Iowa caregivers face low wages but high coronavirus risk

Being a health care worker during a pandemic comes with a fair amount of paranoia.

Sherri Siegel, 48, of Cedar Rapids, who works for Right at Home, went into quarantine earlier this spring when her client's daughter tested positive for COVID-19. Siegel was on high alert for any symptoms of the disease that has so far killed nearly 900 health care workers nationwide, according to the Guardian and Kaiser Health News.

'A couple of weeks ago, I broke out in a rash on my torso,' Siegel said. 'From what I saw online, some people had reported it could be a subcutaneous manifestation of the virus. My doctor said contact dermatitis.'

Direct care workers, who care for patients in nursing homes, group homes or private residences, are at high risk of exposure to COVID-19 yet don't get the same pay, training or respect of other health care workers. And because of visitor restrictions at nursing homes and other care facilities, direct care workers have added family communication to their long list of tasks.

The Gazette is profiling five direct care workers in Iowa to show what their jobs are like during the COVID-19 pandemic:

The veteran

Fran Mancl has been a certified nursing assistant in Dubuque for 32 years. In March, he retired from his position caring for older Iowans at a long-term care facility because of his fears of contracting COVID-19.

'You simply cannot practice social distancing while assisting elderly residents with dressing, bathing, toileting, feeding, walking, oral care, or helping them to participate in one of their favorite leisure activities,' said Mancl, who is in his 60s.

'I believe that working in direct care, in the shadow of COVID-19 and having to be very conscious of and consistently practice infection control protocol, placed me, and many of my co-workers, in persistent high stress both physically and emotionally.'

Jobs including home health care aides and physical therapy aides were expected to grow by 38 percent and 40 percent respectively between 2014 and 2024, according to the U.S. Bureau of Labor Statistics, as baby boomers need more health care services.

But these positions also have high turnover — as high as 65 percent in 2017.

Mancl had mixed feelings when Gov. Kim Reynolds signed an emergency declaration April 10 temporarily suspending some training and examination requirements for nurse aides. The move was intended to get more staff in place, but Mancl worried someone not adequately trained would be more likely to injure a resident.

The rookie

Delaney McMahon, 19, of Iowa City, started working as a nurse aide at Legacy Senior Living in Iowa City in 2018, while she was dual enrolled as a senior at Iowa City High and Kirkwood Community College. She earned her CNA certification in June 2019.

'They were really happy to keep me there because I knew the residents,' she said of the Legacy managers. 'I worked in the memory care unit, so it's harder to respond to a resident unless you know them.'

McMahon, who just started a new job at Crestview Specialty Care in West Branch, likes talking with the residents and hearing stories about their lives. One day, a co-worker at Legacy played 'Music, Music, Music,' a song recorded by Teresa Brewer in 1949.

'All the residents started dancing or bobbing their heads,' she said. 'They remembered it.'

McMahon has learned to practice patience and compassion, particularly as COVID-19 restrictions have caused even more confusion for residents. Some wonder why they can't see their families and forget past conversations about the virus. They are perplexed by the masks worn by staff.

Because families aren't admitted to resident rooms, staff spend a lot of time arranging and facilitating FaceTime or Skype calls.

'Family members are calling a lot more,' she said. 'They call daily, almost, checking on their family member. One day I was trying to get someone in the shower and I got five calls on the phone. I was running back and forth.'

McMahon and her Legacy co-workers got hazard pay for a while, which was helpful because she quit another part-time job to reduce her exposure risk. 'They should have kept it going.'

» READ MORE: 5 ideas to improve direct care work in Iowa

In-home caregiver

Siegel loves her job at Right At Home, a Cedar Rapids company that assists people who need care in private homes, senior communities or nursing homes. She helps clients with cleaning, shopping, grooming or just being there.

Siegel isn't a certified CNA, but came to the profession after working in child care years ago.

'If you're somebody who has a natural inclination to be caring, it's pretty transferable,' she said.

There are moments Siegel will never forget, such as sitting with a client in hospice as a minister said the final prayers and blessings.

But there also is a lot of drudgery for $12 an hour, she said.

'I took a financial class at a certain point. They asked us what we thought was a living wage. It was $17 an hour,' Siegel said. 'I'm getting $12 with Right at Home and, as much as I am grateful, I also want to recognize that I'm not even making a living wage. It's discouraging.'

Clients' families pay what seems like a lot for services, but once the money is divided up to pay for various aspects of care, the actual caregiver gets much less, Siegel said. She's looking for a second job.

Immigrant gets virus

Augustine Fallah's first patient was his grandfather, who got sick after they moved to the United States from Liberia in 2007.

'When I was with him in the hospital, I decided to do something like that,' said Fallah, 32, of Des Moines, about being a caregiver. 'I took the classes and I started to do the work.'

He tries to think of each resident as a family member deserving competency and compassion. But the pandemic has tested Fallah's commitment to his CNA job, which has become harder with all the protective clothing staff must wear and fear of COVID-19.

And then, in late April, Fallah tested positive for the disease — which he believes he contracted at work. He did not want to name the Des Moines-area facility for fear he might lose his job. He recovered at home, using sick time so he could still get paid.

'They always call you every day and ask you the same questions,' he said of the care center staff. 'I appreciate them because it showed love and they care for you.'

Now that he's recovered from COVID-19, Fallah is at a crossroads. He is considering going back to school to become a registered nurse or leaving the health care profession altogether.

'I'm thinking about real estate or a car dealership,' he said.

Covid-19 combatant

Paula Riemer, 63, of Cedar Rapids, goes into each shift at Hallmar, Mercy Medical Center's residential nursing facility, like a warrior suiting up for battle.

'First of all, we go down and get screened. We get our temperature and are asked several questions about the virus. Then we get a little colored sticker to put on our nametag. That's just to get in the building,' she said.

'After that, I go up to second floor Hallmar and we have alarmed doors. We have to wait for the nurse to let us in the morning. We are temped again and, of course, we have to wear a mask. We are gloved and wear a scrub jacket they use in surgery.'

Riemer has worked at Hallmar for nine years and as a CNA for 45 years.

Under COVID-19, staff have foregone most vacations and try not to go places where they might be exposed to the virus, she said.

'I haven't seen my daughter for three months and she lives here' in Cedar Rapids, Riemer said. 'I haven't seen my other daughter in Florida for over a year. You just kind of have to live with it. You have to tell yourself 'This is what I need to do.''

Riemer does at least one special activity each day with her core group of residents. That might be a walk outside, a jigsaw puzzle or a quiet 30 minutes reading in the same room. She also puts together outfits for her residents to make sure they look sharp for one-hour daily visits they now may have with family members.

Hallmar hasn't had any positive tests among residents or staff.

'We really miss the hugs,' she said. 'They do and we do.'

Comments: (319) 339-3157; erin.jordan@thegazette.com