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“Focus must be kept on patient care in the home, where they are the safest. Listen to our workforce and decrease fears with practical solutions and protocols for care.”
– Kim Kranz, RN, MS, CHPCA
Anxiety levels are high right now. The COVID-19 outbreak has overtaken our lives, affecting everyone, but especially our patients and families. We no longer have the comfort of a normal routine, and there is no end in sight from this unprecedented pandemic. Fear continues to increase, especially for those of us in the hardest hit state, New York, the epicenter of the U.S. outbreak.
As health care providers, this pandemic has put us under enormous stress, but there are ways to ensure we are still providing the best possible care to our patients and their families. This is a time to ease fears with thorough information, knowledge and facts.
The Workforce
Focus must be kept on patient care in the home, where they are the safest. Listen to our workforce and decrease fears with practical solutions and protocols for care. Address the workforces’ need by providing personal protective equipment (PPE). The organizations/groups offering the most help in the New York metropolitan area are:
- Our partnering hospitals’ Supply Chain management teams;
- Office of Emergency Management;
- Colleges and universities donating PPE, and
- Volunteers hand sewing 100% cotton masks with inserts for filters.
Our workforce is an essential and medically necessary part of the solution with our partnering hospitals. Overnight, hospitals are increasing surge capacity. Discharge planning is a huge demand. This process should be streamlined and home health and hospice providers need to seek discharge planners quickly and efficiently to help patients transition home faster. Availability of admissions for home health and hospice must be 24/7, this includes expediting referrals from our EDs.
Fear of transmission risk is heightened in our assisted living facilities and adult homes. As responsible providers, we must provide education on what we are doing through screenings of risk on every admission, and in every patient visit and caregiver encounter. Screening of employees is conducted and documented daily prior to any patient care encounter. This is the health care advantage, knowing the risk level before we enter. Describe infection control practices and utilization of PPE. Respect and follow each facility’s policy for PPE use and visitation practices and restrictions. The majority of facilities have allowed us to continue service as they understand the value of our team to prevent hospitalizations.
“Availability of admissions for home health and hospice must be 24/7, this includes expediting referrals from our EDs.”
Telehealth
Maximize the use of remote telehealth monitoring for patients demonstrating the highest risk of hospitalization and incorporate COVID-19 screening and symptom monitoring into your protocols for patient care. With this population requiring oxygen, telehealth plays a key role in monitoring pulse oximeters multiple times a day. Use of this technology will need to extend beyond the home health benefit as necessary. Individualized patient/family assessment is key for this determination.
Hospice
Hospice providers hold a remarkable position during this pandemic. Many of our chronically- and seriously-ill patients with comorbid conditions will fall victim to this virus. As the experts in end-of-life care, we have embraced these patients and families in our partnering with assisted living facilities, skilled nursing facilities, and hospitals to provide bedside care, including general inpatient care. We have contacted all hospital systems informing them that Good Shepherd Hospice is providing general inpatient care for COVID-19 positive and persons under investigation (PUIs) within our two designated inpatient units in Rockville Centre and Port Jefferson, New York.
Letters with information regarding prevention and practices during this pandemic should be provided in all admission packets and your agency website should be kept current. The Center for Disease Control has the most up-to-date information on instructions for proper isolation and prevention. Communicate this information with patients/caregivers. As families practice social distancing, encourage the use of technology to visit with family members. Video chats are the safest form of interaction.
Opportunities For Declines in Home Health Census
Due to the cancellation of elective surgeries, our home health census has decreased. This is an opportunity for clinicians to support the increased demands for:
- Hospice care
- Bereavement
- Customer service support and inquiries
- Caregiver education
- Specialty services
Fast-track and real-time education programs are in place for training.
Palliative Care
Palliative care expertise is also being provided to skilled nursing facilities and hospitals. Trained nurse practitioners and physicians who have the ability to advance the conversation and expedite advance directives are providing bedside palliative care consults and assisting with life goals with patients and their loved ones. We need to be sharing clinical resources. Our knowledge and resource during this time is paramount.
Specialty Care, Donors and Volunteers
Specialty services are critical in supporting the changing needs of our patients and families. Helping Hands, a homemaker program, fully funded by donations, supports our elderly, living-alone population, providing groceries, meals and cleaning.
Donors have asked how they can help. We have put the materials of this ask into financial terms, including the need for additional telehealth monitoring, supplies and laptops for remote home workers. Seek the increased amount of initiatives that aim to aid health care workers.
Fortunately for us, there are many people with time on their hands willing to support our efforts to provide exceptional care in time of crisis. Facebook, Instagram, Twitter and other social media outlets can be sources of disdain and anger, but they are rapidly becoming a way for people to offer support and show their gratitude for everyone in the health care system.
Celebrating Heroes
We are celebrating our heroes with a photo collection throughout our health care system called, “Behind the Mask.” These photos show one image of our clinicians working in full garb and the second reveals a compassionate worker and her hometown. This is one small way for us to acknowledge the efforts made by our team.
The greatest fear for the majority of our workforce is loss of security. Layer that with a health care pandemic and you have the erosion of all security. We are discovering that the best way to ease anxiety is to communicate, communicate, communicate. Keep everyone informed of supply availability, the number of patients served, hospital needs and quickly answer questions from the teams. Finally, draw upon the love and compassion to serve while promoting stability and security during these uncertain times. Fred Rogers said it best, “We are the helpers.”
RECAP: Demonstrating Post-Acute Value
- Prevent hospitalizations/readmissions
- Maximize the use of telehealth
- Work at the top of licenses
- Identify opportunities for clinicians to support increased demands
- Share clinical resources
- Optimize technology with caregivers and their families
- Advance conversations about palliative care and hospice
- Reach out to donors and volunteers
- Celebrate heroes
Kim Kranz, RN, MS, CHPCA, is president of Catholic Health Services of Long Island’s Catholic Home Care & Good Shepherd Hospice. Kim has 29 years of hospice and home health leadership with proven results of innovation, growth, clinical and financial outcomes. At Catholic Home Care & Good Shepherd Hospice, Kim is accountable for system-wide strategic and operational initiatives for all home health and hospice services within Catholic Healthcare Services.
