In Minnesota, home health care aides provide services that keep vulnerable adults and children safe in the comfort of their own homes. They deliver direct care that not only gives quality of life to their patients, but also peace of mind to families and caregivers, an especially important task during these unusual times. During the current pandemic of COVID-19, they are doing all this in light of the risks and anxieties many of us are lucky enough to deal with at home.

Unfortunately, this critical health care workforce does not earn a wage that reflects the value of the services they provide. The average hourly rate for a home health care aide in Minnesota was just $13.92 in 2018 [Bureau of Labor Statistics, 2018]. If a home health aide is the head of their household and provides for children or partners, which is the case for many, they would need to earn at least $27.11 hourly [MIT, 2019] to afford basic expenses in Hennepin County, where many live and work. While they work tirelessly to show up and care for the family and friends of others, they are unable to afford many things necessary to support their own families.

The financial needs of health support and a living wage are immediate, but we should also be reminded of the potential for long-term health consequences for home healthcare aids. Many aides carry work and life-related stress in part due to a low-wage demanding job. This stress is compounded during COVID-19 when there is no working from home and children are not going to school. Historically, epidemics have led to psychological problems from mild trouble sleeping to suicide on the other extreme. These care aides have a critical need for mental health resources and support.

Broad chronic health effects from pandemics, such as the 1918 influenza, have also been reported. Home health care aides are already at a higher lifetime risk for chronic disease risk due to their demographic alone. A majority of aides are non-white, earn low wages, and have a high school education or less, putting them at a higher risk for poor health outcomes compared to others.

With low wages and high rates of long-term physical and psychological harm, home health aides need policy change to support the vital care they provide on a daily basis. How can we as a nation begin to address the inequities faced in this line of work? There are several options.

First we must address the most pressing issue of meeting the COVID-19 related financial needs of home health care aides. We must ensure that agencies are supplied with PPE, disinfectant, and other necessary supplies to protect staff and patients. Congress should also consider passing the “Heroes Fund” [PDF] proposed by Senate Democrats. The fund would disburse an additional $25,000 to every worker deemed essential, including home health aides.

More long-term policy shifts are important to consider as well. Lawmakers could mandate an increased minimum wage and improved benefits for all home-health aides across the country. As it stands today, 88% of all domestic workers don’t receive paid time off or other benefits typically provided by employers. The mandatory minimum wage could be an additional provision attached to the currently pending Domestic Workers Bill of Rights.

It may be financially difficult for small home health care agencies to absorb the expense of a mandatory pay increase. Congress could consider funding some sort of subsidy that allows home health agencies to apply for assistance in providing a living wage, provided that agencies improve transparency. Basic improvements to transparency, such as requiring all subsidized home health care agencies to release financial accountings, could provide private citizens and lawmakers with an idea of how income is being distributed within agencies.

America’s home health care aides do some of the most important work in the country: providing care for our elders and those who live with disabling health conditions. Often they do this work for minimum wage, at great risk to their own physical and psychological health. In times of crisis and in times of bounty, we must find ways to better support them for the commendable work that they do.

Ali Grimes is a graduating master’s student at the University of Minnesota’s Humphrey School of Public Affairs. Margaret Tait and Meghan Munger are Ph.D. students at the U of M School of Public Health. Zach Levin, another Ph.D. student in the School of Public Health, also contributed to this commentary.

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