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En español | Before the pandemic, Laura considered Mary and Courtney, the two home health aides who helped her care for Louis, her husband with dementia, as trusted, beloved, unofficial family members. She relied on Mary to arrive promptly at 8 each morning to gently cajole Louis out of bed, into clean clothes, and onward to the breakfast table. She ran errands on the two afternoons a week that Courtney spent with him drawing funny pictures and singing songs. Whenever either of the aides was there, both she and Louis felt a little more upbeat.
But Louis also has COPD, diabetes and high blood pressure, conditions that make individuals more vulnerable to COVID-19. Afraid of having people coming in and out of the house and possibly infecting him, Laura reluctantly told the aides to take a break for a while. She would handle all the caregiving tasks until the danger passed.
Now, six months into the pandemic, Laura is exhausted and worried she made the wrong choice. She knows she lacks Mary's patience or Courtney's bubbly personality and instead becomes irritable when Louis lingers for hours over breakfast or sits slumped in his armchair in a fog. She assure herself that the home care agency has now equipped the aides with the personal protective equipment they need. But then she wonders guiltily if, by inviting Mary and Courtney back into their home, she would be risking her husband's health just to reduce her own stress.
Family caregivers in general have recently been anguishing over these matters of safety. If their relative lives in a residential facility, such as a nursing home, where others have already contracted the coronavirus, then they have debated about whether to bring that loved one home. If they and their relative already live at home with support services, such as home health aides, then they have debated about whether anyone should be allowed in to help with care — or, if so, when. Being pressed by friends and family members, often with conflicting advice about how to proceed, only adds to the confusion. How can caregivers make the most prudent choice under uncertain conditions when there's no clear-cut right answer? Here are some ideas:
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Work with a home care agency that has a well-considered COVID-19 plan
Most (though not all) home health aides work for agencies that schedule and support their work. Their policies can make the difference between risky and safer home care services. Ask the agency director: What training are you providing the aides you hire for taking precautions against the spread of infection? Are you giving your aides enough personal protective equipment (PPE) to don a fresh mask and gloves whenever they go from one household to another (rather than using the same equipment all day or week long)? How are you determining if the aides are healthy? Frequent testing? Taking temperatures and pulse-oximeter readings? The answers to these questions should be detailed and specific. If the agency director has no answers, then find one who can provide greater assurances.
Work with aides ready to ease your concerns
Effective home health aides are personable, dependable and trustworthy. That's how close and lasting relationships are formed between them and you. You could ask yourself these important questions about any aide you'd consider employing: Is she dependably safe? Does she wear her mask properly and wash her hands often? Does she respond positively or defensively if you ask her to take further precautions, such as changing her shoes when she arrives or, when not providing hands-on care, maintaining social distance in your home?
Seek local information and expertise
School districts around the country are making hard decisions about when to resume in-person classes based on the amount of coronavirus transmission in their communities. A similar approach could influence your decision about whether to bring health aides into your home. If the number of COVID-19 cases in your neighborhood is low, then there is greater likelihood that an aide will not spread the virus. If it is relatively high, as it continues to be in some parts of the country, then it may be too soon to try to get back to normal. Your care recipient's health care providers can take that local information and your loved one's specific health issues into account to offer further guidance. Then you can decide — weighing local conditions, medical advice and what's going on in your home — the best option for you, the person you're protecting and the rest of your family.
Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.