In March, Sue Williams-Ward took a brand new job, with a $1-an-hour elevate.

The employer, a house well being care company referred to as Collectively We Can, was paying a premium – $13 an hour – after it began shedding aides when Covid-19 security issues mounted.

Williams-Ward, a 68-year-old Indianapolis native, was a loyal caregiver who bathed, dressed and fed purchasers as in the event that they had been household. She was identified to entertain purchasers with a few of her personal 26 grandchildren, even inviting her purchasers alongside on charitable deliveries of Thanksgiving turkeys and Christmas hams.

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With out her, the town’s most susceptible would have been “misplaced, alone or mistreated”, her husband, Royal Davis, mentioned.

Regardless of her husband’s fears for her well being, Williams-Ward reported to work on 16 March at an condominium with three aged girls. One was blind, one was wheelchair-bound and the third had a extreme psychological sickness. None had been identified with Covid-19 however, Williams-Ward confided in Davis, no less than one had signs of fatigue and shortness of breath, now related to the virus.

Even after a colleague on the evening shift developed pneumonia, Williams-Ward tended to her sufferers – with out protecting tools, which she advised her husband she’d repeatedly requested from the company. Collectively We Can didn’t reply to a number of cellphone and e-mail requests for remark in regards to the PPE out there to its staff.

Nonetheless, Davis mentioned, “Sue did all of the little, unseen, on a regular basis issues that allowed them to keep up their liberty, dignity and freedom.”

Sue Williams-Ward, pictured with her granddaughter Tamarya Burnett.

Sue Williams-Ward, pictured together with her granddaughter Tamarya Burnett. {Photograph}: Tamarya Burnett

He mentioned that inside three days Williams-Ward was coughing, too. After six weeks in a hospital and weeks on a ventilator, she died of Covid-19. Hers is certainly one of greater than 1,200 well being employee Covid deaths that KHN and the Guardian are investigating, together with these of dozens of dwelling well being aides.

Through the pandemic, dwelling well being aides have buttressed the US healthcare system by maintaining probably the most susceptible sufferers – seniors, the disabled, the infirm – out of hospitals. But at the same time as they’ve put themselves in danger, this workforce of two.three million – of whom 9 in 10 are girls, practically two-thirds are minorities and nearly one-third foreign-born – has largely been ignored.

Dwelling well being suppliers scavenged for their very own face masks and different protecting tools, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve typically achieved all of it on poverty wages, with out extra time pay, hazard pay, sick go away and medical health insurance. They usually’ve gotten sick and died – leaving little to their survivors.

Talking out about their work situations in the course of the pandemic has triggered retaliation by employers, in response to representatives of the Companies Staff Worldwide Union in Massachusetts, California and Virginia. “It’s been surprising, egregious and unethical,” mentioned David Broder, president of SEIU Virginia 512.

The pandemic has laid naked deeply ingrained inequities amongst well being staff, as Broder places it: “That is precisely what structural racism appears to be like like at present in our healthcare system.”

Each employee who spoke with the Guardian’s associate, KHN, for this text mentioned they felt intimidated by the prospect of voicing their issues. All have seen colleagues fired for doing so. They agreed to speak candidly about their work environments on the situation their full names not be used.

Tina, a house well being supplier, mentioned she has confronted these challenges in Springfield, Massachusetts, one of many nation’s poorest cities.

Like lots of her colleagues – 82%, in response to a survey by the Nationwide Home Employees Alliance – Tina has lacked protecting tools all through the pandemic. Her employer is a family-owned firm that gave her one surgical masks and two pairs of latex gloves every week to wash physique fluids, change wound dressings and administer medicines to incontinent or bedridden purchasers.

When Tina obtained the corporate’s do-it-yourself blueprints – to make masks from hole-punched sheets of paper towel strengthened with tongue depressors and gloves from rubbish luggage looped with rubber bands – she balked. “It felt like I used to be in a 3rd world nation,” she mentioned.

The house well being companies that Tina and others on this article work for declined to touch upon work situations in the course of the pandemic.

In different workplaces – hospitals, mines, factories – employers are accountable for the situations wherein their staff function. Understanding the plight of dwelling well being suppliers begins with American labor legislation.

The Truthful Labor Requirements Act, which varieties the idea of protections within the American office, was handed in an period dually marked by Franklin Delano Roosevelt’s New Deal modifications and marred by the boundaries of the Jim Crow period. The act excluded home care staff – together with maids, butlers and residential well being suppliers – from protections equivalent to extra time pay, sick go away, hazard pay and insurance coverage. Likewise, requirements set by the Occupational Security and Well being Administration three many years later carved out “home family employment actions in non-public residences”.

“A deliberate choice was made to discriminate in opposition to coloured folks – principally girls – to unburden distinguished aged white people from the accountability of employment,” mentioned Ruqaiijah Yearby, a legislation professor at St Louis College.

In 2015, a number of of those exceptions had been eradicated, and protections for dwelling well being suppliers grew to become “very properly regulated on paper”, mentioned Nina Kohn, a professor specializing in civil rights legislation at Syracuse College. “However the actuality is, noncompliance is a norm and the penalties for noncompliance are toothless.”

Burkett McInturff, a civil rights lawyer engaged on behalf of dwelling well being staff, mentioned, “The legislation itself could be very clear. The issue lies within the potential to carry these firms accountable.”

The Occupational Security and Well being Administration has “abdicated its accountability for shielding staff” within the pandemic, mentioned Debbie Berkowitz, director of the Nationwide Employment Regulation Mission. Berkowitz can also be a former OSHA chief. In her view, political and monetary choices in recent times have hollowed out the company: it now has the fewest inspectors and conducts the fewest inspections per yr in its historical past.

Moreover, some dwelling well being care companies have labeled dwelling well being suppliers as contractors, akin to gig staff equivalent to Uber drivers. This loophole protects them from the tasks of employers, mentioned Seema Mohapatra, an Indiana College affiliate professor of legislation. Moreover, she mentioned, “these staff are not often ready to query, or advocate or foyer for themselves”.

Ought to staff contract Covid-19, they’re unlikely to obtain remuneration or damages.

Demonstrating causality – that an individual caught the coronavirus on the job – for staff’ compensation has been extraordinarily troublesome, Berkowitz mentioned. As with different healthcare jobs, employers have been fast to level out that staff may need caught the virus on the gasoline station, grocery retailer or dwelling.

Many dwelling well being suppliers look after a number of sufferers, who additionally bear the implications of their work situations. “If you consider good vectors for transmission, unprotected people going from home to accommodate should rank on the high of listing,” Kohn mentioned. “Even when somebody didn’t care in any respect about these staff, we have to repair this to maintain Grandma and Grandpa secure.”

Nonetheless, caregivers like Samira, in Richmond, Virginia, have little alternative however to work. Samira – who makes $8.25 an hour with one shopper and $9.44 an hour with one other, and owes tens of hundreds of {dollars} in hospital payments from earlier work accidents – has no different possibility however to threat getting sick.

“I can’t afford to not work. And my purchasers, they don’t have anyone however me,” she mentioned. “So I simply pray day by day I don’t get it.”

KHN (Kaiser Well being Information) is a nonprofit information service masking well being points. It’s an editorially unbiased program of KFF (Kaiser Household Basis) that isn’t affiliated with Kaiser Permanente.