The Dangers of Providing Necessary Care

We know the doctors, nurses, respiratory therapists, anesthetists, and all those other incredible people caring for patients in the ICU and ED are risking their lives every moment. But there is another side of this pandemic: the side that stays home.

Patients that stay home or are sent home still require care. Many may have comorbidities that require higher level skills (like pulmonary hygiene interventions or medication management) that can’t be performed virtually. So someone HAS to go to them instead.

The definition of “home bound” has completely changed. This is a term home health care providers are extremely familiar with. It is often a reason we have to deny services or discharge services: a patient has recovered to a point where they are no longer home bound. And most payers will NOT reimburse care provided in the home for those who are not home bound. However, due to the recent implementation of “shelter-in-place” orders across the country, EVERYONE IS HOME BOUND.

This means that the utilization of home health care based services will exponentially grow in accordance with the growth of COVID-19 cases. It is understandable. If you can’t go out because you are at high risk or you risk infecting others, then health care has to come to you. But what does that mean for the providers who go from house to house?

The number of health care workers who are infected climbs every day. Some are recovering, some are not. This isn’t meant to spread fear, it’s just the truth. We, as health care workers, are carriers just like everyone else if we have somehow been exposed.

Home care providers are at very high risk for infection due to the inability to maintain social distances from their patients, the manual interventions that require close contact, and the inability to ensure a clean and sanitary environment in which to practice. And that’s only the risk to us!

We also pose a significant risk to our patients! We go from house to house and are out in the world risking exposure and bringing it in with us. In to the homes of the MOST fragile, the homes of the very sick, and even group homes where we could infect many people at once.

But Physical Therapy is STILL a necessary service that many patients will require, not just to recover from COVID-19 or keep them of of ventilators, but to keep them out of the hospital for other conditions like vertigo, back pain, and injuries due to a fall.

If you are a home health care worker and you are feeling the strain of this, you are not alone. Many home health care therapists and other providers are sharing their concerns:

Home health workers fear spreading COVID-19

The APTA has given some guidance on this:

“….our profession plays a crucial role in the health of our society, and there are people in our communities whose health will be significantly impacted by disruptions to care.

[Physical Therapists should] use their professional judgment in the best interests of their patients and clients and their local communities – including rescheduling non urgent care if that is the best approach, or making other adjustments when the risk of exposure to COVID-19 outweighs the benefits of immediate treatment.”

-APTA representative (link)

So the question comes down to this: What care is truly necessary to be performed face-to-face? Are you implementing any virtual visit platforms to complete care that doesn’t have to be done face-to-face? How are you prioritizing your patient care?

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If you are a home health care therapist, let me know what you think in the comments! Or share your tips with others!

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