About a couple of years ago, I discussed the fact that we completely undervalue home health aides. This remains unchanged, but what has changed is their value to us and this includes nurses’ aides working in facilities. I say that even as we’re still in the middle of a global pandemic with a fair amount of the sickness and dying happening among those in the medical profession—whether doctors, nurses, aides, or support staff.

I am singling out nurses’ aides because of the unique position they hold in the medical food chain. Nurses make a good living and have a variety of options open to them in terms of career paths; doctors are doing alright as well. But at the bottom of that hierarchy are nurses’ aides, including home health aides, who are very much on the front lines but without much recognition and without the wages or supports.

This pandemic has brought the issue into sharp focus. We expect nurses’ aides and home health aides to show up for work even when the risk of becoming infected and dying from Covid-19 has made the job something of a crap shoot. Aides, whether working in the home or in a facility, earn between $25,000 and $35,000 a year, give or take, and the increasing minimum wage has been a step in the right direction. Despite this, a fair number of these essential workers still need public assistance just to make their bills. Many also have little in the way of health insurance.

Part of why we undervalue nurses’ aides is because they are generally associated with the dirty work of medicine. By that I mean emptying bedpans and urinals, changing soiled sheets, turning patients, and cleaning up all manner of mess and squalor that the human body can produce. Though many of us won’t admit it, we assume that anyone who does such work can’t do much better—we wouldn’t choose it—so those who do must be limited. Thus, we undervalue them.

Yet, we want to call them heroes on the front lines, especially when the job comes with a fair risk of dying. These aides are often the first person our loved ones see in the morning when they wake up and the last ones they see before they go to sleep. When the pandemic hit, at least early on, they were often the only ones our loved ones saw, doctors and nurses notwithstanding.

It’s worth noting that the position of nurses’ aide is almost always held by women and likely to be held by a black or brown woman. Could this be part of why the job is undervalued and undercompensated? That would be my guess.

It’s not that gender, race, and ethnicity has to be part of every discussion, but it already is whether we want it there or not. Because of other systemic problems, such as deficient schools, over-policed communities, disparities in sentencing, lack of access to credit, exploitative lending practices, and other things that gut communities (including low expectations), nurses’ aides are more likely to be female minorities than not because that’s the rung of the ladder available to them.

With the pandemic and the inability of family to visit relatives in hospitals or nursing homes, how much more valuable are nurses’ aides? This pandemic has brought their worth, like that of doctors and nurses, into clear relief and we would do well to acknowledge that value with more respect and better pay.