It isn’t unusual for Shalonda Ellis to wash her hands 20 times during a six-hour shift.

Seven or eight people a day come and go from the Northeast Philadelphia home of the woman Ellis cares for, and a few aren’t particularly concerned about spreading the coronavirus. But Ellis knows enough to be terrified of bringing the virus home to her own family.

“Everything you touch, everything you do, you’re trying your best to be mindful,” said Ellis, 47. “I bought that hand soap Tuesday and it can be gone by Friday.”

Ellis is among the estimated 75,000 home health aides in Pennsylvania, many of whom are working through the pandemic out of compassion, financial pressures, or both. Pre-pandemic, the job was labor-intensive and thin on rewards. Pay is generally poor in a field overwhelmingly staffed by women; paid time off and employer-provided health care are rare, said Ali Kronley, director of the United Health Care Workers of Pennsylvania. The coronavirus has exacerbated workers’ challenges.

“They’re just exceptionally essential workers who are providing care at extreme risk to themselves and their families,” she said.

Ellis’ coworker at Philadelphia’s Liberty Resources Home Choices, Christal Spivey, 40, used to take the bus to work. SEPTA’s pandemic-prompted switch to limited service, and her concern over picking up the virus from a fellow passenger, have her using much more expensive ride share services instead.

“I’ve been avoiding the bus since COVID,” Spivey said. “I know eventually I’ve got to get back on the bus.”

She never knows where she’ll be assigned each day. To protect her 12-year-old daughter and twin 10-year-old boys, she hasn’t seen them since mid-March. An older daughter is in Florida and her 16-year-old daughter is staying with her.

“It’s hard,” she said, “because I like to hug my babies and give them kisses.”

Amid the too-frequent accounts of health-care employers that are short on supplies and support for their workers, Liberty Resources Home Choices is an outlier. It is one of the few home health care agencies that has created a working partnership between management and its 650 unionized home care workers. This has included bonuses, paid sick time, and consistent, honest communication about the health of both staff and the people they care for.

“There’s no other company or agency out there that looks out for their attendees like Liberty does,” Spivey said.

The company, a for-profit arm of the nonprofit Liberty Resources, scrambled to get protective gloves from places as unexpected as a NAPA auto-parts store. Now home health workers are delivered personal protective equipment (PPE) every Friday as needed. The nationwide mask shortage led Liberty Resources’ staff to make their own protections.

“Our own staff were sewing cloth masks for consumers and workers,” said Fermina Maddox, the company’s executive director. “We have had the best of people coming together.”

Liberty Resources pays more than the average hourly rate for home health workers, about $11.25, Kronley said. Its attendants each received a $750 one-time bonus at the beginning of the pandemic, and are getting an extra $2 an hour, plus $50 weekly transportation supplement, since April 24.

The work remains inherently risky. Four workers have tested positive for the virus. An additional six are showing symptoms. The toll among their clients is worse. Three have died and 18 have tested positive. That information is shared with employees, Maddox said.

“Staff are going to want to know ‘How many people are going to be exposed? Am I going to be exposed? ’" she said.

Some Liberty Resources workers are caretakers for their own parents, and in a few cases both tested positive and quarantined together. One worker who cared for her mother was close to death, Maddox said, but is recovering and returned home Tuesday. The woman’s elderly mother, though, did not survive.

Another Liberty Resources worker’s father died April 24 of the virus. Carl Ballou Jr., an 83-year-old retired city sanitation worker, suffered from COPD and cancer. His son, Antwan Robinson, cared for him for the last seven years.

“When they said he needed long-term care, my father didn’t want no stranger in his house,” he said. “The best thing was for me to do it.”

Liberty Resources workers exposed to the virus take paid sick leave for 14 days and receive information on how to be tested. The company also does contact tracing. But it does not provide workers with health insurance; most get it through a family member or the Affordable Care Act exchanges, Maddox said.

In recent days, protests, looting, and police activity have emerged as new hazards. Spivey was stuck at a client’s home for an hour after her shift ended Sunday because of demonstrations in West Philadelphia. She wasn’t able to find a ride-share service willing to pick her up in the neighborhood until midnight.

But the most concerning part of the work remains contact with people who don’t take the virus seriously.

Ellis works from 6 p.m. to midnight, caring for a woman who is largely bed-bound because of a leg injury.

Some of the woman’s children are helpful, but one son doesn’t believe the virus is a threat and takes no precautions against it. So Ellis tries to minimize her interactions with the family, and stays out of their kitchen, keeping nuts and fruit in her purse for dinner.

“I figure the less I say, the less I gotta talk to you, the less I gotta worry about being in your space," she said.

Ellis considered quitting when the pandemic began. She normally would be working 63-hour weeks with multiple clients, but has scaled back to a 24-hour week with a single client. It was not an easy decision to keep even those hours.

“Who’s going to take care of them?" she said. “Yeah, they’ve got families, but guess what: The families ain’t taking care of them. If they was, I wouldn’t be there.”