Still Dedicated, Always Vigilant: The Direct Care Worker During COVID-19

Direct care workers care for older adults in nursing homes, assisted living facilities and private homes. During the pandemic many of these places can be ground zero for COVID-19 infections, or the direct care worker could be viewed as a disease vector. Either way, direct care workers are essential in the true sense of the word, providing intense caregiving services to people while family members often are kept at bay. In late September Generations Today spoke to two direct care workers, to hear how they have weathered this most difficult of years.

CNA/Certified Hospice and Palliative Nursing Assistant (CHPNA) Musa Manneh, age 57:

Manneh lives in Raleigh, NC, and works for Transitions LifeCare, bathing, grooming and taking close care of people with terminal illnesses who are receiving hospice. His patients range in age from 45 to 90 years old and older, and all have a prognosis of fewer than six months to live. He has been with Transitions for 11 years.

With Manneh caring for terminal patients is innate, as he cared for his first terminal patient at age 14, when his father was dying. When, two decades ago, a friend asked him to take care of his older client until he returned from a vacation Manneh said yes.

“So I went there and was helping him, and ended up helping everybody else, and management liked what I was doing and asked me to come work there. Which I did for five years, in the dementia unit,” said Manneh. Then Transitions wooed him away.

The pandemic has been worrisome for Manneh as despite taking all necessary precautions and following all guidelines, at first his patients would immediately wipe down all areas he came in contact with, even chair seats. Manneh said people now are more settled in, although he still worries in two directions, about potentially infecting his patients and about bringing infections home and potentially infecting his daughters. Two are in college, one is in high school and one in middle school. And although they don’t live with Manneh, they do visit, but not as often lately.

He says the worry was worse in the beginning as less was known about transmission, but still “mentally, it affects you. I’m afraid of maybe being asymptomatic and giving it to my kids, and I have a niece who’s asthmatic, so as the only one that goes from house to house [seeing clients], I need to confine myself from them,” Manneh says. “I have to stay away from them, and that’s hard.”

In the end, however, love for his job motivates him to keep going, despite the risks. “To help patients, they are going through a very difficult time and you are there as a help to remove them from the emotional times,” Manneh said. “They look forward to you coming, you’re helping them with things they have no knowledge of, or experience with, like seeing a loved one at the end stage, going through death. … You try to make the patient more comfortable and to help them.

“It’s motivating to know you are helping someone who appreciates what you do. I’m so blessed. And when they tell you thank you, it makes it all worth it.”

'They’re scared but then a songbird passes by in the hallway and it cheers them up.'

Home Health Aide Kim Williams, age 53

Williams lives in the Bronx with her husband and 14-year-old daughter. Her two older daughters are out of the house. For six years she has worked as a home health aide, and is with her current client from 9 a.m. to 3 p.m. six days a week. At first, however, she worked in an assisted living facility after graduating from her training.

The pandemic threw her into a state of shock at first, she says, as she had been trained to do certain tasks as a home health aide, “but I had to search into myself to do better.” Her husband has emphysema, asthma and diabetes, and her daughter also is asthmatic. Each day when Williams returns from work she strips off her work clothes at the front door, where her husband puts them into plastic, and then she takes a shower.

At the beginning of the pandemic Williams says she was very nervous because she was “walking into a place where there wasn’t the proper PPE attire. My company [Cooperative Home Care Associates] had to distribute attire into the facility, as the facility was not giving out protection to people who were going into other people’s homes. They suited me up in hazmat gear: boots, gown, mask, gloves. They protected me and they are still protecting me,” said Williams.

On the floor where she worked prior to her in-home assignment Williams says there were six casualties. “I wasn’t trained for this,” she said. “I was trained to have compassion and sympathy, but not to see them loading bodies onto trucks.”

To calm herself, Williams sings, and well, too, as she’s an R&B singer when not working as a home health aide. She sang when she worked in the facility, “to uplift them. Everyone was stuck in their rooms, they didn’t want to come out, they couldn’t come down and dine in the facility. They were secluded and it was depressing.”

She prayed and she sang in the hallways. “They’re scared but then a songbird passes by in the hallway and it cheers them up.”

When asked what she does for herself, Williams said, “My counseling is going to my job every day.” But she sees signs now of a resurgence in her neighborhood. “There was a time [early on during the pandemic] when we heard ambulances consistently in our area. Now again, since last week it’s been like a war zone,” Williams said. In fact there was a spike in cases in the Bronx when we spoke with Williams.

But this time it seems the people being loaded into the ambulances were young, ages 15 to 30, Williams said. And seeing that, sometimes the trauma returns. “For myself there is long-term trauma, I will always be on edge, always be on my toes wondering when it’s going to end. It’s just not the norm anymore,” said Williams.

She feels sorry for her clients, too. “Never in a million years did I think I would see anything like this—they’re scared they’re going to pass away and they won’t come out of their rooms. They don’t want the mail brought up, they tell me to leave it on the door knob. They aren’t participating in activities. They’re dying on the inside and the aides have to do the best we can to uplift them,” she added.

The virus has taken a personal toll, too. “We lost my mother-in-law. I was hospitalized in January and when I came out, two days later my husband was sick and he was hospitalized for five days.

“Once it’s over the whole U.S. will need to be in therapy,” Williams said.

Photo of Kim Williams (top of page) courtesy of Kristen Blush.