Insider Interview: Operational Changes In A New World

In our latest of interviews showcasing the personal stories that get buried or lost under competing news cycles we speak with a therapist living in Florida. We try to raise the voices and awareness of those working the frontlines to describe what happens at the local scale. Clinicians face a new reality in times of pandemic. We hope to do our part by highlighting their efforts and perspectives that might be missed by the bigger headlines.

In the latest of our COVID-19 interview series, CareStitch’s Dr. Shelley Ackerman PT, DPT is joined by a home health Physical Therapist Assistant living in Florida.  Our guest is going into their fourth year of practice and is now experiencing first hand what it’s like to work in the frontlines during the COVID-19 pandemic.

SHELLEY: What has your experience been working through the coronavirus pandemic?

CLINICIAN:   I work for two agencies — one small company that is local and then the other one that’s a bigger agency.  They have been really good with communication. Like what to do, what to expect, how to go about things, what to include in documentation.  Both of them have pretty much been on the ball giving clinicians updates almost every day with all the news changing almost everyday.

SHELLEY: What does your daily routine look like to prepare for your day?

CLINICIAN:  In the mornings, I double check my calendar on my phone. I also have a paper calendar because it’s easier to schedule the appointments on paper first then I transfer it onto my phone calendar.  It’s a good thing both of my agencies use the same EMR so it’s easier to go online and check to see if there’s any communication from the day before or any patient updates.  Most of my patients are oriented so they have their own calendar systems. I don’t necessarily call them but if they are living alone and they do have some forgetfulness I will call them first in the morning. The agency policy is before 9am you have to reconfirm them. Right before leaving for my day, I check to make sure I have enough supplies like theraband, hand sanitizer, wipes, and so on.  Before going into the patient’s home, I log in to the EMR and recheck for any messages and review the patient’s chart. I have a patient right now who’s in a continued care center, in their memory care unit. Before entering the building you have to go through the temperature screen first and fill out the pre-screen survey that is the usual four questions

SHELLEY: What are the four questions that they’re asking?

CLINICIAN:  Have you had any of the symptoms in the past 14 days? Have you traveled to any of the hot spots? There’s a spot over there for the temperature check that they do, and the last question asks if you’ve had a positive test result for COVID-19. After you’re screened, they provide you with a yellow star for your badge.

SHELLEY: How has your routine changed now during the pandemic compared to before?

CLINICIAN:  Just mainly the introduction of masks. I have an N95 mask which I’ve been saving for when I really need it.  What I do have are some of the regular face masks and a homemade mask with the filter in between that one of my coworkers made for me, which fit me great.

SHELLEY: That was nice of her and fortunate that it fit you well.

CLINICIAN: Yeah, so basically just the wearing of the masks.  

I’ve already been doing a lot of disinfecting with the wipes, as soon as I’m done with my supplies like the blood pressure cuff machine, it gets wiped down.  In terms of gloves, since I’m a lymphedema therapist I use gloves when I do manual therapy and sometimes there’s also wound care involved with lymphedema patients, so it’s automatic to be changing gloves all the time within a treatment.  At least maybe two, or three times maybe four times. I don’t necessarily believe in double gloving because if for whatever reason you snag it…you just wasted two gloves. 

Our agency provides supplies for lymphedema and wound care.  Any other time, as an independent contractor, I have to provide my own.  Anything beyond, a mask and gloves, like the more advanced PPE, so to speak, I told the agencies that’s going to be on them which they agreed on.   In my territory right now, I haven’t had any active or even suspected COVID-19 cases. My agency told us, until we get PPE kits, we’re not accepting COVID-19 referrals.

SHELLEY: Have you seen PPE supplies running dry?

CLINICIAN:  Right now, the larger agency says that they’re just starting to run low. The smaller company is having to ration the supplies. For example, gloves, every month we’ll get just one case of gloves. Which is about one hundred gloves.  You have the whole County to cover and you have to make it last.  

SHELLEY: Have you seen the census drop since the virus started ramping up?

CLINICIAN:  Oh, definitely.  This is the season for a high census for us, especially down here in Florida.  I haven’t had any joint replacements for two months. They stopped all elective surgeries.  The patients I have right now are the remnants from February that I have not discharged yet. That’s it.

SHELLEY: Have you heard anything about telehealth? Also, what’s your opinion on it?

CLINICIAN: Yeah. Actually, next Thursday the larger agency I work for is holding a webinar, which is mandatory for everyone.  They’re going to probably roll that out in the next few weeks, but they’re trying to get every one trained first. 

I’ve had some patients before where I question, why am I physically here?  I could have done the visit through telehealth.  The visit was mainly just educating the family member or reminding them how to properly do the exercises.

SHELLEY: If you had to choose one word that describes your feeling while working during the pandemic, what would it be? 

CLINICIAN:  Just very cautious. We had a meeting with my smaller agency about a month ago, regarding preparedness for this.  On the survey, one of the questions asked to check if you are or are not willing to treat a patient confirmed for having COVID-19 or somebody that may be positive but isn’t showing any symptoms.  I checked that I’m willing because I know I have enough PPE.

SHELLEY:  What is something positive that has come out of all of this, either for you or your patients through this time?

CLINICIAN: Everyone is washing their hands and there is a heightened sense of cleanliness.

This wraps up our COVID-19 interview series. We’d like to thank all the clinicians for their time giving us an insider’s perspective of their experiences. COVID-19 continues to present challenges for US healthcare systems. The work is tireless. We hope in these series we are able to present the reality of these uncertain times working on the frontline of healthcare.