COVID & the Home Health Industry

It’s no understatement to say that COVID has wreaked havoc with every aspect of our lives:  families, jobs, school, and health care.  However, the home health industry has been hard hit and will continue to feel the effects of COVID for the foreseeable future. Many provider segments have weathered the storm – or still are – thanks to various relief programs and flexibilities such as telehealth.  Home health has not been so lucky.

More than 82% of home health providers experienced decreased revenue due to two major factors: fewer new patient admissions (largely resulting from canceled surgeries) and patients refusing care out of fear of catching COVID – even skilled care ordered by a physician.  A study by the National Association for Home Care & Hospice reported that 87.4% of agencies had patients who refused care.  Reductions in physician ordered visits triggers payment reductions as high as 75% over the 30-day period payment.  Yet agencies’ costs have increased during the pandemic:  personal protective equipment (PPE), overtime, hazard pay and more acutely ill patients all further reduced agencies’ profitability.

Workers are also concerned about the possibility of being infected with COVID, and some show reluctance in working in home care and being assigned new patients.  The widespread shortages of PPE don’t help instill confidence in workers and patients. How does an agency safely deploy staff and also reassure both important constituents?

Some suggestions from the field include:

  • Heightened adherence to the infection control program. Certain elements being discussed for COVID should be part of every agency’s policies.  Observing standard precautions protects workers from patient infections;  the infection control program should have policies related to employee illness and caring for immune compromised patients, all of which are relevant for COVID-infected patients. The new component to this list is temperature and COVID symptom checks.
  • Making every effort to obtain PPE and zealously assuring appropriate utilization. Supervisors can make random, unannounced video calls to staff members to check use of PPE.
  • Cutting down on in-person visits, where possible, and conducting telehealth checks. Keep in mind that telehealth cannot replace in-person visits but can be used as a means for patient monitoring.  Read here about the strict guidelines for telehealth in home care.
  • Where possible, limiting the number of staff members caring for COVID patients. Some agencies are assigning a small cadre of staff to COVID patients, where possible, to minimize exposures.  If this is not feasible, it may be possible to schedule visits to COVID patients for late in the day – last appointment, so to speak – so the staff member can go home afterward and implement home disinfection procedures.  Most if not all healthcare workers have developed their own protocols when arriving home, such as: removing their shoes, disinfecting footwear, leaving shoes on the porch and/or wrapping them in plastic bags; promptly removing and laundering clothes worn during the day; thorough handwashing upon arrival, or showering; disinfecting all work supplies and equipment while wearing gloves as well as surfaces in the car and home; severely limiting contact with family members, especially the elderly or infirm, or even living apart for a time, etc.
  • Observing strict social distancing for any services that don’t involve touching the patient.
  • One of the biggest tools to reassure patients and staff is communication. In this situation, you can’t communicate too much.  Many agencies are posting and distributing their COVID action plans, and telephonically explaining them to patients.  If a staff member is not caring for a COVID patient, he or she can mention this to the patient in an effort to further reassure him. You can incorporate this into a process where you call the patient the day before, inquire about any possible COVID symptoms or exposure, confirm the appointment and reassure her about your staff’s safety.
  • Some agencies provide patients with a laminated sheet of COVID symptoms so they can perform their own symptoms check, and give instructions on who to call if any are positive. Staff members visiting the patient can inquire about an accessible thermometer and sufficient supply of soap, toilet paper and hand sanitizer.
  • As an added measure, staff should stay aware of the number of surfaces they touch in the patient’s home and minimize contact as much as possible. Staff can use a disinfecting wipe on the way out and wipe down any surfaces they touched.
  • Lastly….. communicate once again. Regularly informing patients of all the aspects of your agency’s program will go a long way in minimizing potential exposures and reassuring them of the safety of receiving home heath services from your agency.
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