By Emily Gurnon May 5, 2020
With high rates of COVID-19 infections in hospitals and nursing homes, and stay-at-home orders in force, the message we’re getting is clear: The safest place to be is within our own four walls.
But what if a loved one, or you, needs daily assistance? What if health or mobility challenges mean depending on others coming in to provide care, meals or medications? If so, precautions are in order to avoid contracting the coronavirus from the very person who is there to help.
“People have to weigh the need for the care with the risk of having more people in the home,” said Mollie Gurian, director of hospice, palliative and home health policy for Leading Age, an elder advocacy group.
“A lot of home-health agencies are seeing a drop in service, and I think part of that has to do with people being scared to have [workers] come in,”
Those who need skilled medical care, like tube feedings or changing wound bandages, may not have a choice. Others who use a home health aide for tasks like bathing or dressing may be able to limit the outside help.
Keeping Everyone ‘Clean’
For Brian Owen of Boston, hiring two private health workers was the best alternative for his 93-year-old father Dennis — and Owen and his siblings went to great lengths to make sure the workers wouldn’t present a threat to their dad.
Dennis Owen had been living in a Syracuse, N.Y., hospice, but COVID-19 led the facility to cut the number of its residents in half. As one of the stronger ones, he was forced out. His children decided to move their father closer to two of them, at a hospice in Scituate, Mass., near Boston. Before their dad could move in, however, they needed to quarantine him for at least 14 days.
That’s where things got complicated.
The family found a rental, part of a local resort that was nearly empty because of the pandemic. They scoured it from floor to ceiling, then set out to find two people willing to live there full-time with Dennis. The workers had to agree not to see anyone else, or even go grocery shopping. Brian’s sister would deliver the groceries.
It was tough finding candidates who could commit to the quarantine. “That’s very hard for people to do that, they have obligations, family,” Brian said. The family eventually succeeded, through Craigslist postings and interviews. Dennis Owens is now settled into the new hospice.
Shrinking Numbers for Home Health Agencies
Others looking for care have opted for home health agencies, though client numbers have seen a steep decline since COVID-19 began taking off in the U.S.
Chris Zayid, owner of Affinity Home Care Agency of Commerce Township, Mich., said his company has lost roughly half of its clients. In New York, the site of more than a third of American deaths from the coronavirus, nearly half of home health care agencies reported in March that they’d had patients or family members refusing entry to home-care personnel, according to a survey by the Home Care Association of New York State.
“A lot of home health agencies are seeing a drop in service, and I think part of that has to do with people being scared to have [workers] come in,” said Gurian.
Another factor, she said: With fewer people undergoing elective surgeries because hospitals aren’t scheduling them, fewer patients need help with recovery at home.
The concern about the virus’s spread among older adults is hardly unfounded. Eight out of 10 deaths reported in the U.S. from COVID-19 have been in adults 65 and older, according to the Centers for Disease Control and Prevention (CDC).
The Search for PPE
Like hospitals, the home health industry has been acutely impacted by the lack of personal protective equipment (PPE) such as masks. Hospitals, nursing homes and other congregate facilities take priority over home health for those supplies.
Joy Ekpo, CEO of Destiny Home Health Agency, of Morena Valley, Calif., said the lack of PPE has been a pressing concern.
When COVID-19 cases began rising in March, “we reached out to the emergency department of Riverside County, we sent emails to multiple locations and we were just outright told there is no PPE,” said Ekpo.
Her agency has ordered the N95 mask, the best protection from the virus, from wherever it can. Otherwise, its workers make do with surgical masks and cloth masks, even the homemade variety donated by people in the community.
The PPE situation for Home Instead Senior Care and its 600 North American franchisees is “in process,” said Jeff Huber, president and CEO. Home Instead is continuing to resupply its locations, particularly in virus hot spots. But not all of its home-care staff have masks.
“I work with a lot of home health and hospice agencies that are doing their very best to secure appropriate personal protective equipment so they can serve their patients in their homes in the way that they are accustomed to,” Gurian said. “They’re also trying to make as many accommodations as possible for [clients] who don’t want the same number of people coming into the home as might usually come.”
Staying Safe at Home
Ekpo said clients of any home health agency or who employ health workers privately should make sure the workers are following these guidelines from the CDC:
- Checking their temperature twice a day (morning and night)
- Monitoring themselves for symptoms of coronavirus virus
- Wearing face masks (of any kind) at all times; if the home care workers don’t have them, clients can buy or provide them
- Washing hands or using hand sanitizer frequently
- Not reporting to work when they are sick
In addition, workers at Destiny Home Health are told they must put down a clean “barrier towel” each time they enter a client’s home. That means, whatever they’ve brought with them, such as a purse or bag, goes on the towel to prevent contaminants from coming into the home.
Anne Sullivan, of Torrance, Calif., recently hired a private aide to care for her 89-year-old neighbor after placing ads on Craigslist and Care.com. She’d been friends with him for 13 years.
“The interviewing process, I will tell you, was absolutely hell,” Sulivan said.
The most difficult aspect: trying to determine how much of a risk a candidate might present.
Some would insist they were being very careful about heeding stay-at-home restrictions. “And when we’d get to the questions like, ‘Tell me what you’ve been doing in the last two to three weeks, what’s that look like for you?’ Sullivan said, she would hear things like, “Well, I’m out shopping.” And, Sullivan noted, “that was very, very difficult.”
Sullivan finally found a woman who had great references, understood the importance of precautions and agreed to self-isolate for 10 days before starting the job.
While protecting vulnerable older adults is always important, “COVID brings it to a whole new level,” Sullivan said. If someone gets the coronavirus, she noted, the result could be catastrophic.
“I can fix anything else. I can’t fix COVID,” said Sullivan.
By Emily Gurnon