This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Throughout the COVID-19 pandemic, Michigan’s direct care workers have continued treating, feeding, bathing, and dressing elders and others who cannot care for themselves. For these essential workers, social distancing is impossible – and personal protective equipment (PPE) is both indispensable and alarmingly difficult to obtain.

A key barrier for these workers is cost. The average wage for direct care workers in Michigan is $9.58 an hour. Even with the state's additional $2.24 an hour pandemic hazard pay for those caring for Medicaid patients, many of these frontline providers cannot afford to purchase their own PPE.

Mother and daughter Katrina Jones and Janay Clark have experienced these challenges firsthand. Jones opened Simply a Loving Touch Homecare Services in Wyoming, Mich., after years of caring for her own grandmother. When the pandemic first shut Michigan down, she, like many of the state’s direct care workers, had difficulty obtaining the PPE she needed to keep herself and her staff safe.

"Back in March, when we were so stressed, I was thinking, ‘I am going to have to close my doors because I need masks but can’t find any,’" Jones says. "Then I am told, ‘You can’t shut your doors. You are an essential worker.’ I thought, ‘What can I do? What is the plan of action here?’"

Katrina Jones.

In March, a chance referral from a friend alerted Jones to the Kent County Small Business Recovery Program, which helped Jones acquire PPE. However, she says she's unsure if she ever would have gotten the PPE her business needed if not for that friend.

"That is part of the difficulty," Jones says. "It seems like people have to have a connection."

Additional relief came in June, when the state of Michigan provided PPE to Simply a Loving Touch because the business takes clients with Michigan Medicaid. Simply a Loving Touch received masks, hand sanitizer, gowns, face shields, gloves, and foot covers. When it comes to PPE, Jenee Tyus, executive director of the Michigan Community Health Worker Alliance (MiCHWA), says direct care workers need "everything."

"Our governor and our state is really trying to be supportive," she says. "They recognize the shortages that the state has experienced and continue to make sure folks get what they need."

PPE at Simply a Loving Touch Homecare Services.

With that additional support from the state, Jones, Clark, and the home health aides working for their company have been able to obtain the additional PPE they needed. However, Jones has concerns as Kent County’s COVID-19 numbers have begun to skyrocket again.

"There needs to be a process. It’s like life in general. We can be very responsive once a fire is already exploding," Tyus says. "In the future, we need to be preparing to stockpile all of this stuff, connecting with people who can create and mass-deliver them to an operations center that manages and oversees use and allocation. What’s important is to figure out a way to communicate how, where, and what community health workers might be able to do personally if their employer is unable to provide them [PPE]."

Direct care workers who work in patients' homes face higher risks of exposure to COVID-19. They may care for many patients in many different homes, each with its own set of family members who may be working or going to school. Patients, mostly older adults, have a wide range of health issues. Some, like those with Alzheimer’s or dementia, are unable to wear masks. Others, along with family members, simply refuse to.

"One thing people don’t consider is that if we have a client and they have people over and have visitors and family members that aren’t social distancing, our caregivers are put at unnecessary risk when they go into the home," Clark says. "And they are possibly putting our other clients at risk."

Janay Clark.

Dr. Clare Luz, founding director of the IMPART Alliance, is a leading advocate for Michigan direct care workers. She hopes that a policy brief Michigan's Aging and Adult Services Agency issued in November will keep the state’s direct care workers safer. The brief acknowledges that many direct care workers have had to work without PPE during the pandemic. Reasons cited reflect Jones' experience — lack of availability compounded by steeply rising costs. In response, the brief recommends improving direct care workers’ access to PPE by improving distribution, updating emergency plans, amassing a statewide stockpile, making PPE easier to acquire, and developing a reimbursement process.

"The recommendations in the policy brief reflect, in part, a recognition in terms of understanding the value of direct care workers, including those who work in home care and nursing homes," Luz says. "COVID-19 has shone a bright light on how important and vulnerable they are. I am hoping this raises awareness and will lead to a change in working conditions, the amount of respect we give them, and prevent PPE shortages in the future. They always have been essential. Now we know just how essential they are."

Those direct care workers with connections to agencies like the Disability Network of Mid-Michigan (DNMM) have had a somewhat less stressful experience acquiring PPE.

"Even after the first wave, getting PPE to direct care workers was a really grave concern," says Terri Robbins, who oversees advocacy and community connections at DNMM. "We wanted to do everything we could to prevent that from happening again. Our biggest concern is folks not connected with provider agencies. We beefed up our supply mechanisms so they can get access to PPE. So far, we are in a good spot."

Robbins notes that by accessing PPE supplies made available by MDHHS, Medicaid, and the state’s various Area Agencies on Aging, her agency has been able to deliver PPE to the people they serve.

"I think that we are in a much better situation than we were in February or March," Luz says. "[The Michigan Department of Health and Human Services (MDHHS)] is doing a good job of anticipating need, is aware of shortages, and there is now a committee established specifically dedicated to PPE."

However, PPE access is only one of several issues impacting direct care workers that Luz and IMPART are advocating for. Their ultimate goal is not only to support the current direct care workforce, but also to attract more people to an industry experiencing tremendous worker shortages. In 2017, Luz projected that by 2020, Michigan would fall 32,000 short of the number of personal care aides needed. Because of COVID-19, she estimates the current shortfall at 36,000.

"We have, over the years, advocated for and put forth a list of strategies. Better pay is obviously at the top of the list, as well as benefits and guaranteed hours," Luz says. "It’s not just about the pay rate. There needs to be competency standards, set training and credentialing. And we need to show direct care workers more respect … but always it comes back to money."

Janay Clark helps Kristina Jones put on a face shield.

But as the pandemic rages on, independently employed direct care workers like Jones and Clark still spend their days in other folks’ homes, face to face with the people they care for.

"The care provided in the privacy in people's homes is out of sight and out of mind. That’s part of the problem," Luz says. "It’s partly that the work is performed historically by women, often women of color who are undervalued and undercompensated. They never know what they are walking into. They see the same person every day, but every day is different."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Kristina Bird.