When home care worker Shazia Anwar has had a tough day, when her back hurts from lifting and she’s particularly tired, it’s her clients’ smiles and words of appreciation that keep her going.

Anwar has been a home care worker for eight years and while the work has always been physically and emotionally challenging, she is grateful for the role she plays in her clients’ lives. She is there for five clients 24-7, ready to provide a supportive ear or to take them to the ER in the middle of the night, if necessary. She doesn’t mind. She finds it rewarding and said her clients “are like family to me.”

Yet now with the coronavirus pandemic, the job has become scary. Every day her work requires her to be out in the community, shuttling between her clients’ homes, pharmacies and grocery stores, to make sure their needs are met. She’s in physical contact, in close quarters, with multiple people a day.

She did all that, she said, for a month and half with just four disposable surgical masks she carefully saved and reused out of necessity. Ideally, she said, she would have had a new mask for every client every day but in the first months of the pandemic, masks were in short supply. Recently a friend gave her two homemade cloth masks, which provided some security, and she said more supplies are now being provided. Anwar herself has health conditions that put her at higher risk if she contracts the virus, but when she had her own COVID-19 scare, she worried most about who would take care of her clients and be there for her adult children if she was sick.

“The work we are doing right now,” Anwar said, “it’s work only people can do if they have a heart, because this is a hard time. This is a hard job.”

Since the pandemic began, attention, praise and cheers of appreciation have rightly focused on the health care workers who courageously show up to hospitals and medical centers each day — at great risk to themselves and their families.

From working in the 'hot zone' to protecting their families: the struggles for health professionals

But outside the view of most of us, there’s another group that shows up each day as well, behind closed doors and without fanfare, to provide critical health care to older adults and people with disabilities: home care workers.


For several years, I worked with the organization that provides training and benefits to these workers, and saw firsthand the impact they made in their clients’ lives. Home care workers allow people with disabilities to live independently at home and help older adults age in place. They are some of the country’s lowest paid workers in one of the fastest growing occupations. Home care workers provide sensitive personal care, assist with moving and lifting clients, help with using the toilet, manage medications, cook for clients and other core support to allow their clients to maintain their independence.

Nearly 9 of 10 home care workers are women and 62% are people of color, with an average age of 46, according to PHI, an organization that studies the direct care workforce.

But since the coronavirus outbreak, these workers have struggled to do their work safely, with little access to personal protective equipment, or PPE, despite caring for some of the most high risk and vulnerable populations.

Home care workers are serving an exploding need, with the population over 65 expected to double between 2016 and 2060 and the number over 85 expected to triple. Even before the pandemic, 76% of people 50 and older reported wanting to stay in their homes as they aged, according to a 2018 survey by AARP. With 60% of the state’s coronavirus deaths linked to long-term care facilities by early May, it seems plausible that in the future even more people would prefer to stay at home.

But even with all that demand, the median annual pay for home care workers nationwide is just under $12 an hour, and hours are often inconsistent, with more than half working part time. In Washington, more than 40,000 unionized workers like Anwar earn more than $16 an hour.


Bea Rector, the director of Washington’s Department of Social and Health Services’ (DSHS) Home and Community Based Services, said she would love for home care workers to be more recognized in the broader health care system. The vast majority of the state’s home care workers are funded by Medicaid and care for low-income clients. Workers are employed by agencies or directly hired by clients and then contracted by DSHS, which oversees Medicaid-funded home care.

Rector said when the state Department of Health first prioritized in March who would get PPE in the pandemic, home care workers were left off entirely. After advocacy from stakeholders, the caregivers were moved to the top level of priority. But with the worldwide shortage of PPE, it didn’t mean the equipment would magically appear and it didn’t, leaving workers and their clients vulnerable for months. Rector said they have finally acquired 500,000 masks and are packaging them to send to workers and their clients in the coming weeks.

Anwar wants people to understand home care workers are on the front lines playing a valuable role and should not be forgotten. “They put their life at stake … to take care of their clients,” Anwar said, and allow people to stay in their homes. “Everybody wants to stay in their own environment and have freedom and peace in their life.”