One in 5 home health care workers said they experienced poor mental health — about double what typical American workers experience — a new study published Wednesday found.

The data, from a paper published in the American Journal of Public Health, looks at how home care workers evaluated their own health and well-being between 2014 and 2018. Researchers examined responses from almost 3,000 workers to a behavioral health study collected by the Centers for Disease Control and Prevention. 

The researchers compared how home care workers — a group that is almost entirely women, and largely women of color — fared against other types of low-paid health care personnel, namely health care aides and support workers. The inequities were stark. 

Poor mental health is heavily associated with anxiety and depression, conditions that are already more common in women.  And home care workers were more likely to experience not only poor mental health — defined in the study as more than 14 bad mental health days — but also poor physical health, which uses a comparable metric. About 14 percent of home care workers had poor physical health, compared to about 11 percent of the general population. 

“We know from decades of experience that this workforce, when they are out there day to day helping patients, it may come at the expense of their own health,” said Dr. Madeline Sterling, an assistant professor at Weill Cornell Medical College, and the paper’s lead author. “I view the results as a call to action.”

Because the data was all collected before the COVID-19 pandemic, it does not account for ways the past two years may have worsened health conditions for home care workers, who spent the height of the pandemic working on the front lines without government support. 

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“It’s probably gotten worse,” Sterling acknowledged. “Workers have been on the frontlines often without resources and not adequately paid, and they have gotten sick themselves. It’s draining.”

Already, home care workers were paid little and granted minimal on-the-job protections. In 2020, the median home care worker earned about $13 an hour, or about $27,000 per year, according to the Bureau of Labor Statistics. Almost 1 in 5 lack health insurance. Another 40 percent get insurance through government programs, usually Medicaid, which covers low-income people. 

Even now, workers receive no paid sick leave protections. And home care workers are one of the few classes of hourly employees who are not guaranteed overtime pay, an exclusion that dates back decades. 

Those are all factors that appeared to contribute to worse health outcomes, Sterling said.

“Even if you had access to a doctor, about 31 percent of workers felt like that access was limited by cost,” she said. “Any provisions that could improve wages, and — at least from our study — insurance status would be very helpful.”

Though President Joe Biden campaigned promising to improve pay and working conditions for home care providers, the current version of his Build Back Better plan is far less sweeping in scale. Advocates worry it won’t provide enough money to improve worker pay. There is no guarantee the plan, which faces an uphill battle in the Senate, will be passed in its current form.