Undocumented health care worker struggles to make things work during the time of coronavirus

Emma is 60 years old and her plans to retire are not very clear. The elderly health care worker is undocumented. Despite being part of the United States workforce and contributing with her taxes, she will not receive any retirement benefits when she stops working. 

Her concerns at work related to health have increased lately as the novel coronavirus COVID-19 continues to spread.

Emma, who declined to provide her last name due to her immigration status, is originally from the Philippines and emigrated to the United States when she was 48. For over 10 years she has worked as a home caregiver, now caring for a 91-year-old woman. She gets paid $165.50 a day a through the agency that hired her, and she stays at the house of her client five days a week.

Although she’s supposed to only work eight-hours shift, she said the reality is that she has to care for her client day and night.  

“There's no such thing as rest for us caregiver because even if we're asleep, our ears are open to any movement or any noise … You have to be alert, 24 hours a day,” said Emma.

Emma said she has been very careful with her client. “I take care of myself, you know, the proper hygiene like washing my hands, everything. I always use gloves, even before the coronavirus, because my clients provide them”.

She must be in good health at all times, otherwise she could infect her client, whose age makes her especially vulnerable to any infections.

"If you cough or have a fever she can easily get it and you don't want that because this (job) is my only means of survival”, she said.

The spread of the coronavirus has affected millions of workers who were laid off or lost their jobs due to government orders to stay home. However, workers like Emma are exempt from the order since their work is considered “essential.” 

Despite being a health care worker, Emma does not have health insurance or paid sick leave.

Immigration activists argue that the U.S. medical system should provide affordable health care to undocumented immigrants, especially at a time when the country is facing a pandemic. And they advocate for paid time off for home caregivers who work with clients who are already ill and vulnerable to infection.

“Most of the undocumented population is middle-aged people,” said Hector Plascencia-Juárez, organizer and policy advocate with the California-based #Health4All campaign. "Regardless of age or immigration status, diseases do not discriminate."

Emma says she hasn’t needed to ask for days off.

Instead, Emma diligently follows her own preventive care regimen. Before the pandemic, she would take the bus and train to her client’s house. It was about an hour ride that would cost her $3 each way.

To avoid contact with people after the outbreak began, she takes a ride hailing service, at a cost of about $37 each way, a cost she absorbs. 

 “The problem with this virus is that we don't know who is infected,” said Emma, who lives by herself in a small guest house.

She said she pays very cheap rent because she stays only two days a week there. She goes to her client’s house Friday morning and returns home Wednesday morning. 

 “When I go back to work from my day off, I take (my uniform) in a bag. When I get to work, I change immediately into my uniform”.

When it comes to her own health, Emma said she drinks a mixture of ginger, turmeric, cinnamon, and honey in a cup of warm water. 

“This prevents you from getting sick. So I'm taking this almost every day,” she explained. “Aside from this, I’m taking vitamin C and my regular supplements.”

Emma realizes she has to take care of herself. Like many other undocumented health care workers, she doesn’t have health insurance and is excluded from government aid.

“So, what we can only do is not get sick because when we get sick nobody will take care of us,” she said.

Falling ill would be costly in other ways for Emma and other in-home health care workers.  Most have no employer-provided paid sick leave and they are not automatically covered under the newly passed federal Families First Coronavirus Response Act, which provides for up to two weeks of job-protected paid sick leave to encourage employees to stay home when sick by providing them with a financial cushion.

However, many workers are not fully covered by the new sick leave provisions, including workers for large businesses with more than 500 employees, workers in small businesses with fewer than 50 employees, and health care providers and first responders, explained Elisa Minoff, senior policy analyst at the Center for the Study of Social Policy.

“This means that employers, at their discretion, can deny sick leave to workers in the health care field,” said Minoff.

Another option that could help Emma was announced Monday by California Insurance Commissioner Ricardo Lara.

He informed insurance companies that all California workers affected by COVID-19 on the job are eligible for workers’ compensation benefits, regardless of their immigration status.

This includes workers engaged in front-line occupations such as health care, emergency services, food production, sales, and delivery, among others.

“This unprecedented pandemic has sparked questions and concerns among essential workers in the immigrant community who are showing up for work every day, bringing us vital goods and services,” said Lara in a statement. “Hard-working Californians who are exposed to COVID-19 are entitled to workers’ compensation benefits if they fall ill, regardless of their immigration status.”

Unexpected diagnosis

Emma has seen how much it can help to have health care insurance when a health crisis emerges — and how costly it is to go without.

In 2009, she developed stage 1 breast cancer, which she discovered during a regular mammogram.

"I didn't feel the (mass) or anything, but the mammogram detected it," said Emma. "It is difficult because when they tell you ‘cancer’ you think you are going to die and I am alone in this country."

Emma was referred to the Harbor-UCLA Medical Center in Torrance. A social worker there helped her with the paperwork and she was able to receive emergency Medi-Cal, temporary insurance only offered to those with low incomes and without insurance during medical emergencies.

Emma said that because her cancer was detected early and was considered an emergency, she was able to start her treatment immediately.

She had lumpectomy surgery — where only the tumor is removed without removing the breast — and subsequently received four chemotherapy sessions, 33 radiation sessions and had her ovaries removed, all at no cost. She estimated the total value of the care was over $100,000.

Emma said that she feels very fortunate to have received her health treatment on time, something that does not happen frequently in the undocumented community.

When she had a painful back injury a few years later, that did not qualify as an emergency and she could not quality for emergency Medi-Cal. Uninsured, she ended up with $7,000 in debt for her health care and time off — a crushing load on her modest income.  

It was that experience that turned her into an advocate for expanding health care for the undocumented. And she feels especially passionate about the issue now that the world is confronting COVID-19.

"There are many undocumented people like me who do not obtain the same benefits even if we work the same or much more," said Emma. "So, I think if I can be that little voice that can open the eyes and ears of legislators, I will.”

The Affordable Care Act allows families to get affordable health insurance, but it excludes undocumented immigrants.

Undocumented immigrants are also excluded from accessing the ACA’s state insurance exchange, known as Covered California, to purchase coverage with their own money.

Each county and city has their own policy on offering health care services to undocumented immigrants.

During the coronavirus pandemic, hospitals and clinics or doctors can identify COVID-19 treatment as an emergency treatment, which would be covered under emergency Medi-Cal, according to the Los Angeles County Department of Public Social Services.

The Trump administration recently expanded a rule that blocks the path to citizenship for immigrants who have benefitted from Medicaid, food stamps or federally subsidized housing. In light of the pandemic, U.S. Citizenship and Immigration Services recently relaxed the so-called “public charge rule” and stated that any preventative services testing or health treatment related to COVID-19 will not be factored into any future public charge test for immigrants.

“So, if you are concerned, you think you may be ill or you want to access health care services — even if you're not ill but you're concerned about the pandemic that the world is experiencing right now — this will not impact you,” Daniel Sharp, chief of the Office of Immigrant Affairs of LA County, said recently. “In the future, when you apply for immigration status this will not count against you in any future public charge test.”

Becoming an activist

In 2019 Emma shared her story in the documentary “CoverAge” by filmmaker Set Hernández-Rongkilyo, a young undocumented DACA beneficiary. She currently volunteers at the Pilipino Workers Center where she informs others about health coverage options for those who are undocumented.

Emma said her relatives in the Philippines are impressed with the change she has undergone since she became involved in activism.

“During the coronavirus all I can do is take very good care of myself,” said Emma.

CoverAge documentary will broadcast online live on 4/29 followed by a discussion about healthcare expansion for undocumented. You can RSVP here to receive the link to the film.

If you or anyone you know is undocumented and is looking for medical services during the pandemic the following agencies can help you: 

Office of Immigrant Affairs of LA County (OIA) 1-800-593-8222

https://oia.lacounty.gov/coronavirus-updates/

My Health LA (844) 744-6452 

http://dhs.lacounty.gov/wps/portal/dhs/mhla for a list of their clinics.

Emergency/Restricted Medi-Cal (866) 613-3777

http://dpss.lacounty.gov

For information about workers compensation:

http://www.insurance.ca.gov/01-consumers/105-type/85-wc/

Follow the USC Center for Health Journalism Collaborative series "Uncovered California" here.