In the midst of a pandemic, in-home care providers face new challenges, stresses

Governor Walz applies lotion to a man's feet
Gov. Tim Walz helped dress Jay Spika, as Spika's home care worker, Deb Howze, looked on Nov. 22, 2019. As a home health care provider, Howze said she's taking extra precautions to protect clients during the coronavirus pandemic.
Tim Pugmire | MPR News

Personal care aide Debra Howze helps people manage life at home — like Polly, a client who is 100 years old.

“I’ll go in and help her get her breakfast ready for her,” she said. “She has to have a donut every morning, and she has coffee every morning.”

Every week, Howze ping-pongs back and forth between Polly’s house and three others in the Twin Cities, which can mean long shifts helping her elderly and disabled clients get showered in the morning and to bed at night.

But in the midst of the coronavirus pandemic, Howze’s job taking care of people who are medically vulnerable has taken on new urgency and new stresses.

At 62, Howze is taking all the precautions she can: extra hand-washing, using hand sanitizer and limiting her physical contact with people who aren't her clients.

Howze said she’s working under the assumption that other in-home workers and her clients are doing the same.

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“I’m just praying that everyone else is doing what they’re supposed to do,” she said. “I have to work, I don’t have any other income.”

Personal care assistants fall into a health care gray area; like in-home nurses or home health aides, Howze doesn’t work in a hospital setting. But she helps her clients with essential services that keep them in good health and keep them out of the health care system.

The turnover rate in the industry is high — about 40 percent. And the pay is low, about $12 per hour, according to a survey conducted by the University of Minnesota. Most jobs are paid for by Medicaid.

Benefits vary, too. Howze is a member of a union that represents about 20,000 workers in the state, so she gets paid time off. But she said she hasn’t accrued enough time to cover a two-week quarantine, if she were exposed to the virus.

Gov. Tim Walz’s administration has made accommodations for these workers, for instance designating them as emergency workers so they can still serve their clients and access child care.

And he’s eased unemployment benefit rules for people who lose their jobs or who are sick or quarantined because of work, while Congress is expected to pass a bill that expands unemployment benefits.

The Walz administration will allow an initial in-home assessment necessary to access PCA services to be waived, which is intended to help protect clients from contracting the virus.

But Howze said she wants the state to provide her with protective equipment like masks, so she can keep working safely with her clients.

“Who would take care of Miss Polly? She couldn’t do it on her own. She couldn’t,” said Howze.

Having access to masks could also help protect Howze's clients in case she got sick from the coronavirus and didn't know it.

But there is a severe shortage of personal protective equipment, said Bill English, who is CEO of Accurate Home Care. He said it’s been impossible to stock masks for his more than 700 employees who provide in-home care.

So for now, English said care providers are following the safety precautions recommended by the Centers for Disease Control and Prevention and the company is asking their clients to take the same measures.

"We don’t want the families infecting our care providers,” he said. “Some of them have taken this seriously, some have not."

English said they’ve given their workers the option of taking paid leave to stay out of work for a few weeks if they are either concerned about getting sick or are sick.

In some cases, clients have asked his workers not to come into their home,” said English.

If a worker or client accidentally gets sick as a result of the care relationship, English said he's worried about possible litigation against in-home care providers and he would like to see some additional protections from the state.

“I’m scared to death that a home care agency or a hospital or somebody who is trying to navigate uncharted waters after the fact gets dinged for not doing something that a year from now seems reasonable, but is not something that would occur to do in the midst of a fight,” English said.

In Minneapolis, 33-year-old Adrienne Kleinman has a form of muscular dystrophy that requires her to get help from two PCAs for assistance with everything from showering to shopping.

She said the coronavirus outbreak has added a new layer of stress to her situation.

"You just don't know where people have been,” she said. “Have they been smart about taking care of themselves?"

Kleinman said that as someone with a disability, it's impossible to completely isolate herself from the virus because she still has people coming and going from her house.

So Kleinman said she's relying on trust — trust that her PCAs are doing everything they can to stay healthy, and trust that she's doing the same.

"Self-isolation doesn't suddenly make me not disabled,” she said.