Long Hours, Low Pay, Loneliness and a Booming Industry

Speaking nine months after her mother’s death, Ms. St. Laurent described how life in New York looks from Haiti — “as if money grows on trees,” she told us last winter. “From what they’ve seen on the internet, you could just go in the garden and pick up $100.”

For almost two decades, Ms. Dessin ran a day care center out of her apartment. In 2005, at 50 years old, she decided to pursue a home health aide certification. When she completed the training program that fall, she had her certificate framed.

This lure of education and financial independence also drew Helen Monah, a Guyanese immigrant who moved to New York City in 2018 and began home health care training. She texted her daughter, Rubena Durbin, photos of her progress — a stack of open textbooks and pictures of herself in glasses and scrubs. In December, she was hired by Americare.

“She was so happy to be working in that environment doing what she loved,” Ms. Durbin said.

The work itself was onerous. Apart from regular patient care, Americare home health aides are also required to provide “light housekeeping,” including washing toilets, dusting and removing garbage, according to an employee handbook obtained during the city’s 2018 investigation.

It also puts aides in close contact with their clients. They often have to lift and lower their patients, with their bodies pressed together and faces inches apart.

An executive of Americare acknowledged that in the early pandemic, personal protective equipment was in short supply, so the company gave priority to workers assigned to high-risk patients. The executive said that the company distributed information in multiple languages on how workers could protect themselves and that workers were permitted to use paid time off as needed, adding that at one point in April 2020, as many as 250 aides were quarantining.

“Numerous Americare nurses, therapists and aides said they would not be able to work due to their own underlying conditions, family concerns or general anxiety — decisions that we’ve honored and respected,” said Ms. Gallagher, Americare’s vice president.