Being the First Person in Your Family Working in the Healthcare Field Essay

Contents:

• Introduction
• Underpaid, undervalued, and essential
• A policy agenda for essential, low-wage wellness workers:
• Proceed all health workers safe
• Innovate chance pay
• Enhance pay to a permanent living wage
• Expand paid exit
• Give workers the respect they deserve

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Introduction

The COVID-nineteen pandemic has inspired an outpouring of public appreciation for the country's frontline heroes, from television ads to firefighter salutes to essential worker toys. Just while doctors and nurses deserve our praise, they are not the only ones risking their lives during the pandemic—in fact, they represent less than 20% of all essential wellness workers.

Too often, we overlook the heroism and nobility of millions of low-paid, undervalued, and essential wellness workers like Sabrina Hopps, a 46-twelvemonth-old housekeeping aide in an acute nursing facility in Washington, D.C.

"If we don't clean the rooms correctly, the pandemic will go worse," said Hopps. She cares securely about the patients she works with, and knows that the value of her job goes well across cleaning. "It's me and the other housekeepers who sit and talk with [patients] to burnish up their day, because they tin can't have family members visiting."

Despite her contributions, she doesn't experience recognized. "Housekeeping has never been respected," she told me recently. "When you recall about health care work, the first people you lot think about are the doctors and the nurses. They don't think well-nigh housekeeping, maintenance, dietary, nursing assistants, patient care techs, and administration."

Hopps is one of millions of low-wage essential health workers on the COVID-xix front lines. Like the college-paid doctors and nurses they work alongside, these essential workers are risking their lives during the pandemic—but with far less prestige and recognition, very low pay, and less access to the protective equipment that could save their lives. They are nursing administration, phlebotomists, domicile health aides, housekeepers, medical assistants, cooks, and more. The vast majority of these workers are women, and they are disproportionately people of colour. Median pay is just $13.48 an hour.

Over the last several weeks, I interviewed nigh a dozen low-wage health workers on the front lines of COVID-nineteen. (Yous tin can read their stories hither.) Despite beingness declared "essential," the workers I interviewed described feeling disregarded and deprioritized, fifty-fifty expendable. They spoke with pride about their work, merely few felt respected, even equally they put their lives on the line. Many expressed frustration—and sometimes anger—over their lack of life-saving protective equipment.

It is long past time that these workers are treated as truly essential. This starts with simply recognizing the value of workers like Hopps—but we tin can and must practise more. The policy recommendations in this report aim to keep these workers prophylactic on the job, compensate them with a living wage, support them if they fall sick, and give them the respect and appreciation they deserve.

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Underpaid, undervalued, and essential

The underpaid but essential health intendance workforce in America comprises virtually 7 million people in low-paid health jobs in these three categories:

• Health care support workers help wellness care providers such as doctors and nurses in providing patient care. Roles include orderlies, medical assistants, phlebotomists, and pharmacy aides.
• Direct care workers such equally dwelling house wellness workers, nursing assistants, and personal care aides provide care to individuals with physical, cognitive, or other needs.
• Health care service workers include housekeepers, janitors, and food grooming and serving workers employed in health care settings such as hospitals and nursing homes.

More people are employed in health care back up, service, and direct care jobs than in all wellness intendance practitioner and technician jobs (doctors, nurses, EMTs, lab technicians, etc.). In fact, more people piece of work in hospitals as housekeepers and janitors—like Sabrina Hopps—than every bit physicians and surgeons. The size of this depression-wage wellness workforce exceeds the size of most other occupational groups of essential workers. It employs more than people than the entire transportation and warehousing manufacture and more than than twice as many people equally the grocery industry.

Median wages in health care support, service, and direct care jobs were just $13.48 an hour in 2019—well short of a living wage and far lower than the median pay of doctors (over $100 per hr) and nurses ($35.17 per hour). Dwelling health and personal care workers earn even less, with a median hourly wage of merely $11.57. The wages are so depression that well-nigh 20% of care workers live in poverty and more than than xl% rely on some form of public assistance. These fields are some of the fastest-growing of all occupations, with more a million new jobs projected past 2028.

Table ane. Demographic contour of workers in the health care and social assistance industry, 2019

Occupation	Number of workers	Median hourly wage	% Women	% African American	% Latino or Hispanic
All health care support, directly care, and service workers	six,964,410	$13.48	81%	25%	21%
Registered nurses	2,604,000	$35.17	89%	12%	seven%
Physicians and surgeons	562,440	>$100	41%	8%	8%

Source: Brookings analysis of U.S. Bureau of Labor Statistics' Occupational Employment Statistics and the U.Due south. Census Bureau's Electric current Population Survey.

Over eighty% of health care support, service, and direct intendance workers are women. They are likewise unduly people of color. Similar other low-wage jobs where women and people of colour are full-bodied, many of these positions are plagued by underinvestment and a lack of benefits. Now, these jobs pose an even greater risk to workers' lives.

Despite being undervalued, low-wage health workers make essential contributions during the pandemic and beyond. "Nobody is insignificant," said Tony Powell, a 62-yr-sometime administrative coordinator of a infirmary surgical unit of measurement in Washington, D.C. "Without ecology service, without dietary, without secretaries, without medical and surgical techs and certified nursing administration (CNAs), it wouldn't be a infirmary." Home health workers, for example, provide the commencement line of defense against COVID-19 for millions of elderly and vulnerable people living at home. Without that, the limited chapters of hospitals today would exist stretched fifty-fifty further.

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A policy agenda for essential, depression-wage health workers

Policymakers, employers, and the full general public should each do their function for low-wage essential health workers during COVID-19 and across. The following policy recommendations are aimed at keeping these workers safe on the task, compensating them with a living wage, supporting them if they fall ill, and giving them the respect and appreciation they deserve.

Go on all health workers safety

A outset-order priority for policymakers and employers should be keeping frontline wellness workers safe on the task. Dire shortages of life-saving personal protective equipment (PPE) such every bit surgical masks, N95 respirators, isolation gowns, gloves, and face shields are jeopardizing workers' lives. One poll showed that ii-thirds of health care workers reported bereft face masks equally recently as early May. Frustrated nurses and doctors accept made urgent appeals to the federal authorities to activate the Defense Production Human activity to mobilize production of needed supplies.

While virtually news coverage highlights only the risks to nurses and doctors, PPE shortages are too a matter of life and decease for millions of health care support, service, and straight care workers on the COVID-19 front end line. These workers are at a lower priority for the already-insufficient supplies, meaning that hospitals and health care facilities sometimes overlook their safe as they ration PPE and prioritize vulnerable clinical staff who care for infectious patients.

The workers I interviewed expressed a range of emotions—from fright to frustration to anger—over their lack of access to PPE. David Saucedo, a 52-year-old cook at a Baltimore nursing dwelling, said his supervisors initially denied his requests for PPE.

"Just because I am not a nurse or nursing assistant doesn't mean I don't come in contact with patients," Saucedo told me. "Every footstep a nurse, nursing banana, or physician takes in that facility, I actually walk right behind them." His Alzheimer's patients, he noted, practice not understand social distancing: "They just come up to you, grab you lot, and sit and talk to you."

Saucedo had to argue his case to two supervisors before he was finally given the PPE that nurses in his facilities automatically access. "It's like they prioritized them and forgot about everyone else," he told me. "It makes me feel like I am secondary, non equal. You are expendable, in a way."

Andrea (who preferred we just use her get-go name), a 29-twelvemonth-onetime housekeeping aide in a hospital operating room and mother of two immature children, had a similar experience. Afterwards a patient in a room she was responsible for cleaning was suspected of having the coronavirus, Andrea asked her charge nurse to be fit-tested for an N95 mask. Andrea said the nurse's response was, "No, these are for special people."

"One minute you are important enough," she told me. "The next infinitesimal it is like, no you aren't that important to get the proper equipment, just you lot are of import plenty to clean it for the next patient."

Abode care workers face additional hurdles to accessing PPE. Their employers are much lower in priority for state and federal PPE supplies than hospitals, nursing homes, and emergency services, leaving many agencies struggling to procure equipment on their own and pay for its skyrocketing costs on the private market. A contempo survey found more than 75% of home care agencies face shortages of masks and sanitizer.

Like others in her field, Elizabeth Nifty, a 49-year-one-time home wellness adjutant in Virginia, received no PPE, COVID-19 preparation, or supplies from her employer. She described driving to towns beyond Virginia and West Virginia in search of her own equipment. Yvette Beatty, a 60-year-erstwhile dwelling house health aide in Philadelphia, said her employer was unable to access PPE despite concerted efforts.

"I would love to come across u.s.a. accept hazard masks, instead of putting cloths over our face, or going to the Dollar Store and buying dollar masks," Beatty told me. "Nosotros need equipment. They need to give equipment to agencies. We are running around with cloths, no protective gear. We need the exact same thing as everyone else."

» Policy recommendations to keep workers prophylactic:

• The federal government should fully utilize the Defense Product Act to mobilize manufacturers across the country to increase the supply of PPE. Until every health intendance worker has sufficient access to PPE, their lives are at risk.
• Land governments should encourage companies to increase PPE supplies and help abode health agencies access supplies and finance costs. They can follow the lead of Washington state, which recently added home health workers and other long-term care providers to the height tier of priority for PPE.
• Home care agencies should increment training, information, and resource to frontline workers, so home care workers practise non feel like they are navigating a pandemic on their own.

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Innovate take a chance pay

The extremely low pay that health care back up, service, and directly intendance workers earn has long been woefully inadequate. During a pandemic, it is morally reprehensible. Congress should enact risk pay to ensure that no worker risking his or her life during this crisis is paid less than a family-sustaining wage.

For workers in wellness jobs, federal funding for hazard pay is especially important. Hospital finances have been hit hard by the pandemic. Home care agencies are limited in their ability to heighten pay due to Medicaid reimbursement rates, a major systemic impediment to improving job quality for millions of intendance workers. Hazard pay for health workers has lagged behind temporary pay increases for workers in sectors such as retail and grocery.

Lawmakers on both sides of the aisle take offered proposals for federally funded take a chance pay. In April, President Donald Trump signaled his back up for extra compensation to doctors, nurses, and health workers. On May xv, the House of Representatives passed the HEROES Deed, which included $200 billion for take chances pay for essential workers. Despite this momentum, U.Southward. lawmakers have non passed risk pay into law. In Canada, nonetheless, Prime number Minister Justin Trudeau appear a $4 billion delivery to increase pay for essential workers. He singled out low-paid essential workers as a priority, saying that minimum-wage workers risking their wellness during the pandemic deserve a raise.

The workers I interviewed expressed a strong want for gamble pay. David Saucedo likened the hazards of his job as a nursing home cook to the risks he faced during his military service: "When I was in the Navy, when we went to state of war, I was getting paid chancy duty pay. To me, it is a hazardous task right at present. We should be getting paid hazardous pay." Saucedo noted that boosted compensation could be life-saving, affording his colleagues the chance to take a taxi instead of risking exposure to COVID-19 on public transit. "Everybody is contagious on buses," he said. "The all-time thing you tin do is limit their amount of exposure for a cook or anyone else."

Housekeeping aide Sabrina Hopps agreed that additional compensation could exist life-saving. "If pay was better, I would be able to alive on my own and and then could my children," she told me. "What I make, it is non plenty. Then, I am forced to share an apartment with my son and daughter and my granddaughter. Going back and forth to work, I am jeopardizing their lives." Hopps is especially concerned for her son, who has asthma and is a cancer survivor. Her employer recently introduced a new bonus for employees providing direct patient care, but excluded housekeepers and other depression-paid service workers from the boosted compensation.

» Policy recommendations for introducing hazard pay:

• Congress should pass federally mandated hazard pay for at-take a chance essential workers in the side by side pandemic relief pecker, with a priority for lower-paid workers. Risk pay should double the wages of low-wage workers. In the HEROES Act legislation, Business firm Democrats included $200 billion for take chances pay through a "Heroes Fund" that would administer grants to employers of essential workers. Their proposed rate of an boosted $13 per hour is roughly equivalent to the median wage of wellness intendance support, service, and straight care workers.

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Enhance pay to a permanent living wage

COVID-nineteen has laid bare the wide gap betwixt the value that health care support, service, and direct care workers bring to society and the extremely low wages they earn in return. Brusque-term fixes such as chance pay are urgently needed. But policymakers and employers should also make lasting changes and then that these essential workers finally earn a permanent living wage.

Hospital administrative coordinator Tony Powell explained why wage increases are so disquisitional for depression-paid wellness workers: "They have to realize that these people, only like any other people—doctors, nurses, whoever—they have families. They have to enhance their families, besides. If y'all are working just at the poverty level, that is giving you enough to get to work, get lunch, and attempt to send your kids to school. But without a living wage, it'south non going to hateful annihilation."

Pauline Moffitt, a 50-year-old straight intendance worker in Philadelphia, is barely surviving on the poverty wages she earns caring for immunocompromised and elderly residents. At $9 an hour, her pay is so low that Moffitt and her recently laid-off husband cannot brand ends meet, even as she commutes nearly three hours each way on 5 motorbus and train transfers. "It is a struggle," she told me. "I take to pay a lot of bills. What am I supposed to practise? I pray ever: Lord, please stretch my pay. Delight."

Pennsylvania, where Moffitt works, is one of the 21 states that has not mandated a minimum wage above the federal rate of $7.25 per hour. She wants to see permanent pay increases. "I just wish they would raise it and give us a little more," she said. "Not just for me, simply all the other home health aides that are in the same situation."

» Policy recommendations for permanently boosting pay:

• The federal regime and state and local governments should raise the minimum wage to at to the lowest degree $15 per hour.
• Land governments and the federal government should increment Medicaid funding to allow employers of home care workers to provide a living wage and offering benefits.

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Expand paid go out

While workers of all incomes are vulnerable to COVID-19, low-wage workers have the to the lowest degree admission to paid exit if they fall ill. In 2019, less than a third of workers in the bottom 10% of income earnings had access to paid sick leave, compared to nine out of 10 higher-paid workers in the meridian quarter of income earnings. The gaps for essential workers like home wellness aides are particularly large—a 2017 survey of 3,000 abode care workers found that less than one in v intendance workers had admission to paid leave.

"We don't get any benefits," said Elizabeth Peachy, a 49-yr-old domicile health aide who earns $9 an hour. The funding for her work caring for geriatric patients comes through the country of Virginia, only she is non employed directly past the land. "They accept united states of america work as independent contractors," she told me. "And that mode, we get no ill go out, no overtime, no benefits at all. This is pretty standard."

Peachy thinks policymakers should make changes: "In reality, it is a lot cheaper to pay u.s.a. a little more money, give us some benefits, and allow us to have care of those patients, continue those patients from being in an ER or a nursing home, and help them have a good quality of life in their own home."

Depression-wage health workers without paid leave are in an incommunicable position. They face some of the highest risks of exposure to COVID-19, but have little or no ability to stay home to treat themselves or their loved ones. The public health stakes during a pandemic are loftier—rushing dorsum to their jobs earlier they are fully recovered jeopardizes workers' well-being and risks spreading the coronavirus to patients and colleagues. "The problem is y'all are going to have some workers who are still going to go to work," said Smashing. "And they shouldn't, because they may be ill and they may get the person ill. It would exist amend to take paid sick days because we need these workers to get into homes and take care of the thousands of loftier-chance people."

The Families First Coronavirus Response Human action took steps to temporarily address this disparity and aggrandize paid sick get out and family and medical leave to workers during the pandemic. However, 2 gaps in the legislation undermine these benefits for depression-wage health workers. First, the legislation but applies to employers with less than 500 employees, which could exclude upwards of half of all workers. It likewise stipulates that employers may exempt "health intendance providers," broadly defined past the Department of Labor to include workers across health care institutions and domicile care settings.

» Policy recommendations for expanding paid sick leave:

• In the adjacent pandemic relief nib, Congress should revoke exemptions for large employers and expand access to temporary paid sick leave and family and medical exit to all workers. The HEROES Human activity, passed on May 15, removes the employer size exemption as well every bit the health care provider exemptions.
• Land governments and the federal government should increment Medicaid funding to allow employers of home care workers to offer benefits such as paid exit, alongside a living wage.

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Give workers the respect they deserve

Long before COVID-19, 53-year-sometime Yolanda Ross felt her work as a abode health worker outside Richmond, Va. was not respected. She told me that low-wage wellness workers like her are "underpaid, disregarded and forgotten about, but nevertheless depended upon," while others on the front end line who are deemed "important" are valued differently.

Ross's experience is reflected in the information. Brookings'south Richard V. Reeves (who is writing about the importance of respect more generally) and Hannah Van Drie recently analyzed information on the perceived social continuing of essential jobs. They found a staggering gap between the loftier prestige of doctors and nurses and the depression prestige of lesser-paid but essential hospital workers, including housekeepers.

In interviews, these workers shared stories that bring to life the lack of respect they experience. Several wondered why low-wage essential workers are never included in Television set commercials that applaud doctors and nurses. ICU worker Andrea told me her accuse nurse calls her "housekeeping" and still hasn't bothered to learn Andrea'southward name despite working together for seven years. Ditanya Rosebud, a 46-twelvemonth-one-time melt and hostess at a Baltimore nursing home said her employer responds to her sacrifices by merely telling her, "This is what you signed up for."

Rosebud and her colleagues are working extra shifts and risking their family's lives during the pandemic. "We are simply another body," she explained. "That's it. No more, no less."

Workers too shared stories of life-saving PPE being reserved for "of import people," wages that do not even embrace fifty-fifty basic expenses, hazard pay that is given simply to clinical colleagues, and a lack of appreciation for workers' sacrifices. "People are not looking at people like us on the lower end of the spectrum," said hospital administrative coordinator Tony Powell. "We're not even getting respect. That is the biggest thing: Nosotros are non even getting respect."

The COVID-19 pandemic has already upended then many aspects of order, the economic system, and our lives. Yolanda Ross hopes that information technology will also upend our long-standing notions of who deserves to be valued. "I pray there is a redirection," she said. "That we finish doing things the aforementioned old way and listen to those who don't have a real phonation."

» Recommendations for giving workers respect:

• Government and other civic leaders can exercise more to recognize the contributions of depression-wage workers and requite their work public visibility. A collaboration betwixt city leaders in New York and workforce partners around the social media try #ValueDirectCareWorkers is an example.
• The general public can do more to include lower-wage workers in their recognition of essential workers, including actions such every bit meal donations to hospitals, public demonstrations of thanks and support, and social media letters.
• The media should address the imbalance in coverage of workers, and publish stories, perspectives, and images of lower-wage health workers on the COVID-19 front line.
• Employers should provide low-wage health workers with respect, appreciation, more than equitable pay and support, and opportunities for training, advancement, and better chore quality.

It is long past fourth dimension that low-wage workers who are essential to our social club are treated with nobility. Employers, colleagues, policymakers, and the full general public take their parts to play in finally giving these workers the respect they take always deserved. "It can change," Yolanda Ross reminded me. "There is hope."

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Policy recommendations overview

Click here to download a shareable version of this table.

Prioritize all workers' condom:

The federal regime should fully employ the Defense Product Act to increase supply of personal protective equipment (PPE).

Country governments should encourage companies to increase PPE supplies and assist home health agencies access supplies and finance their costs.

Employers should provide more COVID-19 training on safety and infection command, too as ongoing back up to workers.

Pay workers a living wage:

Congress should pass federally mandated hazard pay for at-hazard essential workers, including health care support, straight care, and service workers.

Land and local governments likewise every bit the federal government should increase the minimum wage so workers earn a living wage.

Land governments and the federal government should increase Medicaid funding to allow for higher wages and benefits for home care workers.

Expand paid sick get out:

Congress should plug the holes in the earlier legislation that denied health care workers access to paid leave.

Requite workers the respect and appreciation they deserve:

Policymakers, employers, and the public should give workers greater recognition, respect, and appreciation.

The media should characteristic the stories of low-wage essential workers and the challenges they face.

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These interviews were conducted between April 1, 2020 and April 28, 2020. Participants have provided permission to Brookings to use their names, likenesses, job titles, location and transcribed words.

We are enormously grateful to Tony Powell, Andrea, Yvette Beatty, David Saucedo, Sabrina Hopps, Elizabeth Peachy, Pauline Moffitt, Ditanya Rosebud, and Yolanda Ross for sharing their stories. We thank and each and every worker on the front end lines for the sacrifices they are making.

Thank you to PHI, SEIU, SEIU Local 1199, Angelina Drake, Tatia Cooper, Yvonne Slosarski, Leslie Frane, and LaNoral Thomas for their collaboration with the worker interviews. Thank you to Richard V. Reeves, Angelina Drake, Tiffany Ford, Ai-jen Poo, Greg Larson, Alan Berube, Morgan Welch, Claudia Balog, and Vicki Shabo for substantive comments and thoughtful input.

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Source: https://www.brookings.edu/research/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/

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