Coronavirus challenges home health aides as they try to provide safe care 

Home health aide Tarisa Carrasquillo no longer walks 20 minutes from her Elmont home to care for her elderly patient out of fear of exposing herself or him to COVID-19.

“I’ve tried to limit on that end how much contact I come into with people where I go because it’s so easily passed to one another,” said Carrasquillo, 38. “I don’t want to bring anything back.”

The cost of driving every day to care for a 93-year-old is one of the many new challenges adding up for Carrasquillo and other home health aides who care for some of Long Island’s most vulnerable populations. People in the industry said they are facing shortages of personal safety equipment to protect aides and patients, increased communication demands to see whether anyone has symptoms, lack of child care for aides, cancellations by patients who either fear bringing in an outsider or who no longer need an aide because a relative is now working from home, and transportation problems. 

Gov. Andrew M. Cuomo's March 20 executive order requiring many New Yorkers to work from home deemed home health aides essential workers who provide a service that should continue during the pandemic.

Across Long Island, 15,090 people worked as home health aides in 2018, according to the most recent data available from the state Department of Labor. In Nassau County, 582 agencies provide the service, while Suffolk is served by 259 home care providers, according to the state Health Department.

The work is up close and personal: aides help with patients’ daily needs such as bathing and getting dressed; moving bed-bound patients’ positions so they don’t get bed sores; using the bathroom; making sure they take their medications properly; and cleaning, shopping and cooking. It is also low-wage work: home health aides typically get paid minimum wage, which is $13 an hour on Long Island.  

Carrasquillo, who has been an aide for more than two decades, said they are perceived to be at the bottom of the health care industry totem pole, but that “if my patient declines in health we’re the first ones to see, because we have daily contact with them,” she said. “The nurses and the doctors don’t really know, unless we say something.”

Getting supplies has been a problem even as aides now have to take extra precautions to protect their patients and themselves. 

“Home health aides are dealing with the elderly at home, not in a hospital setting; we’re in the homes of people who are more at risk to get it,” Carrasquillo said. “And we can’t simply get a simple mask and a box of gloves right now.”

Maria Santiago, director of Westbury-based Home Health Aide Training Institute, said she “got creative” to supply current and former students with resealable plastic bags filled with bleach-soaked paper towels and homemade hand sanitizer. 

Though Carrasquillo can drive to her client, most aides can’t afford to, said Dana Arnone, owner of Massapequa-based Reliance Home Senior Services.

“You’re looking at low-income, minimum-wage earners,” Arnone said. “Most of our home health aides are reliant on the buses to get to work.”

While aides are fearful that taking public transportation to work could put them at risk, Arnone said some patients and their families are canceling care out of concern the aide could pick up COVID-19 on the bus and bring it into their homes.

“If they’re taking a bus, they don’t want them because they’re fearful of them,” Arnone said of some clients. “The families want to know how are they getting to work, who’s picking them up and all these other questions [about safety] that are adding to their fear of having them come into the home.”

Fear of outsiders bringing in contagion is one aspect of two emerging trends, said William A. Dombi, president of the Washington D.C.-based National Association for Home Care and Hospice, an industry group.

“Clients are refusing to accept people coming in their home because of the risk factors,” Dombi said. “At the same time, a greater demand is going to the home care companies because people are looking at the option of going into a nursing home and thinking Kirkland, Washington, and they don’t want to go into a nursing home,” he said, referring to the Life Care Center facility where 35 people died from the virus.

Earlier this month, the state issued suggested guidelines for agencies and home aides to follow that include a series of questions for providers to ask patients or their families. There are no hard and fast rules for aides dealing with patients who show symptoms of respiratory infection such as fever, coughing and shortness of breath — symptoms associated with COVID-19.

If those symptoms are present, New York State Department of Health spokesman Jeffrey Hammond wrote in an email, “Home health aides should follow their employer’s standard protocols for conducting a home visit with a sick person.”

Daniela Scotto, vice president of clinical operations at Brooklyn-based Preferred Home Care of New York, which has offices in Nassau and Suffolk counties, said they call patients and aides daily to ask whether they have symptoms, have been exposed to anyone who does or whether a family member has tested positive for the virus.

“The first step is not allowing the aide in a patient’s home if they have any symptoms,” Scotto said. Their aides also must call the agency if patients show symptoms.

“If the patient has symptoms, then we’re on the phone with the patient’s doctor and we’re moving aides off the case,” Scotto said. The vagueness of the symptoms creates complications since many people cough or have sore throats that could be due to chronic conditions unrelated to the virus, she said.

Another dilemma facing many aides has been child care in the wake of school closures.

“They want to work and the patients want them and the patients need care,” Arnone said, adding that some aides have been unable to work because now they have to stay home with their children. “Childcare should be the least thing that they’re worrying about.”