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Economy & Labor , Health , US

‘The Reality Is, It’s Incredibly Hard’

by Bryce Covert April 14, 2020

This article was originally published in The Atlantic.

What you need to know
  • Preexisting staffing shortages and dismal pay are colliding with a crisis that’s testing the limits of the nurses and health aides caring for the sick and elderly.

Shelly Hughes’s typical day starts at 9 p.m. She’s used to not wanting to get out of bed and go to work, but now the feeling is much stronger. Her son, home from college because of social-distancing measures, tells her every day to quit her job. Lately her husband takes extra care to set out her scrubs and make sure that she has coffee. “He is just a little bit extra affectionate,” she told me. He reminds her to wash her hands and avoid people who cough. It’s “like he’s sending me off to war or something.”

 In a sense, he is. Hughes is a nursing-home aide in Washington State, and her patients are among the most vulnerable to COVID-19. Hughes’s work has always been intimate, and hard: She helps her patients use the bathroom, changes their incontinence products, and repositions her patients so that they don’t get bedsores. She comforts them when they are worried and unable to sleep. But now she’s responsible for keeping them—and herself—safe in spite of staffing and equipment shortages that put both patients and health-care workers at risk.

“It is physically demanding, and it’s emotionally taxing,” Hughes said. The 50-year-old has “pretty bad asthma” and an autoimmune disorder, but, like her mother, she feels called to care work—even though her health issues put her at increased risk of contracting and suffering from COVID and the pay is barely enough to cover her bills. She tries not to let the fear consume her thoughts.

Only when her shift is over at 7 a.m. and she’s driving home, along empty, “eerie” streets, does she let her mind wander: What the hell am I doing? she thinks to herself. Oh my God, this is scary.

Nursing-home employees, nurses, and home health-care workers—the majority of whom are women—are at the forefront of the coronavirus crisis, and they have long been underpaid, overworked, and under-resourced. Registered nurses can expect to make less than $72,000 annually at the median; home health- and personal-care aides earn just $24,000 a year. A quarter of home care workers are uninsured.

 These phenomena are common in majority-female industries. Women dominate 23 of the 30 lowest-paying jobs in America. In occupations where women make up more than half of the workforce, weekly compensation is roughly 15 percent lower than for jobs predominantly filled by men. In fact, as soon as women flock to any given profession, pay drops. According to Ariane Hegewisch, program director of employment and earnings at the Institute for Women’s Policy Research, care work, which “traditionally was done in the home for free by women” is particularly undervalued; these jobs pay less than others that require similar levels of education and skill.

Short supply of health-care workers

The fact that these jobs compensate people poorly and burn them out quickly means that health-care workers have been in short supply across the United States for years. Now, it has deepened the coronavirus crisis, as staffing shortages are colliding with a huge increase in patients. “Nobody wants to stay in these jobs because you don’t earn enough and you don’t get treated well enough,” Hegewisch said. “The fact that we come into an existing underinvestment in staff [makes] it harder to respond now.”

Health-care workers are setting up COVID-19 wards and makeshift field hospitals, putting in long hours, and wearing protective gear fashioned from trash bags and swim goggles. Nurses and nursing-home staff are already starting to get sick and die, and those who haven’t contracted the virus know that they don’t have the time off or the financial cushion to cope if—when—they do. Without paid leave—and after healthcare workers were mostly exempted from Congress’s paid leave expansion in its aid package—“you’re super exposed, [but] you have much less choice about stepping back, so you have to work,” Hegewisch said.

“This layer of protection around you is super brittle,” she added. “Any little thing can pierce it.”

When Hughes first began her career, she was responsible for 18 patients who needed hands-on care for the most basic tasks: eating, bathing, dressing, walking. Even then, she told me, “I felt like I didn’t have enough time to take good care of people.” Things have improved, but the nursing home still doesn’t have enough staff. Then came the coronavirus. Some of Hughes’s co-workers opted to stay home for fear of contracting the virus—one colleague is in her 50s and has respiratory issues; another is seven months pregnant—so when we spoke, Hughes was responsible for 16 patients. “Staffing is pretty abysmal,” she said.

It’s unlikely to get better, even after this particular crisis. The shortage of health-care workers is projected to only grow as the population ages: The government estimates that the country will need an additional 1.6 million registered nurses and nursing assistants, and more than a half million home aides, within the next decade.

Well before the pandemic, 46-year-old Melanie Arciaga, who has worked as a registered nurse for more than 12 years, struggled to take a break during her 12-hour shift at Harborview Medical Center in Seattle. “If it’s a very busy night, I don’t get my breaks at all. I don’t eat or drink [for] 10 hours,” she told me. “Sometimes I just have time to just run to the bathroom and take a gulp of water once in a great while.” Occasionally Arciaga has three different alarms from patients who need help going off at once. “Which one do you run to?” she asked.

 Now her hospital is scrambling to train and outfit employees who have volunteered to work on the coronavirus floor—which in turn means that covering scheduling gaps elsewhere in the hospital is harder. If more workers get reassigned to care for an influx of COVID-19 patients, she and her coworkers will shoulder “a big, heavy, heavy burden for sure,” Arciaga said. “Being in the epicenter, it’s very overwhelming.” But Arciaga can’t help her coworkers anymore. Three weeks after we spoke, she started having mild body aches. She now has a fever and worsening symptoms, so she’s been in quarantine at home.

Fear is creating challenges beyond outbreak centers, too. Melissa Bloom, a 53-year-old nurse in Muskegon, Michigan, was already stretched thin when her co-workers began calling in sick during the pandemic. Employees are now asked to come into work even with symptoms. “If they’re keeping everybody home with a fever and a cough, eventually there’s not going to be people to work,” Bloom told me. Everyone has to wear a surgical mask for their entire shift. Over the course of Bloom’s 12 hours, the elastic cuts into her ears and her breath makes her face hot, fogging up her glasses. Communicating with patients is difficult. N95 masks are in scarce supply, so Bloom made a homemade mask herself—a last resort.

Nurses and doctors across the country are facing equipment shortages like Bloom’s. A week before I spoke with Bartie Scott, a nurse practitioner in Fayetteville, Tennessee, one of the nurses from her clinic took the vital signs of two potential COVID-19 patients in the hospital parking lot, wearing just a cotton scrub jacket, glasses, plastic gloves, and a flimsy surgical mask to protect herself. “We just don’t have the resources like big towns,” Scott said. She took goggles from her garage to wear at work. Her co-worker’s husband donated hazmat suits.

“It was hard to come to work this morning,” she said, choking up. Her husband is an ex-smoker, and she worries about his lungs. “I do feel like it’ll be my fault if I bring it home.” Scott could quit, but her family would be plunged into poverty.

Struggling to make ends meet

Like Scott, many health workers struggle to make ends meet on low salaries. Adarra Benjamin, a home health- and personal-care aide in Chicago, makes just above the city’s $13 minimum wage. She gets no paid time off and no benefits. She’s able to get health care only through her union, the Service Employees International Union. “This is not something that you can really live off of,” Benjamin told me. She’s constantly making decisions about where her paycheck goes: food or transportation? Rent or her mother’s diabetes medications? “It really is a struggle; it really is,” she said.

 Benjamin works a grueling schedule to care for multiple patients. Starting at 9 a.m., she runs errands, cooks, and tidies for her client who has chronic obstructive pulmonary disease. After a three-and-a-half-hour break, she heads to her next client, her great-grandmother, helping her shower and fixing her a small meal before her great-grandmother falls asleep. Benjamin’s day ends only at midnight, after she helps her final client undress, shower, and get ready for bed, and changes her client’s cat litter. “I go a lot of days when I forget to eat,” she said. She repeats this five days a week.

These days, Benjamin is afraid she’ll be exposed to the coronavirus and bring COVID-19 home to her mother, who has diabetes, high cholesterol, and high blood pressure. Benjamin has been “using hand sanitizer every five seconds”; she keeps a bottle in her purse and has one attached to the outside too. “I know it sounds crazy, but I have washed the same jacket five times in the last week because I brush past people or people have walked by and touched me,” she said. But she has to keep going to work. “I have no other choice,” she said. “My bills still have to be paid.” So she’s “compartmentalized” the fear, turning off the news.

Hughes, the Seattle nursing-home aide, is struggling to make ends meet too. Her work “used to be considered a pretty good job; you could support your family, pay your rent and your mortgage,” she said. “Now we’re competing literally with McDonald’s for wages.” The starting pay for her job is $15 an hour. With nearly 17 years of experience, Hughes makes less than $17.50. The cheapest health-care plan that her employer offers still has a $5,000 deductible, so she gets insurance through her state’s Medicaid expansion. Hughes and her husband live paycheck to paycheck and share one car. Most months, she can’t find the gas money for the three-hour drive to visit her family, which means she’s met her baby niece only once.

“Maybe if the job were much, much easier, you could justify [it] not paying a lot,” Hughes said. “But the reality is, it’s incredibly hard.” Hughes and her co-workers are on their feet and “dealing with human tragedy every single day.

When Hughes arrived at 10 p.m. for a shift in late March, she had her temperature taken and she filled out a form screening her for possible COVID-19 exposure. Then she took every patient’s temperature, a new protocol to monitor for signs of the disease. A few visitors used to come at night, but now the front doors are locked. There’s a wing on her floor behind closed double doors: the quarantine area for the newly arrived. The heavy doors make hearing anything on the other side difficult, so she struggles to ensure that patients stay safe throughout the night. That March evening, a patient got out into the hallway with no pants on before Hughes could tend to him.

At the end of her shift, so many people had called out from the next one that Hughes wasn’t sure whether anyone would be coming to relieve her and her co-workers after their nine hours. Eventually, a few showed up. She’d already signed up for hours that she wasn’t supposed to work later in the week, because nobody was on the schedule. “But that’s not sustainable at all,” she said. Every shift had openings every day for the next week.

 After we spoke, Hughes drove home and conducted a newly honed ritual: stripping off her scrubs and putting them directly into the washing machine. She leaves her shoes in a box by the front door. Even so, she thinks that she has a “fairly good chance” of getting the virus. She has friends who work at the Life Care Center nursing home just over an hour’s drive away, in Kirkland, Washington, where at least 37 people have died from coronavirus complications.

“I plan to keep working until I can’t,” Hughes said, walking to her car after her shift, shivering in the chilly morning air. “This is my calling. This is what I’ve chosen to do with my life. I can’t abandon my residents, and I can’t abandon my co-workers.”

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