COVID-19 for Visiting Nurses

This is not my first attempt to write about Covid19 but the numbers are so fluid that they change before I’m done. Ergo, there are no numbers in this post. Needless to say, There’s a whole lot we don’t know about Covid19 but there’s a lot we do know.

First of all, the mortality rate in the US is unable to be calculated.  To be accurate, two data points are needed – the number of people who contract the virus and whether they recovered or died.  The second data point is not yet available. Furthermore, the fact that a nursing home was affected very early, will artificially inflate the mortality rate temporarily because one thing we do know is that the virus is more dangerous to the elderly and patients are not in Nursing Homes because they are fit and spritely.

This is not a dismissal of the serious nature of  Covid19. It is a reassurance that your concern should stop before the panic level.  That leaves a lot of room for preparation and staff education.

The CDC has information for healthcare professionals.  There is a section for home isolation of patients linked to that page. Home health and hospice visiting employees are uniquely qualified to assess the home environment for suitability. The CDC advises:

1. In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. Considerations for care at home include whether:
   1. The patient is stable enough to receive care at home.
   2. Appropriate caregivers are available at home.
   3. There is a separate bedroom where the patient can recover without sharing immediate space with others.
   4. Resources for access to food and other necessities are available.
   5. The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
   6. There are household members who may be at increased risk of complications from COVID-19 infection (.e.g., people >65 years old, young children, pregnant women, people who are immunocompromised or who have chronic heart, lung, or kidney conditions).

Later advice, this morning includes securing food and meds.  I believe the word used was ‘stockpiling’. I am uncertain of the source or accuracy of that statement but I agree with having ample meds on hand.

THIS JUST IN

CMS has issued official guidance for home health and hospice workers. I was afraid we were being forgotten.  

Community Spread

The threat of community spread is also growing. In considering how to advise patients and employees before your community is in the midst of an outbreak, consider the burden of taking precautions.  Washing hands and using hand sanitizer should be a part of everyone’s routine. Avoiding crowds seems easy to some but others either have to work in crowded workplaces or go to school. Depending on the number of cases in your area, you may suggest to patients that they limit visits from people who cannot avoid crowds.

Your employees are precious and if you don’t already know that you will find out if they are affected by Coronavirus.  Give them the tools they need to protect themselves and TEACH them how to use them appropriately. Buy what you need and then some.  

AFTER DIAGNOSIS

If a patient is not hospitalized, consider using telemedicine or informal phone calls to keep up with your patient and extend the amount of time between visits.  Educate the patient and family members about signs of progression of the disease. Do not be afraid to visit the patient but allow for extra time for donning PPE. Agencies may want to consider a small increase in per visit pay to allow for the extra time to be mindful of appropriate infection control precautions.

Should your patient deteriorate, coordinate transfer to the hospital.  Sending a known Covid19 patient to the ER just seems dumb. Larger hospitals have made provisions but many of you are in rural communities with very low risk. It is when these patients are infected that surprise overwhelms sanity. Help your patient by ensuring the hospital is ready to safely receive them.

We have taken care of Tuberculosis patients, MRSA, VRSA and worse. We can safely care for Coronavirus virus patients. If we become ill, the odds are overwhelmingly in our favor. Patients are more likely to develop severe symptoms including death.

If we do a spectacular job, we will save lives.  If we don’t, we have the ability to spread the virus among the most vulnerable population of our elderly.  What’s it gonna be?