Home-Care Workers Press On, Despite Precarity, Pandemic, and Uncertainty

While others have been keeping their distance and working from their own kitchen tables and couches, the city’s home-care workers have mostly continued to do their rounds of elderly patients and others in need of support.

But their work is insecure. If they or their clients have to self-isolate, it can mean a loss of income, and many are undocumented workers, unsure as to whether they can fall back on social-welfare supports in these times.

Not only that, but others say they’d like more clarity from the HSE on what precautions they should be taking – and what role they might be expected to play as the Covid-19 crisis progresses.

“They’re all very committed to what they’re doing and they feel like they have a contribution to make, to protect older people and more vulnerable adults,” says Aoife Smith, of the Migrant Rights Centre Ireland (MRCI).

Insecure Work

Home-care workers for the companies represented by the industry body Home and Community Care Ireland (HCCI) look after some 20,000 clients.

Of these, there are about 17,000 whose care is paid for by the HSE’s home support scheme, and another 3,000 who pay privately, according to HCCI figures.

As of 18 March, 45 of these clients were self-isolating based on advice of a medical professional, and 836 were self-isolating voluntarily, HCCI figures showed.

At the moment, the HSE will only pay for work if it’s carried out, says Joseph Musgrave, chief executive of the HCCI.

The one caveat is that, if a client decides they don’t want to risk having a home carer come into their home, the HSE will give money for two more days after that.

“Beyond the two days, there’s very limited scope for companies of any kind, non-profit or private, to pay to keep a carer employed if there’s no work that they can charge for,” Musgrave says.

The HCCI has called for the HSE to increase that two-days of payments to six weeks with monthly reviews, he says. “We have asked that that be looked at.”

Kelly Melia, who used to work for a private home-care agency in the city, says fluctuations in income for home care workers, aren’t new – thought they might be worse right now than usual.

“Your hours are never set in stone,” says Melia, a member of the Workers’ Party. “Really, it’s like every week would be different. They have no stability, no protection at all with home help. That’s one reason I left home help.”

One week a home-care worker might have loads of clients. Then some might go into hospital, some might pass away, some might change agency, she says. “You’ll just see the gaps in your timetable, and just be told, ‘When we get more people we’ll try and stick you in’, basically.”

One winter, often the worst time for clients getting sick and going into hospital, or passing with flu, colds, and pneumonia, Melia’s hours slumped from 40 hours to 22 hours, she says.

There’s also the issue of not being paid for petrol and travel time, she says. In the last job she was in, she was on €12.50 an hour when she left, she says.

When Workers Get Sick

When home care workers are deciding whether they should stop visiting a client – because either they, or the client, might have Covid-19 – have to weigh up that choice against a loss of income.

How badly do they need that pay cheque? Badly enough to risk bringing the virus home by mistake to parents or children they live with?

HCCI’s member agencies have 3,400 full-time care staff and 9,500 part-time care staff, it has said.

On 19 March, Musgrave said HCCI member organisations had 64 carers self-isolating because public health authorities had told them to, and 134 carers who were doing so voluntarily because they suspected they’d come into contact with Covid-19.

And they’ve 126 carers who can’t report to work because of school closures. “And they can’t find anybody else to care for the kids,” he says.

A spokesperson for the HSE said that its current advice has been that if a staff member has been advised to self-isolate pending confirmation of Covid-19, they can avail of the extended social-welfare payments announced by the government.

But if they decide, without advice, to voluntarily self-isolate, then what happens? asks Smith, of MRCI. It’s not clear enough right now, she says.

“Will they be able to access social protections from the Department of Social Protection?” she asks. “Their contracts are really weak so you can forget about them being paid by their employers.”

The Department of Social Protection’s press office hasn’t yet responded to queries about this.

Smith says another vital group of people left outside of these supports are people who do not have the proper immigration documents, who are working in the home-care sector.

MCRI has a network called My Fair Home, made up of more than 500 people, most of whom are migrant women, who care for elderly people in their homes. “A large percentage of those are undocumented workers, the majority would be undocumented workers,” says Smith.

“They would be living in, living out, in homes across the country, taking care of older people, taking care of vulnerable adults day in day out with very little recognition,” she says.

MRCI has been calling for their regularisation, Smith says. “During times like this, one would hope that the state would be making exceptions for those undocumented workers, but we haven’t heard anything about that yet.”

These care workers face a serious financial insecurity, Smith says. “What happens if they have to self-isolate themselves? If they contract something? People don’t have PPS numbers, they’re not entitled to access state benefits, so what is in place for these workers, who are providing a very valuable role?”

A spokesperson for the Department of Justice says that consideration of cases of people in the state illegally “is done so on a case by case basis”, rather than a group of people all at once. The department has consistently urged people wanting to regularise their positions to come forward, they said.

More Clarity?

Different agencies and home care workers say they’ve had different levels of advice about how to work safely in the current climate.

Melia, who used to work in the sector, says that two home-care workers she spoke to said that, as yet, it’s pretty calm and they had HSE advice on what to do. Plus “it’s still early stages”, she says.

The HSE released some guidance for home-care workers on 12 March, and then more detailed guidance on 19 March.

Smith, of MRCI, says that when she rang around home care workers a week or so ago to get a sense of what was going on on the front line, it seemed many had unanswered questions – about precautions, what to do in different scenarios, and financial supports.

The most recent guidance is welcome, she said. But she does wonder how much is trickling down from agencies to staff.

Musgrave of HCCI says that some of the information that agencies need is about bigger-picture strategy though, too. For example, is the HSE going to ask home-care workers to look after people with Covid-19 in the community, if cases climb to a certain number?

There needs to be a bit more information released so agencies like HCCI’s members can know and plan themselves, and brief staff, Musgrave says. “Now is the time where we need to see a bit more openness and transparency.”

That question ties into the question of personal protective equipment, and whether home-care workers are getting what they need, says Musgrave.

Smith says that when she called around to home-care workers, there were concerns about personal protective equipment.

In some companies, there was no hand sanitizer left, so workers were being given anti-bacterial wipes, Smith says. “With very little additional direction than what the general public is being given, they’re going on as normal.”

They do have protective equipment, she says. “But obviously, there’s a shortage of masks, there’s a shortage of hand sanitisers, the private companies, the workers in their companies are experiencing that they don’t have the hand sanitisers.”

Musgrave says that the standard public-health advice of wearing aprons and gloves, and washing hands when people get to the home, stands if people aren’t caring for those with Covid-19.

“I think we can reassure carers, if there’s no plans to care for Covid-19 in the community, we can reassure carers, look, it’s not going to be needed,” Musgrave says.

“It is a concern that is mentioned by a lot of home care workers right now. It’s the uncertainty,” he says.

Smith says that the home carers she speaks to are proud of the work that they do and want to keep working. They just need more support, she says.