Last April, Kate Doolittle, who sees patients in their homes or in assisted-living facilities, was just getting used to wearing a mask. Most of her clients are elderly and in fragile health, and she worried more about infecting them than about being exposed herself: Early on, one died of Covid-19.

Though Doolittle received her second vaccine dose in January, that anxiety persists, because the vaccines’ effect on transmission remains unclear. She is also learning to tend to a new set of clients: people recuperating from Covid-19 hospitalization. That requires her to change into and out of extra layers of protective gear, often in a client’s driveway. “Sometimes I’m trying to bleach-wipe my pants,” she told me, though she now knows that most people contract the virus by inhaling airborne particles. “You still don’t want to be carrying something from place to place.”

Before the pandemic, aging baby boomers were already expected to strain the home-care industry. Now many companies are turning away new patients because of pandemic-related staff shortages — employees in quarantine as a result of Covid-19 sickness or exposure or whose children are out of school — and the influx of Covid-19 survivors, says William A. Dombi, the president of the National Association for Home Care and Hospice, a trade group. People are also more reluctant to stay in assisted-living facilities, which were ravaged by the virus.

Even after the pandemic ends, the American Physical Therapy Association predicts heightened demand from postponed elective surgeries (typically, many of Doolittle’s clients are recovering from joint replacements, which are on hold at Boston hospitals, along with other elective surgeries), as well as a growing need for Covid-19 rehabilitation and the imperative to address conditions like heart disease that have been exacerbated by a year’s worth of inactivity. The question, Dombi says, is “Can we get the availability of staff to go up?”

In addition to therapists such as Doolittle, whose salaried position at a large agency offers security, workers in the industry include roughly 3.5 million health and personal aides who provide in-home care and who are disproportionately people of color, recent immigrants and women. Many were laid off or unable to work during the pandemic and struggled to access relief, while those who stayed on contended with low wages and a lack of benefits and protective equipment.

President Biden campaigned on a proposal to spend billions to expand home-care and child-care services, including by offering tax credits for unpaid caregiving, making more in-home services eligible for Medicaid and encouraging workers to collectively bargain for increased pay and benefits. Advocates for home workers hope persistent labor shortages will increase bipartisan support for reforms. “We think the table is set for improvements in working conditions, compensation and respect,” Dombi says.

Doolittle hopes that her professional life will be mostly back to normal a year from now — no more Covid-19 patients; no more masks impeding communication with clients who may be confused or hard of hearing. She’s also impatient for her family and friends to get their vaccines so that she can start to have a social life again. “I feel stuck in this limbo,” she said. “Even though there’s a light at the end of the tunnel, we’re not there yet, and we have to be super careful about everything. I still pose a threat to people.”



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