6 Questions to Ask Your Home Health Aide During the Pandemic

Everyone's health requirements are different, and the decision comes down to the individual or their representative. It's worth bringing your care providers into that conversation.

2. Do you offer telemedicine?

Many home-care agencies are connecting with clients over video, phone, email, an app, online portal or other technology to reduce person-to-person contact during COVID-19. While some common types of assistance — dressing, bathing, feeding — cannot be provided via telehealth, many home care agencies have been shifting to telemedicine where possible.

Ken Albert, president and CEO of Androscoggin Home Healthcare and Hospice in Maine, says his agency's use of telemedicine has increased by 33 percent during the pandemic. “Our clients are quickly becoming accustomed to the technology,” he says. “It's been a great adjunct, allowing us to decrease the number of in-person visits while maintaining quality care.”

It also has been beneficial in instances when individuals or families are uncomfortable seeing a provider for an in-person visit, due to a perceived risk of COVID-19 exposure or otherwise. It allows patients to receive the care they need in an environment that they are comfortable with.

But the capabilities of telemedicine vary greatly from agency to agency; While Johns Hopkins Home Care Group recently completed its first-ever in-home intravenous immune globulin infusion using video technology, other agencies may not have the resources to provide even basic video calls. Ask what's possible, and whether switching from in-home visits to telehealth will affect your level of care in any way.

Also check whether your health care coverage — be it Medicare, Medicaid or a private insurer — is covering the telehealth service. While there are extensive waivers that grant telemedicine coverage during the pandemic, there may be some exceptions.

3. Are you or others at the home care agency caring for any COVID-19 positive individuals? If so, will any of those providers or staff be assigned to me?

A May survey by the NAHC found that 63 percent of home health agencies nationwide were treating patients who had tested positive for COVID-19, says Dombi. In “hot spots” within New York and New Jersey, 83 percent of agencies were taking on COVID-19 infected patients.

Most agencies who are treating positive COVID-19 patients are, to the best of their knowledge, separating their workers into those treating positive COVID-19 patients and those who are not, says AARP's Stephen. During New York's surge in COVID-19 cases in April and May, COVID-19 positive patients experienced longer wait times for visits from in-home heath aides because most agencies were keeping their staff separate, he says.

Although this is generally what agencies are doing, “you still want to ask, to make sure,” he adds. If your carer is treating both categories of individuals, be extra thorough in asking about their infection control protocols (more on that in questions 4 and 5). Also be mindful that they may be treating a positive patient without knowing it; the incubation period for COVID-19, which is the time between becoming infected and the onset of symptoms, is on average five to six days but can be up to 14 days, according to the World Health Organization.

4. What infection control protocols are in place?

Taking heightened infection control measures and effectively communicating them to individuals and their families should be an agency's top priority right now, says the NAHC's Dombi. “Basically, the question is: ‘How are you keeping me safe?’ “ he says. “And the answer should provide significant details, not just, ‘We follow CDC guidelines.’ “

If this information is not provided, ask if and how often staff members are being tested; if clients are being screened before visits; how often equipment is being sanitized; what disinfecting practices are being used; what social distancing measures are possible; and what quarantine protocols are in place if a staff member contracts COVID-19.

Questions can go beyond official protocols, says AARP caregiving expert Amy Goyer, to gauge a particular staff person's potential level of exposure. She recommends asking: “In what ways are you interacting in the community? Are you shopping in stores, eating in restaurants, going to friends’ houses or attending religious services or other group activities? If so, what safety precautions are you taking?”

5. Do you have enough personal protective equipment (PPE)?

A critical factor in COVID-19 infection control is PPE; it should come up in any discussion on infection control, particularly because home care agencies have experienced shortages.

"The availability of personal protective equipment seems to have improved,” says Dombi. “Has it improved enough, though, is the question,” he says. “Certainly, the supply of surgical masks, gowns, gloves have improved — N-95 masks are still on the tougher end — but the price of them all is significantly greater. You're looking at things that are 10 to 15 times the price of what it used to be, and that's created some difficulty.”

If your aide or agency doesn't have adequate levels of PPE, ask what the plan is to obtain it and what safety measures are in place in the meantime. Also check whether they have been trained in how to properly use PPE.

6. Will care still be provided if my loved one or I contract or show symptoms of COVID-19 or if we're exposed to someone with the virus?

Several legal and business factors come into play in determining whether an agency that supplies home care aides can service a positive COVID-19 client. Inadequate PPE and staffing levels may also be a factor, hindering their ability to do so.

Whether a worker legally can care for a positive COVID-19 patient is a different question than whether they will, though. “We are getting reports of staff that are not able to care for patients because they've got childcare responsibilities, or health care needs of their own. And still, there's some fear factor for the staff,” says Dombi.

"But most of the home care companies have told me that they've worked around that; that they've got staff who are willing to care for infected patients, then those who are not, and they're able to assign people accordingly,” he says. While care may still be provided by the agency, be mindful that your usual worker may not be assigned to you in this instance, due to arrangements like these.