college education and 34.6% have some professional license or certification.

They also tend to be members of economically disadvantaged groups. More than a third of all aides are African American, and more than a quarter are foreign-born. The majority are also single women, and almost half of all aides have children.

Turnover among home care aides also tends to be lower than similar professions, which suggests to us that they are especially committed to their jobs.

3. What does their economic situation look like?

Home health aides are generally low-wage, mostly hourly workers.

Our calculations found that almost half of all aides don’t earn enough to afford the basics of living. On average, aides earned US$13.40 per hour in 2019.

And while workers with more education are usually rewarded for it, home care aides are not. One additional year of education beyond high school raises earnings for aides by just 9%, compared with 45% for the average U.S. worker.

Their financial insecurity extends beyond low pay. Many are uninsured or underinsured for the very risks that they often face, especially in the current situation. In 2018, 14% of aides lacked any health insurance – compared with 8.5% for the general population.

And many other aides have massive holes in their coverage, according to our own calculations based on the Fed’s 2018 Survey of Household Economics and Decision-making. We found that a whopping 71% of health care support staff, mainly aides, had a health care emergency that was not fully covered by their insurance and left them with a debt they still owed at the time of the survey. That compared with 38% of the general population.

Finally, almost two-thirds of these workers said they couldn’t come up with $400 if a future emergency arose, while almost a third indicated they already couldn’t pay all of their bills.

4. How are they affected by the current pandemic?

The current crisis creates substantial health risks for aides.

Most aides work in people’s homes. And, while we don’t know for sure how many aides are still working in people’s homes, we think most will likely continue doing their jobs – whether either because people depend on their help or simply because they have few other sources of income and little savings and have to keep working.

But that also means that they will be going to work not knowing whether the older adult or family member living there has the virus. In many cases, they will also end up caring for many people released home or into rehabilitation from hospitals after treatment, smoothing the transition from hospital to home for people who have survived the devastating virus.

Yet, they lack essential protective equipment, even basics such as hand sanitizers and gloves amid national shortages. These materials would allow aides to more safely do their jobs.

Home care workers are essential to helping society’s most vulnerable get through the crisis and eventually to flattening the curve of coronavirus infections. Without them, we could see a surge in demand for hospital beds and respirators – already in short supply – and more people could die as a result.

Christian Weller is a senior fellow at the Center for American Progress, Washington, DC

Marc Cohen is Research Director at the Center for Consumer Engagement in Health Innovation at Community Catalyst.

Robyn Stone receives funding from the Gordon and Betty Moore Foundation and the Colorado Department of Health Policy and Financing. She is affiliated with LeadingAge.

Their article first appeared in The Conversation on March 25.

Image: A respirator system is pictured at the intensive care unit of the University Medical Center Hamburg-Eppendorf in Hamburg, Germany, March 25, 2020, as the spread of the coronavirusdisease (COVID-19) continues. Axel Heimken/Pool via REUTERS