What Does Home Care Look Like During a State Lockdown?

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What’s the role of a home care agency in a state that has ordered its population to shelter in place? How are agencies’ operations affected? Does demand for home care increase or decrease in a global pandemic? We asked two home care leaders in lockdown states to get their take.

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COVID-19 continues to spread across the United States, infecting thousands and causing massive disruptions to business and everyday life. As one commentator remarked dryly in a recent social post, “Turns out historical events aren’t nearly as fun when they’re happening to you.”

For home care agencies, one item of critical concern is what operations look like in a state lockdown. With more than a dozen states in lockdown and others likely to follow, home care professionals have major questions about their role in the coming months.

We talked to home care leaders in California and New York: two locked-down states with high population densities and a high number of confirmed coronavirus cases to learn what they’re seeing and get their perspectives on what home care can do moving forward.

The first leader we talked to was Dr. Lucy Andrews, a longtime healthcare veteran who currently serves as the president of the California Association for Health Services at Home and runs a midsize home care agency. We also talked to Kathy Febraio, President and CEO of the New York State Association for Healthcare Providers.

Both lead organizations spanning hundreds of providers across  various types of care; these conversations focused on in-home care providers with an emphasis on private duty.

We’ll address a key question first: can home care workers work during a state lockdown?

The big question: can home care workers work during a state lockdown?

The answer may vary from state to state; as of this writing, in both New York and California the answer is yes.

While home care workers in New York are still viewed generally as essential employees, there’s some uncertainty. The status of home care workers as essential health personnel hasn’t been defined in state law, Febraio explains, so while home care workers are going about their business, that could change in future policy updates.

California’s stance is more definite: Thanks to constant efforts to educate local leaders, California’s governor as declared private duty an essential service.

Educating: Home Care is Healthcare

This fight hasn’t been easy; according to Andrews, it’s taken considerable work to inform local and state governments as well as the public about the vital role of home care in healthcare.

“One of the most important things you can do is make sure that local and state governments understand that we are essential healthcare providers,” she says. “That’s what we’ve seen here and in other states that are on lockdown; it’s critical that they understand that we are critical workers who are doing essential care.”

“Our staff are there to make sure that those activities of daily living continue. But if those things aren’t happening, where are those people going to go? They’re going to get sick, they’re going to fall, and they’re ultimately going to clog the healthcare system. And the last place you want a non-symptomatic elderly person to be right now is in the hospital.

“We have passionately identified ourselves as healthcare providers in any statement or communication that goes out.”

These efforts take many forms; in addition to lobbying local and state officials, agencies in California have taken extensive steps to ensure that their workers are easily identifiable while they’re working.

“Across the state, all our agencies make sure their staff have name tags that identify them as workers,” says Andrews. “Make sure their office staff can take a call if caregiver is stopped and asked why they’re out.”

“You also want to have some kind of ID showing what work you do. We put it in writing; I have a document that has the company name with the owner’s name and phone number, and a statement that they’re doing essential healthcare work. It needs to be clear to everyone why [your employees are] out and about.”

New HR 6201 Legislation Causes Cashflow Concerns For Home Care Agencies

Both leaders are very concerned about new and pending legislation such as HR 6201, a new law that mandates employers to provide two weeks of paid sick leave.

“This could be devastating if there’s not an exemption for home care,” says Febraio.

Andrews agrees: “Margins in home care are razor-thin. Most home care companies don’t have the resources to pay two weeks of paid leave. It could bankrupt a company with 50 employees.”

A concerted effort by thousands of home care agencies has brought attention to the issue at a national level; however, as yet no exclusion has been made for home care. This remains an important fight at the national and state levels.

How are home care operations affected by a COVID-19 state lockdown?

Many of the operational changes necessitated by a state lockdown come down to establishing policies and procedures.

“What happens if I have a care provider that calls me and says I have a cough?” Andrews points out. “What is your process, where do they go, and how do you inform the clients at the house they were at yesterday?”

“Likewise, what if it’s the opposite? Your care provider comes in and says that they have a cough or fever. You need to have a plan for these cases. Educate, educate, educate—you can’t do it enough.”

Meanwhile, they haven’t seen many changes on the staffing front yet. Andrews’ organization is considering reaching out to displaced workers to recruit them for home care, she says, but they’re holding off for the time being.

“What we don’t want it someone who we invested a lot of time training to leave in a month,” she says. “So we haven’t put it out there anywhere yet, but we’re certainly anticipating [an influx of new applicants]. We’re one of the few industries that is still open and recruiting.”

Under state lockdown, does demand for home care increase or decrease?

A state lockdown caused by a pandemic raises a number of questions about the demand for home care. Both Febraio and Andrews reported seeing similar types of scenarios affecting demand, including:

  • Clients and families refusing to let caregivers in for fear of exposure to contagions

  • Clients (especially private pay clients) putting services on hold because family members under shelter-in-place orders are now available to care for them.

  • More people moving out of hospitals and into post-acute settings requiring home care

  • More people moving out of nursing homes and other facilities, taking home care as an alternative

It’s difficult to gauge the demand with any kind of certainty yet, but we asked Febraio and Andrews for their perspectives.

Febraio believes that demand for home care services in New York has stayed relatively flat or lessened slightly. A high number of private-pay clients whose families are now free to care for them at home has contributed to this trend, in her perspective.

Andrews believes that overall, California has seen a slight net increase in the demand for home care, once the various types of situations are accounted for.  A large number of seniors are choosing to move to post-acute care settings.

Both believe that there’s a strong potential for massive future demand that the industry may be unprepared to handle, especially as large numbers of recovering COVID-19 patients move into post-acute care. Ensuring adequate PPE supplies and addressing the question of whether recovered COVID-19 patients can work in care are both issues that need to be addressed.

Home Care Has Work To Do

Ultimately, it’s clear that many questions are yet to be answered, and that it’s essential for home care organizations to educate both the public and their elected officials about the vital role of home care workers in the healthcare system.

Many of the issues above, from ensuring that home care workers are deemed essential, to securing exemptions from HR 6201, to securing PPE supplies for home care agencies, boil down to the need for widespread education about home care.

To a large degree, home care’s immediate future depends on making it common knowledge that home care is healthcare.

If you’re operating a home care agency in a state lockdown, we want to hear from you. What are you observing and experiencing? Email your thoughts to [email protected].

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