We've written often about presenteeism, workers staying on the job while they are sick, and have mentioned paid sick leave as a mechanism for keeping sick health care workers at home. A few years ago, New York City mandated a minimum of 5 days paid sick leave for all companies with over 20 workers, yet few other cities or states have similar regulations. While most presenteeism discussions focus on workers in specific workplaces, little attention has been paid to home health care providers. These individuals face significant time and financial pressures to work while sick, as evidenced by a recent Guardian article examining issues facing working mothers in Denver.
In the first of an election year series of discussion groups, The Guardian asked 5 working mothers, including 3 home health care workers, about the many barriers they face caring and providing for their families. Several quotes from the article are particularly relevant to discussions of presenteeism and infection prevention:
• “As the women discussed, they're paid less than male colleagues, they often struggle to find reliable childcare, they lack medical leave and they rarely even get paid time off”
• “I mean, I cannot miss a day of work, because I have to pay rent.”
• “They [home health care companies] don't give you benefits, they don't give gas [money], they don't pay for my mileage, and you take care of all these sick people in their homes. And then when you get home with this low paycheck, again, you're struggling. The money's not enough for us to take care of our family. No vacation, no sick pay, no benefits.”
• “All the women who were home health care aides lacked paid medical leave, which can leave both them and their clients vulnerable.”
• “When I go into people's homes, I need to be well. I take care of people with AIDS, I take care of people with cancer. They don't need to get pneumonia from me. So it's not just about me as a home care worker, it's about raising the standard of home care not only for myself, but for the people I take care of.”
• “I was sick last year with Type A flu virus. I couldn't take 1 day, and they told me to wear a mask on my face to go to my client. She's 84.”
Much attention has been paid to social determinants of health and how social and economics factors are associated with poor individual and community health. What is clear from this discussion group is that social determinants of health impact infection control through presenteeism and that no one, not even the wealthy, are protected from infections (e.g. influenza) transmitted in the community by home healthcare workers who have to work while sick to provide for their families. A living wage and paid sick leave for all workers are critically needed for infection prevention and for many other reasons, as outlined in this excellent, well-timed, discussion group.
Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.