17/04/2020

Homecare professionals: More important than ever, as forgotten of as ever

The quarantine put into effect due to the pandemic has generated phenomena such as the return of fish and swans to the canals of Venice, the invasion of angry monkeys in some cities in Thailand and the presence of deer on the streets of Japan and foxes in London.

Much less bucolic, but also tangible, has been the sudden (and perhaps in many cases apparent) recognition by societies of workers that are usually invisible, but nevertheless essential: those who provide home care and other tasks, people in charge of the cleaning and security in hospitals, streets, large establishments, not to mention all health workers, from doctors and nurses to technicians, stretcher bearers and laboratory technicians. This is not an exhaustive list of poorly-paid workers, whose jobs receive little social consideration and are generally precarious. Today, these workers are applauded from our balconies and windows, as they keep a world paralyzed by the coronavirus moving.

Let's talk in particular about home care. Taking into account demographic changes and the increasing chronicity of many conditions, care work is increasingly essential. In 2015, 2.1 billion people, both young and old, required care. By 2030, the number of care recipients is projected to increase by 200 million. And, in the scenario of the pandemic caused by COVID-19, home care, mostly carried out by women, is essential at a time when the elderly or people with mobility problems cannot leave their homes.

Prior to the pandemic, the International Labor Organization had already stated that, if not adequately addressed, current deficits in the provision of care services and their quality would create a serious and unsustainable crisis of care worldwide and would further increase gender inequality at work. The availability and quality of care services depends on a properly trained workforce that can operate under decent working conditions and receive wages that comparable to their skills and competencies.

However, care work is consistently undervalued and poorly paid. Workers in the care sector -the majority of whom are women and, disproportionately, migrants- very often experience discrimination and job insecurity, with zero-hours contracts, low wages, poor working conditions, violence and harassment on the job being commonplace. Many care workers are forced to have several jobs to subsist. Austerity measures, public divestment and outsourcing accelerate the precarious conditions and informality of workers in the care sector, particularly the growing number of domestic workers and those who provide home care services. In Europe and in some countries of the Americas, the entry into the sector of multinationals that are not held accountable and are poorly regulated, such as the case of Orpea, a French multinational with a wide expansion in institutions dedicated to geriatrics, is to blame for an even greater decrease in the quality of jobs in the sector and in the decline of care services.

Investing in care as a public good, combined with respect for the workers’ right to union representation, collective bargaining and a minimum wage, can reverse current trends and avoid a global care crisis. The fact that it is a difficult labor force to organize cannot be ignored, mainly due to its isolated conditions. However, in several parts of the world there are successful experiences of unionization that have radically improved the living conditions of care workers. In all cases, a radical change in unionization strategies was imposed and a great effort was made by the organizations to patiently look for each worker outside the work scenario and strive to build a common agenda. In these efforts, the support of a present State is also essential, encouraging the organization of vulnerable and unprotected sectors and empowering them.

During this unprecedented crisis that we are experiencing, care workers are considered essential services. But as the Spanish union Comisiones Obreras says, "Home-based workers, more important than ever, as forgotten of as ever." The union confederation “wants to highlight the work of this group that is tackling the COVID-19 crisis with great integrity, but without adequate protection. Although companies maintain specific security protocols against the virus, there is still a lack of the necessary personal protective equipment (PPE) in most cases. This situation has led many users to dispense with services for fear of contagion”.

The Secretary General of UNI Global Union (global union entity that groups more than 20 million workers in the service and knowledge economy) has addressed the World Health Organization requesting that it update its Provisional Technical Guidelines to clarify that home care workers must be included as health workers for the purposes of PPE. "These workers provide care to a population that is vulnerable to the virus (the elderly, the chronically ill and the disabled), but are often not granted essential health worker status", said Christy Hoffman in her letter. “Now they are also supporting patients who are dismissed from the hospital in order to free up space for urgent cases of COVID-19. These workers are not only at risk of contracting the disease, since people can spread it without having symptoms and symptoms can be confused with other diseases, but without adequate protection they can become vectors of transmission to others”.

In her letter sent to WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, Hoffman made the following suggestions for updating or developing new specific guidelines for home care workers:

Mandatory and sufficient personal protective equipment for home care workers.

Homecare workers should receive masks, gowns, and gloves, as well as disinfectants, sterile equipment, and other PPE for all visits to their patients.

Training for home care workers on COVID-19 and regular information.

Few homecare workers have received formal training in infectious disease prevention. COVID-19 related training is essential to keep them and the community safe. Information should also be constantly updated as we learn and understand more about COVID-19 transmission.

Priority access to diagnostic tests for home care workers.

The pandemic unleashed by the coronavirus only made visible the more than precarious working conditions of those who are presently fundamental in sustaining collective life. The tremendous mark that it will leave on our societies and economies should not make us forget these women and men who, although essential, are constantly invisible.

Adriana Rosenzvaig is the advisor for International Affairs at the Federation of Associations of Healthcare Workers of Argentina (FATSA). In 2000, while General Secretary of the International Graphic Federation, she was part of the creation of UNI, an organization in which she first served as head of the graphic sector and later as head of  Unionization and Campaigns. In 2016 she was the Regional Secretary of UNI Global Union in Montevideo.