Although they live in one of Philadelphia’s most crime-ridden and unhealthy neighborhoods, North Philadelphia’s community of Latino elders has the benefit of having one of the city’s most diverse health care workforces, says University of Pennsylvania Nursing School faculty member Adriana Perez, who provides care and conducts research there.

“The question of disparities and COVID-19’s effect on older Latino adults who are already experiencing disparities is an important one, and the diversity of the health care workforce here is a real asset,” said Perez, PhD, ANP-BC, FAAN. She is an Assistant Professor at Penn’s School of Nursing, an LDI Senior Fellow, a board-certified Adult Nurse Practitioner at North Hancock Mercy LIFE in North Philadelphia, and past Chair of the Expert Panel on Aging at the American Academy of Nursing.

COVID-19 and dementia patients

“A strength of North Philadelphia is that its health care workforce does mirror the community,” said Perez. “Generally, if you have an elder experiencing the symptoms of COVID-19 who only speaks Spanish and is not accompanied by a loved one during this period of lock-down, it presents even more challenges for the medical team taking care of that person.”

“But here, I’ve been pleasantly surprised at how my colleagues are very diverse,” Perez continued. “There are Spanish-speaking staffers at all levels — nurses, primary care providers, nurses’ aides.”

For all minority elders, the workforce becomes so much more important during this pandemic. When people are without their families, having someone that understands their language and culture and knows what their challenges are really makes a difference.

Adriana Perez

“For all minority elders,” she said, “the workforce becomes so much more important during this pandemic. When people are without their families, having someone that understands their language and culture, and knows what their challenges are, really makes a difference. For me, it also highlights why health care in general needs a workforce that reflects the people it takes care of.”

Elder dual eligibles

North Hancock Mercy LIFE is a center in the national Program for All Inclusive Care of Elders (PACE) that provides comprehensive medical and social services to frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits.

Like all other health facilities, the center has made drastic changes in recent weeks, including a close down of its senior center, physical therapy, occupational therapy, adult day care, and meals programs. Its primary care operations remain open but are being switched as fast as possible to telemedicine mode.

A primary care provider at Mercy, Perez uses the trusting relationships with her patients to identify subjects for her studies of  the impact of community-level factors on the overall wellness of older Latino adults with chronic illnesses. The work is funded in part by a Center for Improving Care Delivery for the Aging (CICADA) grant from the National Institute on Aging. Like other academic researchers, she is shifting to lock-down conditions and remote communications in both her clinical and research work. But that isn’t easy with a cohort of frail patients, many of whom have Alzheimer’s and various other kinds of dementia.

Spanish language COVID flyers

“A lot of what we do has moved to email and phone connections, and a coalition of Latino organizations pulled together to help,” said Perez. “The Philadelphia Corporation for Aging (Latino Advisory Council) and other nonprofits have set up areas where family members can come by to pick up meals. Some of the organizations have been putting together Spanish language information sheets about COVID-19 and how to keep family members safe. It has helped dispel myths and uncertainties.”

Perez noted that beyond the elder population she cares for, the Philadelphia-area Latino community subgroup she is most concerned about is undocumented workers. 

“Unfortunately, these immigrants will be impacted more severely by the pandemic,” she said. “Most of them work in essential jobs — they make food or they harvest food, or they work as dishwashers or in service areas. So, they continue to go to work and often work in close quarters. At the same time, many are at high risk for diabetes, hypertension or chronic conditions that put them at higher risk for COVID-19.”

Health care access disparities

“These immigrants,” Perez continued, “are distrustful of who they could actually go to see for health care. They don’t have access to primary care and there are only a limited number of organizations that service their health needs. The majority don’t have access to health insurance and don’t qualify for any benefits under the Affordable Care Act. The most recent COVID-19 stimulus package — the CARES Act — doesn’t include them. These are reasons I think this group will be the most vulnerable during this outbreak.”

Aside from her work in North Philadelphia at Mercy LIFE, forty miles to the southwest in Chester County, Perez has been studying how to improve health and health care for aging populations of immigrant mushroom farm workers.  A year ago, that work came to also involve two Penn students who were her mentees — José Maciel and Antonio Renteria. The two received the 2019 Penn President’s Engagement Prize for their proposal to build a community-based nutrition and health curriculum for Kennett Square farm workers.

Locked down mushroom farms

The final phase of that project was disrupted by the rise of the COVID-19 crisis that closed the farms to outsiders, Perez said. Maciel and Renteria are using phone methods to continue gathering some the information they need to finish, but the lockdown of the farms to outsiders has made it impossible for them to gather the full range of biometric data they had hoped to record.

But it hasn’t discouraged them. “While José and Antonio are finishing this project, their focus is long term,” said Perez. “They want to be researchers involved in improving the lives of farm workers across the country, especially those who are Spanish-speaking immigrants.”

Perez continues her own work as best she can under the restricted conditions and remains concerned for the welfare of the workers still manning the mushroom farms as COVID-19 continues to spread throughout the state. She notes the Pennsylvania Department of Health and Human Services, the United Farm Workers, and a number of other advocacy organizations are gearing up to help.

Workforce worries

“I think a lot of farmers who run these businesses also see how much they rely on these workers and how much better off everyone will be if that workforce is kept healthy,” said Perez.

“I hope what comes out of this crisis is a better national sense of how important these immigrant workers are to our country’s daily life,” said Perez. “We rely on them for what we eat; these people feed us. What would we do without them? And to imagine that situation is inconceivable to me — and should be for everyone else.”