Sonya, an aide on Long Island, told me that since the beginning of the pandemic her agency has had her provide extra care to a patient in an assisted-living facility. Because of the ban on visitors, she was the man’s only conduit to his family. But because she isn’t employed directly by the facility, she found herself excluded from Gov. Andrew Cuomo’s order requiring workers to be tested every week. As an agency aide, she went unnoticed by regulators.

Other aides I interviewed were working in multiple patients’ homes. Direct caregivers are so poorly paid that they often have to accept whatever shifts are offered, shuttling between private residences, assisted-living units and nursing homes. “They’re putting themselves at risk, going from job to job to job and putting the older adults at risk as well,” Amy York, executive director of the Eldercare Workforce Alliance, told me.

Even before the coronavirus reached the United States, the risks to older people were clear. As in South Korea, the first clusters here, too, were linked to long-term care. I happened to be reporting in Washington State in early March when the virus was detected in a facility in Kirkland. Officials there, in interviews, could not address my questions about what should happen to the caregiving staff.

To contain the spread of the virus, wouldn’t aides need hazard pay and extra protective equipment, private transportation and temporary lodging? No one seemed to have an answer, and aides proceeded to work in fear.

Their employers, despite claiming to do the best they could, were in fact mobilizing lobbyists to shield themselves from litigation: The nursing-home industry has tried to limit its liability in more than 20 states and is pushing for nationwide relief in Congress.

Long-term care employees, on the other hand, face criminalization simply for doing their jobs. In May, a home health aide was arrested in Camden, N.J., and charged with multiple counts of “endangering the welfare of another.” The state alleges that, in mid-April, the aide went to get tested for the coronavirus and ignored instructions to self-isolate; the next day, she showed up for work as usual. Her patient later fell ill and died, and four other members of the household got sick. The aide’s test turned out to be positive, although it is not clear whether she had transmitted the virus to her patient or vice versa.

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