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Essential, Undervalued, and Underpaid: Home Health Care Workers in the United States during the COVID-19 Pandemic 42 Executive Summary The COVID-19 pandemic has highlighted the selfless dedication of essential frontline workers; however, there still exists an invisible workforce that remains essential, yet undervalued and underpaid. American home health care workers—direct care workers who provide care to individuals with physical, behavioral, or other needs at home—have for decades endured neglect in the form of wage discrimination. In stark contrast to the more highly compensated technical positions in the health care sector (practitioners, technicians, etc.), home health care workers often are paid well below other health care workers, receiving a median hourly wage of $12.13. Home health care workers also earn lower wages than their counterparts performing similar tasks in nursing homes and long-term care facilities, where the average hourly rate is $20.19. Due to the low wage, over half of home care workers rely on some form of public assistance to make ends meet. Moreover, home health care workers face additional hurdles related to wage/labor discrimination, as about nine out of ten home care workers are women, and over half are people of color (US Census Bureau). In the context of the COVID-19 pandemic, the value of home care work is being brought into the spotlight along with acknowledgement of its shortfall in compensation and protections. Herein, we propose the following actions to better protect these workers against labor/wage discrimination in the United States: 1) raise pay to a living wage; 2) expand and strengthen home health care worker unions; and 3) introduce hazard pay in recognition of the danger of their work during the COVID-19 pandemic, and establish a protocol for establishing hazard pay during future high-risk health scenarios. There are an estimated 2.3 million home health care workers across the United States who continue to work through the pandemic to support the most vulnerable of our population, yet their current wages and working conditions do not reflect their inherent need in Policy Brief on the Future of Work MARTINDALE CENTER society. The aforementioned policy options are intended to address the challenges faced by these essential workers. Issues and Challenges The COVID-19 pandemic has put pressure on a wide swath of industries, including health care, which in particular experienced significant negative effects, in terms of both safety and employment. The health care and social assistance sector saw a significant rise in unemployment at the start of the pandemic, growing from 2% in January to 10.3% in April 2020 (BLS b). Within that sector, home health care workers tend to earn the lowest wages. In 2019, prior to the pandemic, the median hourly wage of home health care workers was $12.13, corresponding to an annual median income from wages of $25,240 (BLS a). For a family of four with no other income, this puts home health careworkers below the poverty line, on average (ASPE). As an example of the problem, Scot Rosenzweig, a health care activist whose late fiancée was his first attendant, described the financial struggles faced by home health care workers: As an attendant, she had tomake a choice between paying basic living expenses or health insurance. Attendants in Pennsylvania currently average $10.35/h. My current attendant works 42 hours weekly caring for me and has had to take a second full-time job. In 2013, my fiancé passed away at age 41, unable to pay for health insurance she desperately needed (Rosenzweig). Clearly, wages in this important health care sector are insufficient. While unemployment rose during the first few months of the pandemic, the general job outlook for home health care These Martindale Center Policy Briefs on the Future of Work were prepared by teams of students and young professionals serving as Research Externs with the Lehigh University / United Nations Partnership working in affiliation with the International Labour Organization. Authors: Elisa Mayerberger • Jessica Mun • Julia Patridge • Isabel Quinatoa • Sophie Saddik • Liz Sullivan • Sarah Yeager Series Editor: Stephen Cutcliffe, Ph.D. February 2021 Essential, Undervalued, and Underpaid: Home Health Care Workers in the United States during the COVID-19 Pandemic