En español | Just a few weeks ago, Ruth Rofs, 76, was preparing to welcome professional caregivers into her Indianapolis home for the first time. The plan was that they would come twice a week, for four hours each day, to help with her 80-year-old husband, James, who has congestive heart failure and dementia. “But I think I'm just going to wait,” Rofs says, noting that the number of confirmed COVID-19 cases in Indiana is climbing. “I just don't want him to get exposed to something that's coming from another patient. I need help, but I'm afraid.”
Rofs isn't alone. Every year an estimated 12 million Americans who are infirm, chronically ill or disabled depend on some form of in-home care, according to the National Association for Home Care and Hospice (NAHC). Many are 65 or older and have serious underlying medical conditions, placing them in the high-risk category for severe illness or death if they contract the novel coronavirus.
But physical distancing, as the federal government advises, is particularly difficult during in-home care, which often requires close contact for tasks like bathing, grooming and feeding. “Remember, though, the reason health care workers are going into people's homes is because those people need care,” says NAHC President William Dombi. “And those needs are still there in spite of the pandemic. If they don't get the care they need, they may end up in the ER, and that's not the place for them to be right now.”
To continue needed in-home care, nurses, hospice attendants, personal aides and therapists are taking extra safety precautions to mitigate the risks of transmission and keep their patients as safe as possible. For registered nurse and hospice case manager Lisa Ewing, the day starts and ends with self-monitoring. Her agency, Androscoggin Home Healthcare and Hospice, located in Maine, requires all staff to take their temperature and assess their wellness, then report that information to their supervisors. Patients are also screened using the Centers for Disease Control and Prevention (CDC) protocols before visits. “We are checking for fever, shortness of breath, a cough and whether they have had exposure to anybody that's been in a hot spot,” Ewing says.
She then gears up accordingly. “If symptoms are presenting, but there's been no known exposure to COVID-19, we wear goggles, gloves and regular surgical masks,” she says, noting that her agency also has the more protective N95 masks on hand, should staff need to care for patients with the coronavirus.
Where possible, Ewing is cutting down on in-person visits and opting for telecare, such as phone and video calls. “Patients who I usually visit twice a week now want me to come just once a week, so I'll do a telephone visit for their second session instead,” she says. “I'm being extra careful when I call them to make sure they have what they need: medication, supplies, etcetera.”
Stepping in to help nurses with this kind of patient support are other in-home aides, like Jessica Butler, who also works for Androscoggin, as a physical therapist. “Our role as therapists has shifted a bit,” she explains. “We're playing backup to the nurses because they are just so busy. If there are things that we can do within our practice, we're picking those things up.” For Butler that includes monitoring her patients’ mental health. “The biggest concern for a lot of them is being isolated and not being able to access the outside world,” she says, “so we're stepping up those wellness checks.”
Outside of work hours, precautions persist. For registered hospice nurse Staci Long, of Premier Hospice and Home Health in Indiana, that means leaving her shoes at the front door and putting her scrubs right into the washing machine after she gets home from a shift. From there, she's regularly washing her hands and disinfecting surfaces in her house and car — “Lots of Clorox wipes.”
At home, Long stresses to her 18-year-old son the need to follow the government's coronavirus-prevention guidelines and how important it is for the whole household to stay healthy so she can keep caring for her patients. “He's been really, really good,” she says. “He's always double-checking — ‘Hey, did you wash your hands when you came in?’ — so I know he's thinking about it and doing the best he can to keep us safe.”
Ultimately, in-home aides are on the front lines of the crisis, just like other health care workers. “A pandemic is worldwide, but the infections and the crisis that a community is experiencing are local, so the response needs to be local,” says Brent Korte, executive director of EvergreenHealth Home Care in Washington. “One great thing about home care and hospice is that we are inherently community-based care. We were here before COVID, we'll be here after COVID, and we can respond to those very unique community needs."
What to ask your caregiver
• What extra precautions are you taking? Heightened infection control is being adopted across the nation, so visits are likely to involve more health screenings, steps and personal protective equipment than normal. Patients with underlying conditions, particularly respiratory ones, may be monitored more thoroughly. Many agencies are posting their action plans online or sharing them with patients via phone calls or information brochures.
• What care is necessary right now? The CDC recommends that nonessential health care appointments and procedures be canceled during the pandemic, for the purpose of practicing physical distancing. Ask if there are visits you can cut or condense for now. It can reduce your risk of exposure and also ensure that health care workers are available for those who are in need.
• Is telecare available? Phone calls, video calls, email, health apps and other technologies may be available to reduce your person-to-person contact.
• What’s my care plan? Routines change during a pandemic, which means your health care may too. If changes are being made, establish a plan with your aide and a family member, if possible. Go through the CDC’s COVID-19 guidelines, enlist emergency contacts and a support network, check your medicine and household supplies, work out how you’re going to stay virtually connected to loves ones, if needed. If family caregiving is being substituted in for your regular home care, creating a care plan is essential.