Many Home Health Care Workers On Front Lines -- Unprotected

 

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Thousands of home health care workers in Oregon have struggled to protect themselves and their elderly, frail patients during the coronavirus pandemic.

They’ve cobbled together face masks out of bandanas. They’ve bought antiviral wipes. They’ve begged their employers to allow telehealth visits.

But mostly their work - and that of home care workers who help with the basics of daily living - must be done in person and up close.

“It’s not possible to stay six feet away,” said Joy Vegar, a home care worker in Lakeside in Coos County. “I’m being as careful as I can. It’s very scary.”

Home health care workers cannot delay their work until after the pandemic is over. They serve clients who need help recovering from an injury or illness or to get by, day by day.

There are tens of thousands of home health and care workers in Oregon. Home care workers, like Vegar, find their own clients and work on their own. Home health workers are usually employed by an agency registered with the Oregon Health Authority. There are nearly 70 home health agencies in the state.

Though the two perform different duties, with home care aides helping with bathing and other functions and home health workers focused on medical conditions, both see patients at their home and both have struggled to protect themselves during the pandemic. Multiple workers in both fields told The Lund Report that though they’re on the front lines, they’ve been forgotten in the focus on hospitals and the shortage of protective gear for hospital employees.

Yet they often work in some of the riskiest environments -- senior care homes where the highly contagious virus can quickly spread, to both workers and the elderly.

“I’m absolutely freaking terrified that I will pick something up and take it to one of my patients,” a nurse who requested anonymity out of fear of losing her job told The Lund Report. “If I get something and don’t know it, I have the potential to spread it to 200 people in a day.”

Nearly 70 long-term care facilities in Oregon have staff and residents, or just staff, who are infected with COVID or suspected of having the disease, according to a recent posting by DHS. https://govstatus.egov.com/or-dhs-covid-19 They represent only a fraction of more than 670 senior care facilities in the state. But their elderly residents are among the most vulnerable. At least 32 residents in 16 care facilities or senior homes have been killed by the coronavirus, according to a report last week by the Oregon Health Authority. https://govsite-assets.s3.amazonaws.com/0NtmRxaGTU2WdC1MGu8O_COVID-19-We...  That’s about 40 percent of the death toll in Oregon on Monday -- 75 people. https://govstatus.egov.com/OR-OHA-COVID-19

“We’re taking care of the most vulnerable people in our society,” said Cristal DeJarnac, a home care worker in the Bend area. “They have underlying conditions. They are the most susceptible to the coronavirus.”

Passionate About Their Jobs

Working in home health care is not a high-profile job. But those who do it, tend to be passionate about their work.

“I love our senior citizens,” one worker said. 

Many home health care workers are registered nurses or licensed practical nurses. Physical therapists, occupational therapists and speech therapists also provide home care. So do aides who usually belong to SEIU Local 503, the Service Employees International Union. Both Medicare and Medicaid pay for home services.

Their clients tend to be elderly people who need help managing on their own or recovering from an illness or injury.

Several nurses and therapists who spoke with The Lund Report on the condition of anonymity said that their job often involves training clients and their families. For example, a nurse might check a patient’s medication and ensure that person knows what to take and when. Other people, perhaps recovering from a stroke, need help getting around. A physical therapist might teach them to use a walker. Someone recovering from hip surgery might need exercises or someone to walk with. Some clients are at risk of falls. So the therapist surveys the home, gets rid of threats, like rugs, and teaches them balance exercises. 

Wound care is a big part of the job, especially for elders who are not very mobile. They develop pressure sores. They might need extra cushioning, for example, or encouragement to change their position frequently.

Home health care workers also have clients with dementia. Psychiatric nurses can teach caregivers how to approach such patients to avoid triggering a violent reaction, for example.

These professionals keep clients out of costly medical facilities, allowing them to live in their own home or a residential care facility, including adult foster care homes.

“It’s a fantastic service delivery model,” said one home health worker. “It’s cheaper than keeping a patient in rehab.”

Home health and care workers are usually in the field, traveling from client to client. Nurses said they often see about five patients a day.

They said some of their visits could be done online. Two Portland-area health care workers at Providence Home Health, part of Providence Health & Services and one of the largest home health care agencies in Oregon, said they’ve pressed their supervisors to allow them to conduct telehealth visits. But Providence said its patients need to be seen in-person.

“That is our core business, seeing patients in the sanctity of their own home,” Providence told The Lund Report in an email.

Shortage Of Protective Gear

When the first coronavirus cases emerged in Oregon in early March, Providence Home Health, with 800 health and hospice workers and nearly 4,000 clients, instructed staff to ask patients and family members about symptoms. 

“We have asked our staff to screen every patient prior to every visit, consistent with the screening that the (Oregon) region (of Providence) is using,” it said in the email. For clients with symptoms of COVID-19 such as a dry cough, shortness of breath or fever, Providence outfitted staff with protective gear. If not, they got nothing, staff members said.

“If the patient and other members in the home screened negative, then the guidance has been that they do not need to wear (personal protective equipment), mostly due to our PPE conservation efforts,” Providence said. A shortage of masks, gowns and other PPE have plagued health workers nationwide. But some Providence Home Health workers are frustrated.

“It’s like all or nothing,” a worker said.

That policy, which followed Oregon Health Authority guidance, sidestepped studies that showed that infected people without symptoms were often highly contagious.

A Providence nurse said she visited multiple care facilities a week, going from one to the other. She wasn’t even asked to wear gloves.

“Some facilities have 50 people in them,” she said. “I touch many people a day.”

Worried about infecting residents or getting her family sick, she had friends sew face masks, which she wore and distributed to colleagues.

Another home health nurse who works in Portland for Health Living At Home, a home health care network with privately owned franchises in Oregon, Washington, Arizona, Nevada, Utah and California, said when her employer failed to supply her with protective gear she bought gloves in a store and searched for other equipment online. 

“Some people are getting friends to make them masks,” she said. “We’re all trying to stay as safe as we possibly can, but it’s really scary.”

She said her manager wanted to help but couldn’t get enough gear from their usual supplier -- Medline Industries, Inc., a privately owned manufacturer and distributor of medical supplies headquartered in Northfield, Illinois.

The manager at Healthy Living at Home in Portland did not respond to multiple requests for comment. But a Medline spokesman confirmed that the company has not been able to fulfill requests.

In the first three months of the year, Medline sold 15 million more face masks than usual, spokesman Jesse Greenberg said.

Most of the protective wear is made in Asia, and China is the main manufacturer of so-called N95 masks, which protect health care workers from the coronavirus and other pathogens. When China shut down in January while grappling with COVID-19, production stopped.

“A backlog developed, and we’ve been trying to crawl out of the hole ever since,” Greenberg said.

Medline cleared out its own stockpile, and in February created an inventory management system for its customers. Greenberg said the company has fulfilled clients’ orders but has been able to only supply the amounts they traditionally ordered -- not the vastly increased quantity they’ve needed during the pandemic.

The Federal Emergency Management Agency has been involved in shipments of protective wear from Asia but FEMA has required companies like Medline to sell half of supplies to FEMA-identified hotspots.

To ease the shortage in Oregon, Medline converted a medical manufacturing plant in Redmond into a face mask recycling facility. It takes in used masks from Providence and others and decontaminates them, sending them back for reuse. The process takes between seven to 10 days, door-to-door.

The facility is processing 100,000 masks a week, Greenberg said.

Requirements On Protective Gear Tighten

With evidence mounting of the threat posed by asymptomatic people, federal, state and local public health authorities have stepped up their recommendations on face masks, asking the public to wear homemade masks in public. Hospitals also tightened their policies, for example, Oregon Health & Science University switched to a “masks on” policy that requires all staff to be masked around patients, regardless of their diagnoses.

Providence Home Health has made masks more available, staff said. At Health Living at Home in Portland, protective gear became available after The Lund Report started posing questions, a nurse said.

But the shortages aren’t over. At Providence, home health workers said they’ve been using a certain kind of sanitary wipe to clean surfaces and equipment, like stethoscopes, that they carry among patients. But those wipes do not kill coronavirus, a nurse said.

“All of the (wipes) that we’ve been using on patients for cleaning and trying to sanitize equipment -- none of it’s good against COVID,” one worker said. The lack of antiviral wipes is a worse problem than the lack of face masks, the worker said.

Providence acknowledged that it faced a shortage of the wipes that would typically be used to kill the virus. It said it had other products to kill the virus but has asked staff to limit those to patients with symptoms or who test positive.

“We want to make sure that we have the products that will eradicate COVID when we absolutely need them,” Providence said.

You can reach Lynne Terry at [email protected] or on Twitter @LynnePDX.

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