Everyday as we monitor the news feeds concerning home health and how COVID-19 affects our workers one gets the sense a lot of personal stories get buried or lost under competing news cycles. In order to raise the voices and awareness of those working the frontlines we decided to provide a platform for them to describe what is happening at the local scale. Through speaking with clinicians facing a new reality in times of pandemic we want to highlight their efforts and perspectives that might be missed by the bigger headlines.  

This is the first in our interview series where CareStitch’s Dr. Shelley Ackerman PT, DPT speaks with home health clinicians about their experiences on the frontlines. Today we are joined by an occupational therapist based in Detroit. Our guest has worked in home health for 14 years now across varying functions but more recently, in the past year, they returned to working on the ground, in the field.  Please read on as they talk about their perspectives on the field managing a path through the pandemic and avoiding pitfalls at all cost. We hope through these discussions we can shine a light on the people risking their lives to help contain the spread of the virus and continue to deliver care to patients who need support. 

Please note, the statements expressed by our guests do not always reflect the opinions of the staff at CareStitch. We keep an open forum where different views and points can be expressed without retribution.  

SHELLEY ACKERMAN: How has your experience been so far working through the pandemic, and do you feel like it’s changed the way you provide home health care?

CLINICIAN: Yeah. It’s really unlike anything I’ve ever experienced as a clinician. I’ve never experienced anything like this extreme. And, during the last few years, I’ve spent a lot of time in management and doing emergency preparedness so I have been living this for a long time from the other side of the desk, but you know, it’s nothing that we could have done to prepare us for this.

Yeah, it’s completely different. I live in an area where the virus hit really hard. When the pandemic first hit, my caseload just completely dropped for me and my peers because basically the patients were just afraid to let us in their house and the family members.

Now it’s just the opposite because I work for a large health system where we’re treating tons of COVID patients, we have so many people coming out of the hospital. Today was the first day that every single one of my patients was COVID positive coming out of the hospital. From a clinical standpoint, it’s still the same as far as needing to focus on ADL, fall prevention, and safety.

We always had a lot of people with COPD and CHF. So we’re always focusing on breathing, that was such a big part of what we did before, but now it’s even bigger. Lung function and lung capacity has been our main focus.

SHELLEY ACKERMAN: Let’s discuss safety measures and procedures that you’re following to help prevent the spread of the virus. What are you doing now that you were not doing before?

CLINICIAN: When the virus first hit, we felt like our standard procedures were really good. We had been cited in surveys of having really good clean procedures as far as putting down barriers for our bag, washing our hands, and using sanitizer anytime we touch the patient and all that stuff.

So we kind of thought at the beginning of this, that was going to be enough. And then it got really confusing because basically every day, they would change the rules and just add a little bit more as they learned about the pandemic.

The company was getting feedback about us clinicians not being happy and being very nervous. So at first it was kind of like do what you’re already doing.

And then they added in a screening process. So we would call the patients first and then ask them if they have had any of the COVID symptoms also if they had been exposed to anybody who’ve tested positive. If that was the case, then we would not see them. We would provide them with a number, they would call and get advice on testing and all that stuff.

The next thing that really changed was they said, okay, you can wear a surgical mask if you want, it is your choice. They then switched to surgical masks for everyone and for patients that are COVID positive, we have to wear N95 masks along with the rest of the PPE. But there’s still not enough masks to go around.

SHELLEY ACKERMAN: Has there been a shortage of supplies?

CLINICIAN: Yeah. So there’s been a shortage of everything. I was able to acquire everything I felt like I needed from elsewhere last week. So I had a friend give me a bunch of N95 masks from a hairstylist. I got gloves from a friend that was in a business who was shut down. The company was giving us one N95 mask and we had to reuse it. We were only supposed to use it with patients who are COVID positive.

So now, like I said, our caseload is flip-flopped. So most of our patients are COVID positive.

We’ve really upped the standards. We’re supposed to gown up, wear boots and all that stuff, but all of those supplies are still low. So basically, almost every day or every other day, I’m having to go in and they’ll give me however many gallons of hand sanitizer they can spare to give me. I’ve had to reschedule a couple of my patients because I didn’t have enough PPE to see them. Some other companies are saying, well just do with what you have. My company is not doing that. My company is saying to not see the patients if you don’t have everything.

Every day, the health system I work for, they put out an update and they also attach all the latest research articles that are out there. Also, every day at 10:15am, my therapy department will have a call for updates.

So I feel like I’m super well-informed on one hand. But the one thing is all the research shows that N95 masks are the only way to prevent from getting it. And the surgical masks prevent you from giving the virus to anybody else. We’re still today, only supposed to use the N95 masks with people we know that are positive, which makes no sense whatsoever. We have more research now that shows that people spread it, you know, before they even know they have it and are symptomatic. So we’re still in this area where even though we’re starting to refill PPE’s, all this research is out there. With most of our patient contacts, I think we are at risk. So once I got a hold of those supplies on my own, I do wear my N95 masks for every encounter.

SHELLEY ACKERMAN: You mentioned that you were in management prior. From a management standpoint, how does your agency differ from the way other agencies you’ve heard from your peers are operating?

CLINICIAN: My company is a nonprofit. They’re really big, so they can afford to do a lot that some of the smaller companies can’t. A lot of the other companies are really laying off a lot of people and or not paying them when the caseload initially dropped.

Whereas my company allowed our productivity to go down. They still paid us our normal wages, which was cool. The other thing too, there are a bunch of companies out there just saying, “Hey, you got to go see these patients with whatever PPE you have.”

They’re just saying, we feel for you, but tough luck. No one has PPE’s. You just have to deal with it. The other thing that my company is doing is they just announced that they’re paying us extra points, extra dollars until the end of April. So, we’re getting $26 extra per point. Unfortunately, they’ve had to lay off non-clinical personnel. The lack of non-elective procedures has hit us hard.

Another thing that a lot of the companies are doing too is if you have an exposure or if you think you’re sick, they’re not paying for time off. My company is paying.

SHELLEY ACKERMAN: After learning all your patients on your caseload for the day were COVID positive, what would be the one word that described your feelings right before you got onto the road?

CLINICIAN: Nervous. You just get a feeling in your stomach. All the people we’re seeing, they’ve been in the hospital, they’ve been treated, and the doctors at least feel like they’re well enough to come home but they are still within their quarantine period.

They’re trying to get the patients out of the hospital since the hospitals are overloaded. So you’re wondering if this person is really ready to come home or did they just need the space.

But here’s the way I feel, as opposed to some of my other colleagues. I almost would rather be treating only the COVID positive patients because we know they’re positive, we know that they’ve been treated, we know where they are in the process. Whereas everybody else that we encounter, especially in Detroit where it is such a high risk area, all of our patients have a preexisting condition, all of our patients have poverty, all the risk factors. So it’s like when the ones that are not considered COVID positive that’s almost worse because it is unknown.

When I go see the COVID patients, I have all of my PPE on, so I feel a little bit safer with them than I do with my normal population who live here.

SHELLEY ACKERMAN: Do you feel like within your agency or even in other agencies, the administrators and management are in panic mode?

CLINICIAN: Oh yeah, absolutely. I can feel it from the management. I feel like they’re so stressed out for two reasons. One is they don’t want to tell us the wrong information and have it go out to the media and they’re stressed out because they don’t want to send us out unprepared.

We want to thank our guest for sharing their story and to all of the frontline healthcare workers for risking their lives to help save others’.

As COVID-19 presents challenges for US healthcare systems, many professionals on the frontline are working day and night to ensure patients’ needs are met while juggling an increasingly treacherous landscape.  While the work is tireless, many on the frontline appear as blips on the front page and are often forgotten or left behind by the chaotic nature of news cycles.