En español | For those living at home who require the assistance of home health aides and other caregivers, avoiding others to avoid the coronavirus isn’t necessarily an option. The Centers for Disease Control and Prevention now recommends face masks be worn when social distancing is difficult to maintain. That’s often the case in caregiving situations, when it’s difficult to stay 6 feet apart. We asked health and hygiene experts for other tips on staying healthy before, during and after in-home visits by aides and other caregivers. Some answers have been edited for length and clarity.
• K.C. Rondello, a disaster epidemiologist and clinical associate professor at Adelphi University's College of Nursing and Public Health
• Carl Fichtenbaum, an internist specializing in infectious diseases and a professor of clinical medicine at the University of Cincinnati College of Medicine
• Brandon Brown, an associate professor and researcher specializing in infectious diseases at the University of California Riverside
• Brian Sansoni, senior vice president of communications at the American Cleaning Institute
Before the caregiver visit
Rondello: All presume that the home is a safe place to be, that it is protective. An individual's home is meant to be a sanctuary from the outside world, and in the midst of a pandemic, that refuge must be biologically secure as well. For that reason, we need to do everything in our power to preserve the safety of the home. That starts by limiting both the number of people going in and out and the number of times they do it. However, there are some essential services that must be done in the home, such as caregiving.
Fichtenbaum: Older adults should first check with caretakers/aides through their home care company if they have a policy of screening staff for COVID-19 symptoms or exposure each day prior to a visit. If you hire someone directly, call them the day before and ask about symptoms like fever, cough, sneezing or runny nose. Ask if they have been exposed to someone with COVID-19 in the past two weeks. If yes to either, it's probably best to avoid the visit. Whenever the caretaker arrives, make sure they wash their hands thoroughly for 30 seconds with soap and water before any care is completed. Remind them not to touch their face, mouth, nose or eyes while in the home.
Rondello: To some extent this is a numbers game. It is nearly impossible to get your risk down to zero, so the next best thing is to minimize your risk as best as you can. Every time someone comes into your home from the outside, that risk goes up a little bit higher. You do not need to live as a hermit and avoid all human contact, but you do need to make smart choices.
During the caregiver visit
Rondello: The caregiver should wear gloves around the patient, and both the patient and caregiver should cover any coughs or sneezes (followed by hand rewashing). For those responsibilities that don't require close proximity, like doing laundry or preparing meals, the rules of social distancing apply. For instance, the caregiver and patient should maintain a 6-foot distance from each other.
Brown: The caretaker should also be careful to touch as few surfaces as possible. Physical distancing and not touching surfaces may not be possible in situations where dressing, cleaning or assisting older adults with exercise are among the activities. In that case, PPE [personal protective equipment, such as gloves and masks] should be used. Additionally, the caretaker should ask the older adult if they feel any symptoms of the virus and provide a one-page laminated sheet for them which lists the symptoms, a number to call and other important information. If they have a thermometer, that is a good tool to measure potential fever. Also, ask if they have enough soap, toilet paper — and if they have mobility issues, hand sanitizer.
Sansoni: If the caretaker is caring for someone diagnosed with or showing signs of Alzheimer's or another form of dementia, the caretaker should do all of the cleaning and store all cleaning products, including liquid laundry packets, up, out of sight and out of reach in a locked closet or cabinet when not in use.
To be extra cautious, if the caretaker is retrieving packages or mail, that person may want to open the package and discard the packaging outside the home and wash his or her hands immediately after handling the package.
After the caregiver visit
Sansoni: Older adults may want to clean and disinfect surfaces that the visitor touched, which are also frequently touched by the patient. This includes things like tables, hard-backed chairs, doorknobs, light switches, remote controls and handles — there are many of them, on the refrigerator, cabinets, toilet and sink. Always follow label instructions for any cleaning product you use.
Rondello: Antimicrobial wipes are a good choice if they are available, or another household disinfectant will do (make sure to follow the instructions on the label). You can also use household beach in a solution of one-third cup per gallon of water. Remember to allow the solution to remain in place for one minute before wiping and also ensure that the room is well ventilated and you wear gloves.
When it comes to clothing or linens being brought in from the outside, do not shake out the dirty laundry. Wash the clothes using the warmest appropriate water setting, and be sure to dry the clothes completely.
It is not necessary to practice extreme measures such as leaving groceries out on the porch for three days before being brought inside. But wiping down prescription bottles, food containers and other packaging is reasonable. Once you have done so and sanitized the packaging, wash your own hands before taking the medicine, preparing the food or eating.
5 steps to disinfecting surfaces
1. Pre-clean surfaces with soap and water prior to disinfecting to remove excess dirt or grime.
2. Use the disinfecting spray or wipe as directed.
3. After disinfecting, let the surface air dry, making sure it stays wet for as long as recommended on the product label. This is critical in ensuring that the proper germ or virus kill takes place as intended.
4. If disinfecting food contact surfaces or toys, rinse with water after they air dry.
5. If using a disinfectant wipe, throw out after using. Do not flush any non-flushable products.
Source: American Cleaning Institute