While caring for loved ones is challenging, COVID-19 has opened up a whole new world of worries! Afraid to access support services that would normally provide respite, many caregivers have taken a “just hang on” approach because of concerns about coronavirus transmission risks. At the time of this writing, Tennessee has been fighting the coronavirus for a little over 2 months, and “just hanging on” has become more and more difficult.  Some families have put off hiring paid caregivers or even accessing services like home health or hospice because of fears of COVID-19.

Services like home health, hospice, and paid personal care attendants provide help in the home when help is needed.  Yet, so many folks want to know: “How can I be sure they are being safe and doing all they can to keep from spreading this illness?” For answers, we interviewed members of the senior service community for the questions to ask when interviewing an in-home service.

How is your agency screening employees for COVID-19 symptoms?. The CDC has identified common symptoms of COVID-19.  Among them, the presence of fever is a symptom that many agencies are checking through once or twice-daily temperature checks.  Since fever may not be present in milder cases, staff should also monitor for the other signs and symptoms of the illness.

What personal protection equipment can I expect caregivers to wear when in my home and will I be asked to wear any PPE?  Care providers should wear masks, and you may be asked to wear a mask as well.  Some agencies will phone before arrival and ask that members of the household put on their masks before the home health provider enters.  Masks may not be the only PPE used.  Depending on the case, staff may also wear face shields, shoe coverings, gloves, paper gowns, or even a full body suit if there is a suspicion of or a positive test for COVID-19.

What special training do employees receive regarding COVID-19?  While nurses, physical therapists, and social workers may have had training about disease prevention as part of their education, COVID-19 is a new illness with a new set of concerns. Do not be shy about asking about how staff are trained and kept up to date about notifications from the CDC.  Lynn Pique from Always Best Care said that their agency is encouraging families to ask questions so that they will feel more comfortable about seeking help during this difficult time.

How will information be communicated to me if a caregiver tests positive for COVID-19?  With privacy rules, your agency may not tell you which of your service providers tested positive, but they should let you know that you have encountered someone who tested positive. They should encourage you to contact your physician to see what steps you should take next.

I’ve decided to have a service in my home (hospice, home health, or a paid caregiver). What can I do to help reduce risk?  Providing care is also about preventing illness.  Holli Douglas from Amedisys said that her agency and many others are teaching what they are calling “preventive cleanliness” to their patients and the other members of the household.  For disease prevention, the CDC recommends good hand washing, disinfecting high touch areas, physical distancing, and precautions when leaving and returning to the home. All home health, hospice, and personal care agencies interviewed encouraged use of masks when outside of the home and said that they help clients and their families obtain masks if needed.  

Special Considerations–

Can I ask that the same paid caregiver be scheduled to come to my home instead of rotating caregivers?  Agencies are doing all they can to help ensure the same personnel are in the same homes to help reduce potential spread of the illness.  Before COVID-19, personal care agencies often used shifts and rotations to help with coverage, especially for longer timeframes. Now they are providing staff incentives to work longer shifts and help reduce the number of people going in and out of your home.

What is the process for cancellations?  Before COVID-19, most personal care agencies billed a fee for cancellations that occurred without 24-hours notice.  Some providers are temporarily waiving that fee so that clients feel more comfortable calling in if they have a cough or other sign of illness.

If using a home health or hospice service, will telehealth services be used as part of my care? U.S. Centers for Medicare and Medicaid Services (CMS) has made special allowances for telehealth services during COVID-19 for some service providers.  Ask your service provider how the agency might use telehealth as part of your service.  For example, Jennifer Fox from UT Hospice said that their nurses might use it to extend their visits—starting their care in the home with vital signs and physical checks and then returning to their cars and using a telehealth service to further connect with their clients, ask questions, and engage in conversations about their needs and care.

Would I be eligible for any additional services that I may not have received prior to the COVID-19 outbreak?  CMS has also increased flexibility of home health services,  “allowing Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessments for all Patients.” Such assessments may lead to valuable additional services.  Ask your home health agency if you will be receiving a different service than you may have before the pandemic, or are eligible for additional therapy as part of your home health.

We know that a decision to employ care in the home can be a difficult one, especially during a pandemic. Remember that our Elder Care Coordinator team is here to help you navigate through the maze of care.  Contact us at (865) 588-3700 for assistance, to ask questions, or for referrals to care providers.  We are here for you.