HOUSTON — Florenstine Johnson had heard that a global pandemic was spreading. But the 76-year-old Houstonian also had a funeral to get to.

She flew back from the proceedings in Maryland a few days ago, to a city under siege. Now Johnson is praying the decision to go won’t cost her a paycheck, let alone her well-being.

“I believe in the Lord Jesus Christ, but also wisdom,” she said, “so using hand sanitizer.”

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Johnson is one of about 70,000 home health aides across the state, men and women who earn little above minimum wage to care for the elderly and those living with disabilities, among the most vulnerable to severe or fatal reactions to the new coronavirus.

They are not trained medical professionals, but handle essential tasks like cooking, cleaning, bathing, picking up groceries and prescriptions. Sometimes they are the only people a client sees all day.

With the virus starting to ravage cities such as Houston and San Antonio, many aides, their employers and the people they care for are struggling with questions like whether they should continue working, whether they can afford not to, and how will their clients get by without them.

“Many of them are in this field because they’ve cared for people most of their lives,” said Pat Whitten-Lege, who helps run In-Home Attendant Services, in Houston. “So they have good hearts and are bonded to their clients, but they’re also worried about their own families. What are they going to do if they don’t get paid?”

Anxious clients, no masks

Aides are now told to monitor their own temperatures before entering homes, and to stop working if they have fevers, coughs, shortness of breath of sore throats — symptoms most commonly associated with the virus. Some home health companies have discussed sharing staff if shortages emerge. Many are frantically searching for face masks and other medical protective gear, often to no avail.

“The No. 1 challenge is trying to give our staff protective gear,” said Al Visram, a co-owner of Crescent Home Health, in Houston. “Gloves aren’t really a problem. Masks I can’t find.”

As the crisis deepens, many are worried. Ashley Sherrard, who lives in Kaufman, just east of Dallas, had to turn her son’s aide away because her boyfriend is a paramedic. Sherrard’s son, Walker, has heart and lung defects, as well as an immune deficiency. He has already been hospitalized once this year for pneumonia.

“I think she was a little surprised, but she totally gets it,” Sherrard said of the aide, who has also had to stop her second job, as a substitute teacher. “She wants to put his health first, because she knows how bad it is when he gets sick.”

Bernadette Fields, who runs Bernadette Fields Healthcare south of Houston, said one of her aides quit because she was afraid to ride the bus.

“I had another worker who called me and I said don’t panic,” Fields said. “I just tell them they have to follow protocol and continue doing everything they’re doing. That’s the best thing they can do, wash their hands and sanitize.”

Johnson, who works for Fields, said she returned to her elderly client earlier this week, though the woman was initially concerned about being exposed to the virus.

“I reassured her and she’s comfortable with it,” Johnson said, adding that she will stop working if she develops symptoms.

“I can’t afford it,” she said, “but I will do it.”

$10.50 an hour, no paid sick leave

Visram’s employees don’t all have email, making it hard to get them daily updates during the crisis. He and his wife, Rosaura, who run the company together, had planned to host a training at their office but were forced to cancel after the city banned large gatherings.

Their administrative staff has been frantically calling aides to make sure they complete an online webinar about enhanced hygiene during the crisis.

But with many aides already struggling to make ends meet — attendants in Texas earn on average about $10.50 an hour, according to the federal Bureau of Labor Statistics, and don’t receive benefits — there is a strong incentive to continue working even in the face of exposure. The hourly rates are in large part determined by Medicaid.

“This is the single largest issue that I’m hearing about,” said Dennis Borel, who heads the Coalition of Texans with Disabilities. The state last estimated, in 2015, that there were about 1.2 million people receiving care from home health aides.

Many of them, Borel said, stake their independence “on someone who gets very low pay and doesn’t have sick leave. That’s what the big concern is: Are they going to get the same level of attendant care? Are attendants going to feel they need to come to work if they’re sick? That key person, is that person going to be available?”

Parents and patient advocates are hoping that proposed federal stimulus money can help relieve the financial burden on aides, most of whom are women and non-white, and that state lawmakers can provide additional relief, such as temporary paid sick leave.

Washing hands til they sting

Mary Morris, a 76-year-old aide who works for the Visrams, receives a retirement stipend but said this job allows her to depend less on her children for help.

As news of the pandemic heightens, Morris is becoming even more devoted to an already stringent routine.

She is taking her own temperature each morning, wearing gloves, carrying hand sanitizer and sterilizing her client’s room each time she leaves. She has a mask but hasn’t worn it yet because she’s afraid her client, a woman in her 40s who is recovering from a stroke, won’t react well to the change.

“I had to talk to her about the gloves,” Morris said. “She’s very sensitive about changes like that.”

Vera Johnson, a 59-year-old aide who has her own disability, said she can’t afford to stop working. Her husband died a few years ago, she has children, and her mother, who has asthma and Alzheimer’s, is now living with her. Her air conditioner also recently stopped working.

“I find I’m washing my hands so much that they’re stinging,” Johnson said. “They’re so dry.”

She said her elderly client loves to walk, and they normally make four laps around her apartment complex. That had to stop.

“She’s just very scared to go outside,” Johnson said.

Johnson couldn’t talk anymore, though. Her daughter was calling. They needed to go shop for emergency supplies.

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