Madeline Sterling, M.D., M.P.H.

At the start of coronavirus pandemic, when New Yorkers were cheering in the streets for the cleaning staffs at city hospitals, Madeline Sterling, M.D., M.P.H., remembers a home health care worker lamenting that no one had bothered to clap for people like her. Home health care workers – mostly middle-aged African-American and Hispanic women earning low wages – put themselves at risk every day, Sterling said. But they are largely overlooked by the medical community and society at large.

Sterling should know. She is a physician-scientist and an assistant professor of medicine in the Division of General Internal Medicine at Weill Cornell Medicine in New York City who has been caring for patients during the pandemic. And her long-standing relationships with a large healthcare union and home care agencies allow her to conduct research on how home health aides contribute to the care of heart failure patients, many of whom these workers tend. It also gives her a window into whether their training helps their patients carry out self-care in the home after hospitalization.

So when Sterling’s community partners asked her to listen to what the home health care workers had to say about the stressors that came with being on the frontlines of the pandemic, she started thinking of how best to share their stories. And what followed was one of the fastest qualitative studies of her career.

Through the existing partnership, Sterling quickly recruited 33 home health care workers who worked across the city’s five boroughs. Her team conducted virtual interviews from March to April, asking the workers what it was like being part of a vulnerable workforce while caring for equally vulnerable adults who may or may not have had COVID-19 – and a time New York was considered an epicenter for the pandemic.

The NHLBI-funded study revealed that these workers experienced challenges that exacerbated the inequities they already faced. They often had to make tough trade-offs between their own health and their finances, the study found. For example, they had scant information about COVID-19 and often worked with little personal protective equipment, putting themselves at a heightened risk not only for contracting and transmitting the disease, but also for losing wages and benefits if they chose not to work.

“Being a home health worker isn’t a job where a person can work from home,” Sterling said. “We need interventions and policies to better support these frontline health care professionals who are often women but, more importantly, are mothers or daughters taking care of not only their patients, but also their own families.”

Sterling plans to conduct further studies with other key stakeholders in home care, such as home health care agencies, to better understand the scope of the problem during the pandemic.

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