Telehealth has stolen the spotlight as the new way to deliver patient care following the overnight disruption of COVID-19.
While the CMS and providers have encouraged broader use of telehealth tools to maintain regular visits and contain spread of the virus, many beneficiaries use another favorite handoff in the continuum of care—home health.
Providers have sent COVID-19 patients home when they don’t need intensive care. Remote monitoring and other innovations allow healthcare workers to minimize exposure and to potentially lower the cost of treatment. This option precedes the pandemic. Providers and insurers for years have been searching for ways to avoid costly settings.
Home healthcare has faced a challenge though: inadequate staffing. Low wages and unforgiving work have dissuaded new workers from entering an occupation that faces increased demand because of a booming elderly population.
Now the backbone of the sector faces another challenge: President Donald Trump’s assault on those who make up a significant portion of the workforce. Last week, Trump announced he would ban immigration into the U.S. and suspend green-card applications. Over the course of several days, that threat was walked back to a 60-day suspension, and ultimately he said it wouldn’t apply to the healthcare workforce. Still visa and green-card applications have slowed in recent years.
Politico reported that from Oct. 1, 2018 and July 29, 2019, the State Department issued 12,179 visa rejections. That’s up from 1,033 rejections in fiscal 2016, the last year under former President Barack Obama.
Almost 9% of those home healthcare workers are not citizens. These workers don’t have glamorous jobs, and it’s unlikely they’ll be labeled as heroes by anyone other than those they care for. Their clients depend on them to bathe, get dressed, eat, keep up with their medications and clean their homes.
During the pandemic, many of those have also put themselves at extreme risk. The Kaiser Family Foundation last week reported that 53% of all long-term care workers are personal-care workers who come in close contact with patients.
It shouldn’t come as a surprise that there will be 8.2 million job openings in home care through 2028. These workers are paid, on average, $10 an hour. First-year turnover can exceed 80%.
And if the economic burden of caring for our elderly loved ones on low pay isn’t enough, many of these home health aides face another insidious burden: xenophobia.
Of the 4.5 million direct-care workers employed in the U.S. in 2018, about 1 in 4 was an immigrant. Almost 9% of those home healthcare workers are not citizens. Those people have faced increased uncertainty about living in the U.S. during the Trump administration.
Last week’s executive order was just the latest missive in Trump’s fight against immigration. The Supreme Court has yet to rule on the lawfulness of Trump’s decision last year to end the Deferred Action for Childhood Arrivals program, which previously allowed undocumented immigrants who came to the U.S. as children to legally avoid deportation.
The impact of that move elicited an op-ed early during the COVID-19 outbreak from several general counsels in large health systems. They pleaded for the estimated 29,000 front-line medical workers at risk of being deported while working to save lives in COVID-19 hot spots.
The impact of Trump pausing immigration could affect more than the permanent residents and noncitizens in the home health space.
It doesn’t matter that immigration to the U.S. is ostensibly shut down while the globe cowers amid the ferocity of this modern plague. What matters is the message being sent during a time of immense fear and division.
Those healthcare workers may see this as an added reason to bail on this occupation. And who will lose out? The providers that had been depending on them as linchpins in caring for the patient as a whole.