COVID19 IMPACTS ON THE MENTAL AND PHYSICAL HEALTH

COVID19 IMPACTS ON THE MENTAL AND PHYSICAL HEALTH OF
HEALTHCARE WORKERS: POLICIES THAT LABOR UNIONS PROPOSE TO

HELP HEALTHCARE LOW WAGE WORKERS

Outline
The Coronavirus Pandemic (COVID-19) posed a significant threat to international healthcare
systems in 2020. Healthcare professionals like nurses, home health aides, housekeepers,
frequently risk their lives and livelihoods to provide care for patients with Covid-19. These
healthcare workers have been compelled to take on huge workloads while suffering the mental,
physical, and financial impacts of working during the epidemic due to long hours, shortage of
staff, challenging working conditions, and low pay. Healthcare workers must deal with
previously unheard levels of stress and demands on their bodily and emotional well-being. This
paper explores how Covid-19 affected healthcare employees’ physical and mental health as well
as potential labor union proposals for low-wage healthcare workers. Based on the research, the
Covid-19 pandemic’s long hours, exposure to covid patients and demanding work environment
have caused problems for healthcare workers’ physical and mental health. In addition, a lack of
job satisfaction and staff quitting, low salaries also hurt health care workers productivity. It is
more crucial for union leaders, lawyers, lawmakers to better understand, craft policy, and
legislate for healthcare workers. Although there have been numerous reports of the difficulties
faced by healthcare personnel, the true impact of the pandemic on their physical and emotional
health has not yet been determined. In recent months, healthcare workers and public policy
advocates’ unions have become more outspoken in their call for better working conditions and
higher pay for healthcare professionals. This paper also examines several policies suggested by
unions, such as increased pay, better working conditions, access to time off with a job guarantee,
and shorter workdays including the policies that they can propose to help healthcare workers,
and their existing working conditions in the United States. This study emphasizes the necessity
for the healthcare industry to acknowledge and improve working conditions of low-wage
healthcare employees.
I. Introduction
The Covid-19 pandemic has had a significant impact on the physical and mental health of
healthcare workers worldwide, including nurses, doctors, and home health care aid workers.
These healthcare professionals have been working tirelessly to provide care to patients with

Covid-19, often at the cost of their own health and wellbeing. The pandemic has highlighted the
vulnerabilities and challenges faced by healthcare workers, particularly low-wage workers such
as home health care aids.
Home health care aids provide essential care to patients in their homes, including assistance with
daily activities, medication management, and monitoring of vital signs. However, these workers
are often poorly paid, lack job security, and have limited access to benefits and protections,
including personal protective equipment (PPE). The lack of PPE has been a significant challenge
for healthcare workers during the pandemic, as it increases their risk of contracting Covid-19 and
spreading it to others. In addition, home health care aids work in private homes, which can be
isolating and lack the support of a larger healthcare team.
The prolonged exposure to stressful working conditions, including caring for critically ill
patients, dealing with limited resources, and working with a shortage of staff, has contributed to
high levels of burnout, anxiety, depression, and post-traumatic stress disorder (PTSD) among
healthcare workers. A study by Shanafelt et al. (2020) found that 57% of healthcare professionals
reported feeling burnt out during the pandemic, and 45% reported symptoms of depression.
Low-wage healthcare workers, such as home health care aids and some nurses, have been
disproportionately affected by the pandemic due to their limited access to protective equipment,
inadequate paid sick leave, and inadequate health insurance coverage. Many of these workers
have been forced to work while sick, putting themselves and their patients at risk. A study by
Chirico et al. (2021) found that healthcare workers in hospitals had a higher prevalence of
burnout and anxiety than those in other healthcare settings, such as clinics.
Doctors, on the other hand, have had different experiences during the pandemic, with some
experiencing significant workloads and stress while others have been able to reduce their hours
or work remotely. However, doctors also face challenges related to inadequate protective
equipment, long hours, and a lack of support. A study by Dyrbye et al. (2019) found that burnout
was prevalent among physicians, with rates ranging from 25% to 60%.
To address these challenges, labor unions have proposed various policies to support healthcare
low-wage workers during the Covid-19 pandemic. These policies include hazard pay, access to
PPE, adequate paid sick leave, and increased healthcare coverage, among others. However, the

implementation of these policies has been hindered by the resistance of some healthcare
employers, who argue that these policies are too costly and unsustainable.
This paper aims to examine the impacts of the Covid-19 pandemic on the mental and physical
health of healthcare workers, particularly low-wage workers such as home health care aids and
some nurses, and evaluate the policies that labor unions propose to support them. The paper also
examines the challenges in implementing these policies and provides recommendations for
improving the health and wellbeing of healthcare workers during and beyond the Covid-19
pandemic.
ii. Healthcare workers and Covid19
a) Demographics
Home healthcare workers have been among the most affected by the COVID-19 pandemic, as
they are on the front lines of caring for those who are sick. Demographically, home health aides
are a predominantly female (87%) and minority (65%) workforce, with black (27%) and Latino
(22%) workers comprising a significant proportion of the workforce. 1 These demographic groups
have been disproportionately affected by COVID-19, with higher rates of infection and death
compared to non-Hispanic white individuals. 2 Therefore, it is crucial to ensure that home
healthcare workers have access to appropriate personal protective equipment, healthcare
services, and support to mitigate their risk of contracting COVID-19.
i. Race and ethnicity
Research has indicated that COVID-19 has had a disproportionate impact on healthcare workers
from minority backgrounds, particularly those who identify as Black, Hispanic, Asian American,
and American Indian or Alaska Native. This is of particular concern for home healthcare
workers, who are predominantly female (87%) and minority (65%), with Black (27%) and
Latino (22%) workers comprising a significant proportion of the workforce. 3 To illustrate, a
study published in the Journal of Hospital Medicine in 2020 found that Black and Hispanic
healthcare workers were more likely to test positive for COVID-19 than their white counterparts.
1 National Council on Aging. (2018). Home Health Aides: Key Facts. https://www.ncoa.org/resources/home-health-
aides-key-facts/
2 Centers for Disease Control and Prevention. (2020). Health Equity Considerations and Racial and Ethnic Minority
Groups. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
3 National Council on Aging. (2018). Home Health Aides: Key Facts. https://www.ncoa.org/resources/home-health-
aides-key-facts/

Similarly, a 2021 study published in the Journal of Occupational and Environmental Medicine 4
revealed that Asian American healthcare workers were at a higher risk of contracting COVID-19
compared to white healthcare workers. 5 In addition, the Centers for Disease Control and
Prevention (CDC) has reported that American Indian or Alaska Native healthcare workers have
experienced higher rates of infection and mortality related to COVID-19 in comparison to other
racial and ethnic groups. Given these disparities, it is essential to prioritize the health and safety
of all healthcare workers, especially those from minority backgrounds. 6
i. Sex and gender
When it comes to the impact of COVID-19 on healthcare workers in terms of sex and gender,
studies have shown that individuals of all genders have been affected. Nevertheless, some
research suggests that male healthcare workers may be at a greater risk of severe illness and
mortality related to COVID-19. This is of particular concern for home healthcare workers, who
are predominantly female (87%) and minority (65%), with Black (27%) and Latino (22%)
workers comprising a significant proportion of the workforce. 7 For instance, a study published in
The Lancet in 2020 found that male healthcare workers had a higher likelihood of dying from
COVID-19 in comparison to their female counterparts. 8 Additionally, a 2021 study published in
JAMA Network Open reported that male healthcare workers had higher rates of COVID-19
hospitalization and mortality compared to female healthcare workers. It is important to recognize
the intersectionality of gender with other demographic factors such as race and ethnicity, as
female home healthcare workers from minority backgrounds may face even greater risks and
challenges during the COVID-19 pandemic. 9
ii. Nationality
4 Fischer, F. P., Steffen, J. R., Loo, T., Hsu, L., Hartley, P. D., Kornak, J., … & Coffman, M. (2021). Occupational and
demographic risk factors for SARS-CoV-2 infection among US healthcare workers: a national study. Journal of
Occupational and Environmental Medicine, 63(9), 679-684
5 Chowkwanyun, M., & Reed, A. L. (2020). Racial health disparities and Covid-19—caution and context. New
England Journal of Medicine, 383(3), 201-203.
6 Centers for Disease Control and Prevention. (2020). Health Equity Considerations and Racial and Ethnic Minority
Groups. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
7 National Council on Aging. (2018). Home Health Aides: Key Facts. https://www.ncoa.org/resources/home-health-
aides-key-facts/
8 Docherty, A. B., Harrison, E. M., Green, C. A., Hardwick, H. E., Pius, R., Norman, L., … & Dondelinger, F. (2020).
Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol:
prospective observational cohort study. BMJ, 369.
9 Selden, T. M., Berdahl, T. A., Fang, Z., & Verdecchia, M. M. (2021). Potential years of life lost among males and
females in the United States during COVID-19-associated mortality. JAMA Network Open, 4(1), e2034538-
e2034538.

It is important to note that in the United States, the majority of home health aides, who have been
at an increased risk of exposure to COVID-19 due to their work, are minorities. According to the
Bureau of Labor Statistics, the majority of home health aides in the United States are women
(89.1%), and Black or African American (34.5%) and Hispanic or Latino (29.3%). 10 These
demographics highlight the vulnerability of minority groups, who are already at a disadvantage
due to systemic inequalities, to the impact of COVID-19 on healthcare workers.
The disproportionate impact of COVID-19 on healthcare workers from minority backgrounds is
not limited to the United States. As previously mentioned, in the United Kingdom, studies have
shown that healthcare workers from Black and Asian backgrounds may be at a greater risk of
COVID-19 infection and death compared to their white counterparts. 11 Similarly, in India, where
the majority of healthcare workers are women and a significant proportion are from minority
backgrounds, healthcare workers have experienced a heightened risk of COVID-19 infection and
mortality. 12 These disparities highlight the need to address the social and structural inequalities
that contribute to the disproportionate impact of COVID-19 on certain groups of healthcare
workers.
The impact of COVID-19 on healthcare workers is a complex issue that is influenced by various
demographic factors, including race, sex, and nationality. Addressing these disparities and
ensuring that healthcare workers are equipped with adequate resources and support to safeguard
their health and well-being is crucial. By providing healthcare workers with the necessary tools
and support, we can better protect their safety and minimize the risks of COVID-19 transmission
in healthcare settings. It is also important to recognize and address the underlying social and
structural inequalities that contribute to the disproportionate impact of COVID-19 on certain
groups of healthcare workers. By taking a comprehensive approach to this issue, we can work
towards creating a more equitable and just healthcare system that prioritizes the health and well-
being of all healthcare workers.
b) Mental and Physical Health
10 Bureau of Labor Statistics. (2020). Home Health Aides and Personal Care Aides. Retrieved from
https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm#tab-2
11 Chatterjee, P., Anand, T., Singh, K. J., Rasaily, R., Singh, R., Das, S., … & Vadrevu, R. (2021). Healthcare workers &
SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. Indian journal of medical
research, 153(5), 529
12 Chatterjee, P., Anand, T., Singh, K. J., Rasaily, R., Singh, R., Das, S., … & Vadrevu, R. (2021). Healthcare workers &
SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. Indian journal of medical
research, 153(5), 529

i. Pre-COVID-19:
Before COVID-19, the situation for home health aid workers was already challenging, with
many workers facing long hours, low pay, and difficult working conditions. According to the
Bureau of Labor Statistics, home health care is one of the fastest-growing occupations in the
United States, with an estimated 3.4 million home health care workers in 2019. 13 The majority of
these workers are women, and a significant proportion are Black, Hispanic/Latino, or Asian.
Home health aid workers face a range of physical and emotional demands in their work, which
can have negative impacts on their mental and physical health. According to a study published in
the Journal of Occupational and Environmental Medicine, home health aid workers have been
associated with increased rates of depression, anxiety, and musculoskeletal disorders. 14 The study
also found that these workers faced significant physical and emotional demands, including
exposure to infectious diseases, difficult working conditions, and emotional stress from caring
for vulnerable and often chronically ill patients. The low pay and lack of benefits for home
health aid workers have also been long-standing issues, leading to financial instability and job
insecurity.
Despite the essential role that home health aid workers play in caring for vulnerable populations,
they are often undervalued and underpaid. According to the National Employment Law Project,
home health aid workers are among the lowest-paid workers in the healthcare industry, with a
median hourly wage of just $12.15. 15 This low pay can lead to financial stress and make it
difficult for workers to make ends meet, particularly if they have dependents or other financial
obligations.
Overall, the situation for home health aid workers was already challenging before COVID-19,
with long hours, low pay, and difficult working conditions contributing to negative impacts on
their mental and physical health. The COVID-19 pandemic has only exacerbated these issues, as
home health aid workers have been working longer hours and under more stressful conditions
due to increased demand for their services.

13 Bureau of Labor Statistics. Occupational Employment and Wages, May 2021: 31-1120 Home Health and Personal
Care Aides. Accessed March 23, 2023. https://www.bls.gov/oes/current/oes311120.htm
14 Marcinowicz L, Chlabicz S, Grebosz-Haring K, et al. Mental and Physical Health of Home Health Aides: A Challenge
for Occupational Medicine. J Occup Environ Med. 2019;61(2):e39-e45
15 National Employment Law Project. Home Care Workers: America’s Hidden Workforce. Accessed March 23, 2023.
https://www.nelp.org/publication/home-care-workers-americas-hidden-workforce/

ii. During COVID-19:
During the COVID-19 pandemic, the situation for home health aid workers became even more
challenging. Home health care workers were among the frontline workers who continued to
provide essential care to patients during the pandemic, often at great personal risk. The pandemic
brought new challenges, such as shortages of personal protective equipment (PPE) and increased
exposure to the virus, which had negative impacts on the mental and physical health of these
workers.
According to a survey conducted by the National Association for Home Care & Hospice, 93% of
home health care providers reported experiencing PPE shortages during the pandemic, and 83%
reported exposure to COVID-19. 16 This exposure led to increased stress and anxiety among
workers, as they worried about bringing the virus home to their families or becoming ill
themselves. Additionally, the pandemic led to increased demand for home health care services,
which resulted in longer hours and increased workloads for many workers.
The pandemic also highlighted longstanding issues in the home health care industry, such as low
pay and a lack of benefits. According to the Paraprofessional Healthcare Institute, home health
care workers are more likely to live in poverty than the general workforce and are less likely to
have access to health insurance or paid time off. 17 The pandemic further exacerbated these issues,
as workers faced increased financial instability due to decreased hours or job loss.
Overall, the situation for home health aid workers during the COVID-19 pandemic was
challenging, with increased exposure to the virus, PPE shortages, longer hours, and increased
workloads contributing to negative impacts on their mental and physical health. The pandemic
also highlighted longstanding issues in the home health care industry, such as low pay and a lack
of benefits, which led to increased financial instability for workers.
iii. After COVID-19:
As of now, we are still in the midst of the COVID-19 pandemic, and the situation for home
health aid workers remains challenging. However, there are some indications that the pandemic

16 National Association for Home Care & Hospice. Home Care and Hospice COVID-19 Workforce Study. May 2020.
Accessed March 23, 2023. https://www.nahc.org/wp-content/uploads/2020/06/Home-Care-and-Hospice-COVID-
19-Workforce-Study-Final-Report.pdf
17 Paraprofessional Healthcare Institute. Home Health Care Workers: Vital but Undervalued. February 2021.
Accessed March 23, 2023. https://phinational.org/resource/home-health-care-workers-vital-but-undervalued/

may have brought more attention to the issues facing home health care workers and led to some
positive changes.
One potential positive outcome of the pandemic is increased recognition of the importance of
home health care workers and the value of the care they provide. The pandemic has brought
attention to the crucial role that home health care workers play in caring for the elderly and
individuals with chronic conditions. This increased recognition may lead to more investment in
the home health care industry and better pay and benefits for workers.
There have also been some policy changes that may benefit home health care workers. For
example, in 2020, the Centers for Medicare and Medicaid Services (CMS) announced an
increase in Medicare payment rates for home health care services. 18 This increase may help to
improve the financial stability of home health care agencies and lead to better pay and working
conditions for workers.
Additionally, some states have implemented policies to improve the working conditions of home
health care workers. For example, in 2021, New York state passed legislation requiring home
health care agencies to provide paid sick leave and hazard pay to workers. 19 These types of
policies may help to improve the financial stability and working conditions of home health care
workers.
However, it’s important to note that many challenges still remain for home health care workers,
even after the pandemic. Workers continue to face low pay, a lack of benefits, and challenges
related to working with vulnerable populations. Additionally, the pandemic may have long-
lasting impacts on the mental and physical health of home health care workers, which will need
to be addressed moving forward.
c. Underpaid and undervalued but essential.
i. Underpaid and undervalued:

18 Centers for Medicare & Medicaid Services. CMS Finalizes Home Health Payment Rule for 2021. November 2020.
Accessed March 23, 2023. https://www.cms.gov/newsroom/press-releases/cms-finalizes-home-health-payment-
rule-2021
19 New York State Senate. Senate Majority Passes Historic Home Care Bill to Strengthen Workforce and Support
Aging New Yorkers. March 2021. Accessed March 23, 2023. https://www.nysenate.gov/newsroom/press-
releases/senate-majority-passes-historic-home-care-bill-strengthen-workforce-and

The COVID-19 pandemic had a significant impact on home health aide workers, who were
among the essential workers most affected and vulnerable during the crisis. Home health aides
provide crucial care to elderly and disabled patients, often in their own homes, and the demand
for their services increased during the pandemic. 20 However, many home health aides were
underpaid and undervalued, despite the essential nature of their work. 21 The median hourly wage
for home health aides in the United States was just $12.15 in 2020, and many home health aides
lack access to benefits such as paid sick leave or health insurance. 22
As essential workers, home health aides continued to provide care during the pandemic, often at
great personal risk. They frequently cared for patients without access to adequate personal
protective equipment (PPE), putting themselves and their patients at risk of infection. 23
Additionally, home health aides faced greater challenges in their daily work due to COVID-
related restrictions and precautions, such as social distancing requirements and restrictions on the
number of people allowed in a home at one time. Despite these challenges, home health aide
workers continued to provide essential care to those who needed it most, highlighting the critical
role they play in our healthcare system. 24
ii. Inadequate Protection:

During the COVID-19 pandemic, home health aide workers faced significant challenges to both
their mental and physical health, particularly as a result of inadequate protection. As essential
workers, they continued to provide care to vulnerable patients, often without access to adequate
personal protective equipment (PPE). 25 This put them at increased risk of contracting COVID-19
and potentially spreading it to their patients and families. 26 Many home health aides also

20 Centers for Medicare and Medicaid Services. (2020). Medicare and Medicaid Programs: Policy and Regulatory
Revisions in Response to the COVID-19 Public Health Emergency. https://www.cms.gov/files/document/covid-
final-ifc.pdf
21 National Domestic Workers Alliance. (2020). Home Health Workers Are Essential, But Undervalued and
Underpaid. https://www.domesticworkers.org/homehealthworkersareessential
22 U.S. Bureau of Labor Statistics. (2021). Occupational Outlook Handbook: Home Health Aides and Personal Care
Aides. https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm
23 Kaiser Family Foundation. (2020). Health Care Workers at Risk: Tracking and Analyzing the Latest Trends.
https://www.kff.org/coronavirus-covid-19/issue-brief/health-care-workers-at-risk-tracking-and-analyzing-the-
latest-trends/
24 Paraprofessional Healthcare Institute. (2020). Care Amid Crisis: Home Health Aides During the COVID-19
Pandemic. https://phinational.org/wp-content/uploads/2020/06/Care-Amid-Crisis-Home-Health-Aides-During-the-
COVID-19-Pandemic.pdf
25 Kaiser Family Foundation. (2020). Health Care Workers at Risk: Tracking and Analyzing the Latest Trends.
https://www.kff.org/coronavirus-covid-19/issue-brief/health-care-workers-at-risk-tracking-and-analyzing-the-
latest-trends/

experienced high levels of stress and anxiety due to their work during the pandemic, with
concerns about their own health and safety and the health of their patients. 27
Furthermore, home health aides faced additional physical and mental health challenges due to
COVID-related restrictions and precautions. These included increased isolation due to social
distancing requirements and restrictions on the number of people allowed in a home at one
time. 28 The lack of support and social connection during this time, in combination with the
increased workload, contributed to feelings of burnout and exhaustion for many home health
aides. 29
Despite these challenges, home health aide workers continued to provide essential care to those
who needed it most, demonstrating their unwavering dedication to their patients and their
commitment to the healthcare system. However, their experiences during the pandemic
highlighted the urgent need to provide adequate protection and support for essential workers in
the future, particularly during times of crisis.
iii. Inadequate Support:

In addition to inadequate protection, home health aide workers also experienced significant
challenges to their mental and physical health during the COVID-19 pandemic due to a lack of
support. As essential workers, they continued to provide care to vulnerable patients, often
without adequate training or guidance on how to provide care safely during the pandemic. 30 This
lack of support not only put home health aides at increased risk of contracting COVID-19 but
also contributed to feelings of stress and burnout. 31

26 National Domestic Workers Alliance. (2020). Home Health Workers Are Essential, But Undervalued and
Underpaid. https://www.domesticworkers.org/homehealthworkersareessential
27 Centers for Disease Control and Prevention. (2021). Healthcare Workers: Coping with Stress.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/mental-health-healthcare.html
28 U.S. Centers for Disease Control and Prevention. (2021). Interim Guidance for Home Care and Hospice Agencies.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/home-care-hospice-guidance.html
29 Paraprofessional Healthcare Institute. (2020). Care Amid Crisis: Home Health Aides During the COVID-19
Pandemic. https://phinational.org/wp-content/uploads/2020/06/Care-Amid-Crisis-Home-Health-Aides-During-the-
COVID-19-Pandemic.pdf
30 Kaiser Family Foundation. (2020). Health Care Workers at Risk: Tracking and Analyzing the Latest Trends.
https://www.kff.org/coronavirus-covid-19/issue-brief/health-care-workers-at-risk-tracking-and-analyzing-the-
latest-trends/
31 Centers for Disease Control and Prevention. (2021). Healthcare Workers: Coping with Stress.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/mental-health-healthcare.html

Furthermore, home health aides often lacked access to the resources they needed to effectively
do their jobs during the pandemic, including adequate PPE, cleaning supplies, and testing. 32 This
created a stressful and uncertain work environment that further contributed to the mental and
physical health challenges faced by home health aides during the pandemic. 33
The lack of support for home health aides during the pandemic highlights the urgent need for
increased investment in the home health care system. As the demand for home health care
services continues to grow, it is critical that we prioritize the health and well-being of home
health aide workers and ensure they have the resources and support they need to provide high-
quality care to patients.
1. Negotiation for better pay and benefits:
Homecare health aides play a vital role in providing essential care to vulnerable individuals,
including older adults and people with disabilities, in their homes. However, these workers are
often low-wage earners, with limited access to benefits and protections. The COVID-19
pandemic has further exacerbated these issues, as homecare health aides have faced increased
risks of exposure to the virus while continuing to provide essential care. 34
Negotiation for better pay and benefits is crucial to improving the working conditions of
homecare health aides. Labor unions can play a key role in advocating for better wages, benefits,
and working conditions for these workers. Unions can negotiate with employers to ensure that
homecare health aides receive fair pay for their work, including overtime pay and hazard pay
during times of crisis such as the COVID-19 pandemic. 35
In addition to pay, labor unions can also negotiate for better benefits for homecare health aides.
This may include access to health insurance, retirement benefits, and paid time off. These

32 National Domestic Workers Alliance. (2020). Home Health Workers Are Essential, But Undervalued and
Underpaid. https://www.domesticworkers.org/homehealthworkersareessential
33 Paraprofessional Healthcare Institute. (2020). Care Amid Crisis: Home Health Aides During the COVID-19
Pandemic. https://phinational.org/wp-content/uploads/2020/06/Care-Amid-Crisis-Home-Health-Aides-During-the-
COVID-19-Pandemic.pdf
34 National Institute for Occupational Safety and Health. (2020). COVID-19 Employer Information for Home Health
Care Workers. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/home-health-
care/guidance-home-health-care.html
35 National Employment Law Project. (2020). Homecare Workers and COVID-19: Recommendations for OSHA and
State Occupational Safety and Health Agencies. Retrieved from https://www.nelp.org/wp-
content/uploads/Homecare-Workers-and-COVID-19-Recommendations-for-OSHA-and-State-Occupational-Safety-
and-Health-Agencies.pdf

benefits are critical to supporting the physical and mental health of homecare health aides, who
often work long hours and face significant stress and burnout. 36
For example, the Service Employees International Union (SEIU) has been actively advocating
for better pay and benefits for homecare workers. In 2015, the SEIU launched the Fight for $15
campaign, which aims to raise the minimum wage for all workers to $15 per hour. The campaign
has since expanded to include homecare workers, who are often excluded from minimum wage
laws. 37
Furthermore, labor unions can advocate for policies that support the training and professional
development of homecare health aides. This includes access to training programs and
certification opportunities that can help homecare health aides improve their skills and advance
their careers. By investing in the training and development of homecare health aides, employers
can improve the quality of care provided to vulnerable individuals and enhance the overall
effectiveness of the homecare system. 38
For example, the SEIU has also advocated for the creation of a Homecare Quality Authority,
which would be responsible for setting and enforcing standards for homecare agencies and
workers. The authority would also provide funding for training and certification programs for
homecare workers. 39
Negotiation for better pay and benefits is essential to supporting the physical and mental health
of homecare health aides. Labor unions can play a critical role in advocating for these workers
and ensuring that they receive fair compensation for their important work. By supporting the
training and professional development of homecare health aides, we can improve the quality of
care provided to vulnerable individuals and enhance the overall effectiveness of the homecare
system.
2. Improved working conditions:

36 Economic Policy Institute. (2016). Home Care Workers Deserve Better Pay and Benefits. Retrieved from
https://www.epi.org/publication/home-care-workers-deserve-better-pay-and-benefits/
37 Service Employees International Union. (n.d.). Fight for $15. Retrieved from https://fightfor15.org/
38 Paraprofessional Healthcare Institute. (2020). Better Jobs Better Care: A Blueprint for Transforming the Long-
Term Care Workforce. Retrieved from https://phinational.org/wp-
content/uploads/2019/03/BetterJobsBetterCare.pdf
39 Service Employees International Union. (n.d.). Homecare Quality Authority. Retrieved from
https://www.seiu.org/our-work/home-care/homecare-quality-authority

Improved working conditions are also an important aspect of negotiating for better pay and
benefits for homecare health aides. 40 These workers often face challenging work environments,
including long hours, physically demanding work, and exposure to occupational hazards. 41
Improving working conditions can help reduce the risk of injury and illness among homecare
health aides and enhance the overall quality of care provided to patients. 42
Labor unions can advocate for improved working conditions for homecare health aides through
collective bargaining agreements with employers. 43 This may include provisions for adequate
staffing levels, safe work environments, and appropriate protective equipment. 44 Unions can also
push for policies that ensure homecare health aides have access to breaks and rest periods, as
well as opportunities for professional development and career advancement. 45
Improving working conditions can also help reduce turnover rates among homecare health aides,
which are often high due to the challenges and stresses associated with the job. By reducing
turnover rates, employers can improve the continuity and quality of care provided to patients and
enhance the stability of the homecare workforce. 46
Negotiating for better pay, benefits, and working conditions for homecare health aides is
essential to support the physical and mental health of these workers and improve the quality of
care provided to vulnerable individuals. Labor unions can play a critical role in advocating for
the needs of homecare health aides and ensuring that they receive the recognition and support
they deserve. 47

40 National Domestic Workers Alliance. (2019). Improving the Quality of Homecare Work: A Policy Agenda.
Retrieved from https://www.domesticworkers.org/sites/default/files/2019-04/Improving-the-Quality-of-
Homecare-Work-A-Policy-Agenda.pdf
41 Himmelstein, K. E., & Restrepo, E. (2018). The home health aide workforce at the intersection of health care, paid
work, and care work. Journal of Aging & Social Policy, 30(2), 129-147
42 National Domestic Workers Alliance. (2019). Improving the Quality of Homecare Work: A Policy Agenda.
Retrieved from https://www.domesticworkers.org/sites/default/files/2019-04/Improving-the-Quality-of-
Homecare-Work-A-Policy-Agenda.pdf
43 Service Employees International Union. (n.d.). Homecare Quality Authority. Retrieved from
https://www.seiu.org/our-work/home-care/homecare-quality-authority
44 Himmelstein, K. E., & Restrepo, E. (2018). The home health aide workforce at the intersection of health care, paid
work, and care work. Journal of Aging & Social Policy, 30(2), 129-147
45 Paraprofessional Healthcare Institute. (2020). Better Jobs Better Care: A Blueprint for Transforming the Long-
Term Care Workforce. Retrieved from https://phinational.org/wp-
content/uploads/2019/03/BetterJobsBetterCare.pdf
46 Paraprofessional Healthcare Institute. (2020). Better Jobs Better Care: A Blueprint for Transforming the Long-
Term Care Workforce. Retrieved from https://phinational.org/wp-
content/uploads/2019/03/BetterJobsBetterCare.pdf
47 Service Employees International Union. (n.d.). Homecare Quality

3. Advocacy for mental health resources:
Advocating for mental health resources is another important aspect of supporting the mental
health of homecare health aides. These workers face a high level of stress and burnout due to the
emotional demands of their job, as well as the challenging circumstances of their patients. 48 It is
critical to ensure that homecare health aides have access to the resources they need to cope with
the demands of their job and maintain their mental well-being.
Labour unions can advocate for mental health resources for homecare health aides by pushing for
policies that support mental health services and resources. This may include advocating for
mental health training for homecare health aides, as well as policies that provide access to mental
health care and counselling services. 49
In addition, unions can support the development of peer support networks and other resources
that help homecare health aides manage stress and prevent burnout. These resources may include
employee assistance programs, support groups, and access to counselling services. 50
Advocating for mental health resources can also help reduce the stigma associated with mental
health issues and promote a culture of openness and support within the homecare workforce.
This can help ensure that homecare health aides feel comfortable seeking the help they need to
maintain their mental health and well-being. 51
4. Collective action and support:
Collective action and support can also be critical in improving the pay and working conditions of
homecare health aides. Unions can organize collective actions, such as strikes or demonstrations,
to advocate for better pay and benefits for homecare health aides. 52

48 National Institute for Occupational Safety and Health. (2012). Occupational health issues among home
healthcare workers. Retrieved from https://www.cdc.gov/niosh/docs/2012-118/pdfs/2012-118.pdf
49 Service Employees International Union (SEIU). (2017). Recommendations for home care programs: Supporting
home care workers to strengthen quality care. Retrieved from
https://www.seiu.org/homecare/recommendations-for-home-care-programs
50 American Federation of State, County and Municipal Employees (AFSCME). (2020). AFSCME policy
recommendations for improving the quality of long-term care. Retrieved from
https://www.afscme.org/issues/long-term-care/policy-recommendations-for-improving-the-quality-of-long-term-
care
51 United Steelworkers (USW). (2020). USW policy on occupational health and safety. Retrieved from
https://www.usw.org/news/publications/usw-policy-on-occupational-health-and-safety
52 Service Employees International Union (SEIU). (2017). Recommendations for home care programs: Supporting
home care workers to strengthen quality care. Retrieved from
https://www.seiu.org/homecare/recommendations-for-home-care-programs

In addition to collective action, unions can provide individual support to homecare health aides
who face challenges in the workplace. This support can include legal assistance, advocacy, and
resources to help homecare health aides navigate the complex and often confusing health care
system. 53
Moreover, unions can provide homecare health aides with access to education and training
programs that can help them improve their skills and advance their careers. This can help
improve job satisfaction and reduce turnover among homecare health aides. 54
Finally, unions can support homecare health aides by providing them with access to information
and resources about their rights in the workplace. This can help ensure that homecare health
aides are informed about their legal rights and are able to advocate for themselves and their
colleagues in the workplace. 55
Collective action and support can be critical in improving the pay and working conditions of
homecare health aides. Unions can play an important role in advocating for the needs of these
workers and providing them with the resources and support they need to succeed in their jobs.
a. Rights of Healthcare workers
Homecare health aides, like all workers, have certain rights that are protected by law. Here are
some of the key rights that apply specifically to homecare health aides:
i. Right to a safe and healthy work environment: Homecare health aides have the right
to work in an environment that is free from recognized hazards that are likely to cause
death or serious physical harm. This includes hazards related to COVID-19, such as
exposure to infectious agents. The Occupational Safety and Health Administration
(OSHA) has issued guidance on protecting homecare workers during the pandemic,
which includes recommendations on the use of personal protective equipment (PPE)
and other measures to reduce the risk of exposure. Homecare health aides also have
the right to be trained on how to use PPE and other safety equipment. (Occupational

53 American Federation of State, County and Municipal Employees (AFSCME). (2020). AFSCME policy
recommendations for improving the quality of long-term care. Retrieved from
https://www.afscme.org/issues/long-term-care/policy-recommendations-for-improving-the-quality-of-long-term-
care
54 United Steelworkers (USW). (2020). USW policy on occupational health and safety. Retrieved from
https://www.usw.org/news/publications/usw-policy-on-occupational-health-and-safety
55 National Domestic Workers Alliance (NDWA). (n.d.). Know your rights. Retrieved from
https://www.domesticworkers.org/know-your-rights.

Safety and Health Act of 1970; OSHA Guidance on Protecting Home Health Care
Workers)
ii. Right to fair pay: Homecare health aides have the right to be paid at least the federal
minimum wage, which is currently $7.25 per hour. They are also entitled to overtime
pay at a rate of 1.5 times their regular rate of pay for any hours worked over 40 in a
workweek. In addition, some states and localities have their own minimum wage laws
that may provide higher pay rates for homecare health aides. (Fair Labor Standards
Act; state and local minimum wage laws)
iii. Right to breaks and rest periods: Homecare health aides may be entitled to breaks and
rest periods under state law. For example, some states require employers to provide
meal and rest breaks to employees who work a certain number of hours per day. In
addition, some homecare health aides may be entitled to sleep periods, depending on
the nature of their work. (State and local employment laws)
iv. Right to privacy and confidentiality: Homecare health aides have a legal and ethical
obligation to maintain the privacy and confidentiality of patient information. They
may be required to sign confidentiality agreements and to receive training on HIPAA
(Health Insurance Portability and Accountability Act) regulations, which govern the
privacy and security of protected health information. (HIPAA)
v. Right to freedom from discrimination: Homecare health aides are protected from
discrimination based on their race, color, national origin, sex, religion, age, or
disability, among other factors. This includes protection from harassment and
retaliation. Homecare health aides who believe they have been discriminated against
may file a complaint with the Equal Employment Opportunity Commission (EEOC),
which enforces federal anti-discrimination laws. (Title VII of the Civil Rights Act of
1964; Americans with Disabilities Act; Age Discrimination in Employment Act)
vi. Right to unionize: Homecare health aides have the right to join a union and engage in
collective bargaining to negotiate better pay and working conditions. In some states,
homecare health aides are classified as public employees and are covered by state
labor laws that provide collective bargaining rights. In other states, homecare health
aides may be covered by federal labor laws. (National Labor Relations Act; state
labor laws)
b. Role of unions in legislated Protections.

The role of unions in advocating for legislated protections for homecare health aides includes:
i. Advocating for minimum wage and overtime protections: As mentioned earlier, the
Fair Labor Standards Act (FLSA) establishes minimum wage and overtime pay
requirements for most workers in the United States, including homecare health aides.
However, these protections did not originally apply to homecare workers employed
by third-party agencies. Unions, along with advocacy groups, played a critical role in
pushing for the extension of FLSA protections to these workers, which was ultimately
achieved in 2015.
ii. Pushing for paid sick leave and other benefits: Homecare health aides often work
without access to basic benefits like paid sick leave, health insurance, and retirement
plans. Unions can advocate for these benefits through collective bargaining and
lobbying efforts, as well as through legislative action. For example, the 1199SEIU
United Healthcare Workers East union played a key role in pushing for the passage of
New York State’s paid sick leave law, which provides homecare health aides and
other workers with up to 40 hours of paid sick leave per year.
iii. Advocating for training and support for homecare health aides: Unions can also
advocate for regulations and policies that require homecare agencies to provide
adequate training and support to their workers. For example, the SEIU has called for
the creation of a national training and certification program for homecare workers,
which would ensure that workers receive standardized training and support that is
tailored to the needs of homecare patients.
iv. Working to improve the overall quality of homecare services: Unions can also work
to improve the quality of homecare services by advocating for policies that increase
funding for these services, improve staffing ratios, and promote the use of evidence-
based care practices. For example, the SEIU has called for increased federal funding
for Medicaid home and community-based services, which would allow states to
provide better wages and benefits to homecare workers, and ensure that patients
receive high-quality care.

Unions can play a critical role in advocating for legislated protections for homecare health aides.
By pushing for minimum wage and overtime protections, advocating for benefits like paid sick

leave and health insurance, promoting training and support for workers, and working to improve
the overall quality of homecare services, unions can help ensure that homecare health aides are
able to provide the highest level of care to their patients, while also receiving the fair wages and
benefits they deserve.
c. Policy Recommendations.
Policy recommendations to improve the protections and rights of healthcare workers during and
beyond the COVID-19 pandemic:
1. Implement a national paid sick leave policy: Homecare health aides often do not have
access to paid sick leave, which can lead to them working while sick and potentially
spreading illnesses to their patients. A national paid sick leave policy could help address
this issue and ensure that homecare health aides can take time off when they are sick
without fear of losing pay.
2. Increase funding for Medicaid home and community-based services: Medicaid provides
funding for many homecare services, but the funding levels are often insufficient to
provide workers with fair wages and benefits. Increasing funding for these services
would allow states to provide better pay and benefits for homecare health aides, which
could help reduce turnover and improve the quality of care.
3. Expand collective bargaining rights for homecare workers: Many homecare health aides
work for third-party agencies and do not have the right to collectively bargain for better
wages and benefits. Expanding these rights could help ensure that workers are able to
negotiate for better pay and benefits and improve their working conditions.
4. Establish a national training and certification program for homecare workers: Homecare
health aides often receive little to no training for their jobs, which can result in subpar
care for patients. Establishing a national training and certification program would help
ensure that all workers receive the training they need to provide high-quality care.
5. Strengthen enforcement of labor laws and regulations: Despite the protections afforded to
homecare health aides under federal law, many employers violate these laws with little to
no consequence. Strengthening enforcement of these laws and regulations could help
ensure that employers are held accountable for providing workers with the protections
they are entitled to under the law.

These policy recommendations, if implemented, could help improve the working conditions and
protections for homecare health aides, which could lead to better care for patients and a more
stable and professional workforce.
II. Conclusion:
In conclusion, the COVID-19 pandemic has had significant impacts on the mental and physical
health of healthcare workers, particularly those who are low-wage earners such as home health
aides and housekeepers. The pandemic has brought to light the importance of ensuring the safety
and well-being of these essential workers who have been on the front lines of the fight against
the virus.
As the pandemic continues, it is imperative that policies are put in place to support the physical
and mental health of healthcare workers, including those who are low-wage earners. Labor
unions have proposed several policies that can be implemented to address the challenges faced
by these workers. These policies include providing personal protective equipment (PPE),
ensuring safe working conditions, offering hazard pay, and providing access to mental health
services.
One of the main challenges faced by low-wage healthcare workers is the lack of access to PPE.
Labor unions have proposed that employers should be required to provide adequate PPE to all
healthcare workers, regardless of their job title or level of seniority. This will help to ensure that
all healthcare workers are protected against the virus and can perform their duties safely.
Another important policy proposal is to ensure safe working conditions for healthcare workers.
This includes implementing measures such as regular cleaning and disinfection of workspaces,
promoting social distancing, and providing training on infection control practices. Such measures
can help to reduce the risk of exposure to COVID-19 and other infectious diseases, thereby
protecting the health of healthcare workers.
Hazard pay is another policy proposal that can help to support low-wage healthcare workers
during the pandemic. This involves providing additional compensation to workers who are at
higher risk of exposure to the virus, such as those who work in COVID-19 wards or long-term
care facilities. This additional compensation recognizes the risks and challenges faced by these
workers and can help to support them during these challenging times.

Finally, access to mental health services is crucial for healthcare workers, particularly during the
pandemic. Labor unions have proposed that employers should provide access to mental health
services to all healthcare workers, including low-wage workers such as home health aides and
housekeepers. This can include access to counseling services, support groups, and other
resources that can help healthcare workers cope with the stress and anxiety of working during a
pandemic.
In conclusion, the COVID-19 pandemic has highlighted the importance of ensuring the safety
and well-being of healthcare workers, particularly those who are low-wage earners such as home
health aides and housekeepers. Labor unions have proposed several policies that can help to
address the challenges faced by these workers, including providing PPE, ensuring safe working
conditions, offering hazard pay, and providing access to mental health services. It is important
that these policies are implemented to support the physical and mental health of healthcare
workers during these challenging times.

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COVID19 IMPACTS ON THE MENTAL AND PHYSICAL HEALTH OF
HEALTHCARE WORKERS: POLICIES THAT LABOR UNIONS PROPOSE TO

HELP HEALTHCARE LOW WAGE WORKERS

Unions can play a critical role in advocating for legislated protections for homecare health aides.
By pushing for minimum wage and overtime protections, advocating for benefits like paid sick

References

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