Sharnette Morris spends her workdays in other people’s homes, caring for the elderly and those with disabilities.
Morris works as an aide for three home care agencies but said none have provided her with personal protective equipment during the coronavirus pandemic. The Baltimore resident estimates she’s spent about $100 of her own money on supplies such as gloves, cloth masks and hand sanitizer.
She makes between $11 and $12 an hour, depending on the job.
Morris, 48, worries about the virus, but not reporting to work isn’t an option for her: “This is the kind of job, if you don’t come to work, you don’t get paid."
Labor and disability advocates are urging Republican Gov. Larry Hogan’s administration to protect low-wage home aides like Morris and the medically vulnerable people in their care, saying they’ve been overlooked in the pandemic and will be at risk if the state faces another wave of infections.
"A lot of these workers are going right from one person’s house to another person’s house and doing so by public transit,” said David Rodwin, an attorney with the Public Justice Center in Baltimore who has represented home care workers. “Because these workers are spread out and not at any one location, they’re less visible and not at the forefront of anyone’s minds.”
The Maryland Department of Health does not separately track or require reporting of COVID-19 among home care aides, state officials said.
Advocates want the state health department to require home care agencies to provide workers with gloves, masks and hand sanitizer, as well as training related to the pandemic. Home care workers come into close contact with their clients, helping them with bathing, grooming, cooking, laundry and other tasks.
Dawn Seek, who directs the Maryland-National Capital Homecare Association, a trade group, said a shortage of PPE was a significant problem for agencies when the pandemic hit. Agencies faced long waits for orders. Now, supplies are becoming more available, but costs are skyrocketing — particularly for masks, she said.
She said agencies are working hard to secure PPE but still face difficulty getting certain items, such as protective gowns.
“Everybody wants to provide it,” she said. “It’s just a matter of being able to get their hands on it."
Seek said her organization has been coordinating with vendors to distribute information about PPE supply availability. Some companies also have been working with county governments to obtain protective equipment.
In letters to the Hogan administration, a coalition of organizations, including labor groups and the Greater Maryland Chapter Alzheimer’s Association, has highlighted concerns over PPE and training for home care aides.
They also urged the state to increase wages for these workers using Medicaid funds.
In Maryland, the median annual income for home care workers is just over $20,000, according to a 2018 report by PHI, a research and advocacy organization focused on direct care workers. Nearly 90% of home care workers in the state are women, and more than 60% are black.
More than 30,000 home care workers work in Maryland, Rodwin said.
"They should not have to spend their low wages on lifesaving PPE,” he wrote in a letter to state Health Secretary Robert R. Neall.
Swizette Anderson, 37, of Baltimore, who works for two home care companies, said that one gave her two masks about a month ago. The other hasn’t provided any. She has bought her own supplies.
Advocates say these workers make it possible for many people with disabilities live independently.
“Our concern is that there isn’t a lot of protecting of these folks going on,” said Mike Bullis, executive director of the IMAGE Center for People with Disabilities. “There’s a lot of fear out there.”
Asked for comment, officials with the state health department referred to a letter Neall sent to advocates in April. The letter cited a state directive addressing PPE requirements for nursing homes.
But Rodwin said that directive does not apply to home care agencies.
More than 1,300 agencies are licensed in Maryland to provide home care services. Rodwin contends that the state has a responsibility to require agencies to protect workers, particularly because it licenses the agencies and allows them to receive state Medicaid funds.
Many home care workers are classified as independent contractors. The trade group’s Seek said that agencies typically do not provide supplies to such workers as they are considered to be in business for themselves, rather than employees.
Rodwin said home care workers are frequently misclassified as independent contractors. He said that to protect public health, the state should set testing protocols and PPE requirements for all home care agencies, regardless of how their workers are classified.
Morris, one of the Baltimore home care workers, said she is considered an employee of two agencies she works for and an independent contractor at another — but none have provided her supplies. She did not want to name her employers.
The issue has drawn concern from state Sen. Clarence Lam, a Democrat representing a district that includes parts of Baltimore and Howard counties. Lam, a Johns Hopkins physician, called home aides “integral to the health care system.”
“Home health aides really allow folks to be discharged from health care facilities as soon as possible to recover at home,” thus keeping them out of group settings where the risk of exposure is higher, Lam said.
In May, Lam wrote to Neall, asking for the state to take a variety of steps, including requiring home care agencies to provide PPE and making home health workers a priority in the state’s testing strategy.
“Home health care patients are a medically vulnerable population and without proper consideration, the state is risking increased COVID-19 outbreaks,” Lam wrote.
In a response to Lam, Neall wrote that when it comes to testing, the state’s current priorities “are to expand COVID-19 testing to all nursing homes and to focus on the Eastern Shore poultry industry COVID-19 outbreak."
Hospitals and long-term care facilities have been given the highest priority for PPE, Neall wrote. Home care agencies having difficulty getting it should “attempt to purchase it through their normal channels” or try the Maryland Manufacturing Network, a state portal that connects buyers with manufacturers of PPE, he wrote.
In a statement to The Sun, state health department spokesman Charlie Gischlar said aides who are developing symptoms or think they’ve been exposed “should visit one of the appointment-free testing sites in the state or obtain a doctor’s order for a test at any of the multiple locations in Maryland."
Aides may face PPE requirements in settings such as retirement communities. At Erickson Living facilities, which include Oak Crest in Parkville and Charlestown in Catonsville, licensed caregivers hired by residents must have appropriate PPE upon arrival or the community will provide it, a spokesman said. They are screened at the gate and must wear masks the whole time.
Lam said if home care workers don’t feel safe, the state could face a workforce shortage.
“That could potentially lead to more people residing in health care facilities, where the risk of exposure is higher,” Lam said.