With the sudden spike in unemployment due to COVID-19, millions of Americans found themselves without a job and a steady means of income. Though massive expansion of federal aid for unemployment has managed to stabilize poverty levels, many Americans still face daily struggles to pay rent, buy groceries, and care for their families. Among those most strongly affected by unemployment are patients already dealing with health conditions that can hardly be put on hold for the pandemic. 

In an effort to better understand the struggles that these patients face, I spoke with Rebeca Massey, a Licensed Master Social Worker who works with families in the pediatric hematology center at Texas Children’s Hospital in Houston. Massey recalls the widespread effects of just the initial spike in unemployment, estimating that “when it first started and Texas closed…about 80 percent of what I did was helping recently unemployed families with things like rent assistance or utilities.”  Many of the families under her care had lost employment suddenly and unexpectedly and were now scrambling to figure out how to pay bills without their usual income. Unfortunately, Massey’s experience is no exception. Over the course of the pandemic, unemployment jumped from 4.4% in March to a staggering 14.7% in April before dropping to around 13% in May, leaving nearly 21 million Americans still unemployed and patients around the country struggling to manage both financial and physical wellbeing. 

In our interview, Massey discussed the effect of unemployment on patients’ access to healthcare and treatment, showing concern that some patients may not be able to afford the treatment they need. “We don’t know if they can afford their medications, and a lot of my lower income families don’t have savings,” she explained. “So not getting paid, even for just a week, could set someone back.” 

Indeed, a Reuter’s analysis of job losses in March found that job losses were significantly concentrated in sectors such as hotels, service, and education as restaurants and schools began to close down. Many of these service industries tend to have hourly-paid workers, especially employed at small businesses. Hourly workers tend to face significant hurdles to saving money, including unpredictable income and over 75% have less than $500 in savings. For these people, even temporary unemployment can completely eliminate any savings they have accrued, leaving little left for medical bills. 

The fear that patients may no longer be able to afford necessary treatments also comes from the mass loss of employer healthcare due to COVID-19 unemployment. Families USA estimated in a recent study that nearly 5.4 million Americans became uninsured following unemployment between February and May of this year, meaning that many Americans are now unexpectedly without income or healthcare coverage. For these families, difficult decisions must be made between medications and rent checks. Even if they are able to set aside money for necessary expenses and medication, unemployment can still prevent patients from receiving telemedicine by limiting the doctor’s ability to communicate with the patient. According to Dr. Anne Peters, a professor of medicine at the University of Southern California, some patients lose access to technology that would allow them to receive telehealth such as cell phones or internet access, limiting doctors’ ability to contact and treat the patients. 

While Massey encourages patients’ families to continue searching for positions, she also acknowledges that doing so in the time of COVID-19 can be exceptionally difficult. “I have immunocompromised [patients] as well, [whose parents] don’t want to put their other kids in daycare because they don’t want to get their kids sick,” she explains “so the parents have to stay home with the children, and if that is a single parent household… it’s really hard.” Massey adds that “as a social worker, that’s really hard because I can’t watch their kids, but they need someone who can.”

Yet despite her pressing fears about patients’ ability to maintain their fiscal and physical health, Massey is vigilantly attentive to patients’ mental health during unemployment. Patients often have very little control over their situations. One cannot control whether or not they have an understanding landlord or family nearby. Massey therefore urges that patients focus on their mental health as well, recommending listening to audiobooks or trying similar activities in an effort to ease tension when there is little that can be done. She says that “especially with the primary caregiver, there’s a lot of stress … with school closures and not being able to go outside.” Families dealing with illness, unemployment and the stress of a global pandemic can become quickly overwhelmed. She explains that “I still have families that are looking for positions and are not able to find one, and they’re still struggling with having to pay their rent, and they don’t have family close.” While mental health is rarely at the forefront of patients’ minds in times like these, Massey repeatedly reminds the families she works with that focusing on mental wellbeing is not only beneficial but necessary. 

Similarly, Dr. Jennifer Sherr, a pediatric endocrinologist at the Yale School of Medicine, advocates for mental health screens on all returning patients during COVID-19, with a special focus on those who have become unemployed. “This way I have some sense of what I’m walking into,” she explains. “I can look for resources while we talk.” Screening patients who have recently become unemployed can help healthcare workers to spot potential mental health crises earlier on and can help physicians to better understand their patients when performing telehealth. Focusing on mental health can also be a good way to lend patients some sense of control over a chaotic situation, as they find themselves with a sudden excess of time and deficit of resources. 

Although helping patients who have lost employment is fairly common work for social workers, the mass unemployment caused by COVID-19 has given rise to new challenges in the healthcare system. Massey describes that resources established for patients and the beginning of the epidemic are starting to wane now several months in. “At first,” she says “a lot of our normal programs were offering COVID assistance funds … but now because it’s gone so long, a lot of those funds are diminishing.” With Houston’s COVID case count still on the rise, many local hospitals have minimized the number of elective procedures being performed and have begun to allocate more funding for COVID preparation, leaving little funding for the already overwhelmed programs intended to support unemployed patients. All these factors make dealing with unemployment during COVID-19 exceptionally hard for patients. Massey describes that “we have a set standard of programs that the family can qualify for … but because it’s being used so much, I’m running out of resources for these parents.” The effect is also compounded for single-parent households, Massey adds. “[Unemployment] puts them in a really difficult situation; a lot of my single parents are very emotionally stressed right now.” And with hospital aid diminishing, these situations are set to become harder still. “These families,” Massey says, “right now, they need someone.”

With expansions on federal unemployment benefits set to expire next month, many patients experiencing unemployment worry that their months-long struggle to support themselves, their families, and their health is nowhere near done and that the fight may become substantially harder without the extra relief from the CARES act, which has thus far managed to stabilize poverty levels during the pandemic.

In the meantime, however, patients can take action to support themselves through patient advocacy programs like the Patient Advocate Foundation, which seeks to help reduce the financial burden of the epidemic on patients and aid in insurance navigation and enrollment. Programs like these can help patients to cope with the immediate effects of the epidemic by providing assistance in decision-making and helping them better understand the options available to them. Ultimately, however, with Houston’s recovery czar predicting that business recovery could take upwards of a year, it is evident that additional measures will need to be taken to protect unemployed patients not only now, but for months to come. 

Edited by Anusha Zaman