The relationship between patient and caregiver is one of trust and intimacy.
Patients reveal the innermost parts of themselves to health care professionals because they rely on those professionals for help. When patients open their homes to allow health professionals to care for them, patients allow another intimacy layer to be gently peeled away, exposing patients’ innermost sanctuary and safe space.
Caring for patients in their innermost sanctuaries is something Brookings Health System’s home services team has done for over 35 years. One of the core services offered is home health, which provides a wide range of care services inside a patient’s home following an illness or injury. Hospice, which Brookings Health has provided for 25 years, is medical care designed to maximize comfort and quality of life for patients facing a life-limiting illness. A lesser known, but equally important service, is HEARTH, an acronym for Helping Elderly Adults Remain in Their Homes. The HEARTH program provides in-home assistance with personal care, meal preparation, housekeeping, and other needs.
In the past 35 years there has always been a need for home care services in the Brookings area. The COVID-19 pandemic, however, has intensified local demand in some unexpected ways while home care providers have simultaneously learned to treat a new virus.
Indirect virus impacts
“When COVID-19 first started, many people were nervous,” said Home Services Director Lynne Kaufmann, RN. “We had some new patient referrals last March that we would have never gotten before. People were anxious and didn’t want to go to the clinic or the clinic was closed and they still needed care, so they contacted us. At the other end of the spectrum were people who were nervous about our staff coming in to their home and they decided to put our HEARTH services on hold for a while.”
As the pandemic evolved, so did the government rules about the types of health services that could be provided at home. The Centers for Medicare and Medicaid Services (CMS), the largest payer of home health services, redefined when a patient is considered homebound to include when their physician advises them not to leave their home because of a confirmed or suspected COVID-19 diagnosis or if the patient has a condition that makes them more susceptible to contracting COVID-19.
“That opens up opportunities for home care to more people, plus it allows some people to stay on home health services a little longer,” Kaufmann said. “As required by Medicare, the people newly defined as homebound still need a face-to-face meeting with a clinician before starting home health. However, that appointment now could be in person or virtual.”
The pandemic has also influenced hospital discharges for patients to home health services.
“If a patient is stable, many hospitals are discharging them slightly earlier than they did pre-pandemic for two reasons. One, to help protect the patient from being exposed to COVID-19 if they are high risk, and two, to help free up bed capacity for other patients in need,” Kaufmann said. “That means our team is taking care of patients who need more TLC while recovering at home. It also means patients require more time with our health care professionals than what we saw pre-pandemic.”
COVID has also impacted hospice care, especially related to the location of service.
“The visitation restrictions we’re seeing in long-term care facilities like nursing homes and assisted living centers are prompting families to keep their loved one at home if they are deteriorating,” Kaufmann commented, noting they can provide hospice services in a patient’s home, a family member’s home, or a long-term care facility.
“The restrictions on visitation in a facility are hard for people when they are used to seeing their loved one on a regular basis. It’s also harder to get someone admitted to a long-term care facility right now, too. Families are just keeping their loved one at home longer.”
Preventing, caring for COVID
Like all health care staff at the frontlines of the pandemic, home care professionals have also received continuous education and training on COVID-19 best practices. Their instruction also focuses on the nuances of keeping patients safe while going to their home.
“Going from house-to-house is different,” Kaufmann said. “Prior to COVID-19, our staff followed universal precautions related to infection control, which mostly involved wearing gloves when working with patients. They only wore full personal protective equipment (PPE) if the patient had a confirmed infectious disease. Now we’re masking for every patient, every time.”
When home care professionals drive from patient to patient, they also make sure they follow enhanced infection control guidelines, putting on and taking off masks and eye protection appropriately as well as sanitizing their hands before, during and after each patient visit.
As COVID-19 cases rose in Brookings County this fall, hospitalized COVID-19 patients who stabilized started being discharged to home health for further recovery. To protect non-COVID patients, Brookings Health schedules visits to recovering COVID patients at the end of the day. To protect themselves from contacting the virus, health care professionals wear N95 respirators, eye protection, gowns and gloves inside the homes of infectious patients.
“Most of our COVID patients who receive home health receive respiratory assessments, including checking their oxygen levels, listening to their lungs, ensuring they’re taking their medications, and monitoring for other symptoms,” said Kaufmann. “Many recovering COVID patients have a really long recuperation. They start with ramped up services, and then we gradually wean them off over an extended period of time.”
With cases continuing to rise in the community, Kaufmann adds their team needs to remain flexible.
“We have adapted our care to meet the requirements of each patient and their particular situation, and we will continue to do that,” Kaufmann said. “We do not know how many referrals we will continue to see or how sick people will be. We do not know yet how a vaccine may impact the need for our services. But what we do know is that we need to continue meeting the needs of each patient at their home at a personal level for as long as the pandemic plays out and beyond.”
More information about Brookings Health System’s response to COVID-19 and efforts to ensure safety can be found online at brookingshealth.org/COVID.
Courtesy of: Brookings Health System