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Invisible, but on the front lines of a pandemic.

“God, please do not let me get sick right now.” That Elizabeth Davis’s prayer these days, as the storm of coronavirus cases gathers around us. What happens to Davis if she gets sick? What happens to the folks she cares for? The answers to those questions affect us all.

Without visits from home care aides, elderly and disabled people with few resources might miss meals or medication, they might fall, or grow sicker, all of which could land them in overtaxed, under-equipped emergency rooms, where they might be exposed to the coronavirus.
Without visits from home care aides, elderly and disabled people with few resources might miss meals or medication, they might fall, or grow sicker, all of which could land them in overtaxed, under-equipped emergency rooms, where they might be exposed to the coronavirus.Shutterstock/Ocskay Bence

“God, please do not let me get sick right now.”

That is Elizabeth Davis’s prayer these days, as the storm gathers around us.

The home health aide inhabits a treacherous and largely invisible intersection right now: the place where vulnerable low-wage workers provide the services that keep their equally vulnerable elderly and disabled clients at home — and out of the hospitals currently bracing for the full impact of the coronavirus pandemic.

What happens to Davis if she gets sick? What happens to the people she cares for? The answers to those questions affect us all.

Because of her age, the Springfield woman, 69, is at higher risk for serious illness if she catches the virus that causes COVID-19. But Davis doesn’t worry about her health as much as her finances. Employed by three agencies, she works 40 hours a week and makes about $14 per hour. She has no cushion: If she gets sick and blows through her 40 hours of paid sick leave, she’s going to find it hard to make her mortgage payment, her utility bills, her car insurance premium.

“If I got sick, it would ruin me, so I take all the precautions,” she said. “I assume everybody has an infection, and I try to stay well.”

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Nobody wants to see a health care worker have to choose between working sick and financial collapse, let alone make the wrong decision. But here we are.

And sickness isn’t the only danger here. Her kids are grown, but Davis worries about her colleagues, who now face child care challenges in addition to the dangers of contracting COVID-19 or giving it to a client. Those who have to stay home to care for their kids will face hardship, too.

Davis’s work brings her into very close contact with her elderly clients: She cleans their homes and prepares their meals, helps them get in and out of bed, takes them for walks, bathes and toilets them.

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“These are the front-line aides who are invisible to many,” said Kevin Smith, who heads Best of Care Inc., a home care agency.

Without visits from home care aides, elderly and disabled people with few resources might miss meals or medication, they might fall, or grow sicker, all of which could land them in overtaxed, under-equipped emergency rooms, where they might be exposed to the coronavirus.

The work, vital at the best of times, is absolutely critical now — to all of us. Davis has to stay healthy.

So her agencies pepper her with text reminders to wash her hands. She doubles up on gloves, though she worries about running out. We know hospitals across the country are in desperately short supply of personal protective gear like masks and protective glasses. Smith says the situation among home health aides is “grim.”

“I’ve been working round the clock to make sure protective equipment from the national stockpile gets to direct care workers in homes," said Lisa Gurgone, executive director of Mass Home Care, which represents agencies that serve more than 60,000 recipients.

So far, aides are managing to make their visits. But clients have been canceling, afraid of the close contact, even though workers have been screened and trained in safe practices. Right now, Gurgone said, an aide refused entry by a client won’t get paid. She and others, including 1199 SEIU, the union that represents some 50,000 aides, are working with the state to change that, and to provide better sick leave and other financial supports.

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Whether or not they succeed, we can add this to the many ways the pandemic has laid bare the unfairnesses baked into our society. The people who do this vital work are overwhelmingly women, and of meager means. In Massachusetts, more than a third of home health and personal care aides were born outside the US, and half are people of color.

We desperately need these workers: There are thousands of open jobs at nursing facilities and home care agencies in Massachusetts. And yet we pay them lousy wages, fail to provide the care their children need, shred the safety net that would help workers, and their clients, sleep at night.

Well, we’re about to be confronted by the cost of those failings. And for once, everybody will have to pay it.


Globe columnist Yvonne Abraham can be reached at yvonne.abraham@globe.com. Follow her on Twitter @GlobeAbraham.