Conducting Home Health Visits During COVID-19
By Joseph Duffy, contributor
COVID-19 has therapists working in home healthcare rethinking how to protect themselves and their patients. Therefore, it's essential to review the latest precautions that can lower the risk of infection when conducting home health visits during COVID-19 outbreaks—ranging from sanitation practices to guidelines for therapists wearing personal protective equipment (PPE).
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General guidelines for home health visits during COVID-19
The National Association for Home Care & Hospice and AARP have published information on how home healthcare professionals can stay healthy during the COVID-19 crisis. Highlights include:
- Wash your hands frequently using soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer that contains 60 to 95 percent alcohol. Use soap and water if your hands are dirty.
- Avoid touching your eyes, nose and mouth with unwashed hands
- Wipe down surfaces before using them, such as tabletops and door handles
- Maintain a distance of six feet from anyone present in the house
- Do not touch household pets
- Avoid sharing household items with the patient
- Stay home if even mildly sick
- Get a good night's sleep for a stronger immune system
- Stay healthy by exercising and eating right
- Clean your phone if you touched it during your patient session
- Wear appropriate PPE and ask the patient to wear a face mask when possible
Also, consider calling your patient before your visit to ask if anybody in the residence is exhibiting COVID-19 symptoms, such as a fever or dry cough.
What are the PPE requirements for home visits?
When it comes to wearing PPE for home visits, Jamila Harley, M Ed, CCC-SLP, associate director of health care services in speech-language pathology for the American Speech-Language-Hearing Association (ASHA), said ASHA recommends that clinicians and facilities follow guidelines from the Centers for Disease Control and Prevention (CDC) and their local health officials.
"Due to unknowns about the novel virus and risks of transmission, even in asymptomatic individuals, ASHA recommends the highest level of protection available when performing aerosol-generating procedures," she said. "Policies for PPE optimization can vary by facility and state. However, all clinicians should adhere to standard precautions at a minimum. ASHA also recommends if SLPs have limited access to PPE, they are encouraged to voice their concerns to OSHA, after proper engagement with their employer."
ASHA posted comprehensive guidelines related to multi-site care delivery and resumption of services, which are helpful for many different therapist disciplines.
Expert tips for staying safe
Haley recommended the following safety tips for home health visits during the COVID-19 pandemic:
1. Do a personal and professional risk assessment. Understand your facility's policies for admitting patients, monitoring COVID-19 exposure for patients and staff, and for staff and patients who have confirmed or suspected exposure. Weigh the level of risk against the benefits of in-person services.
2. Develop and execute a plan. Do a mental walkthrough of your interaction with the patient/client from beginning to the end of the home visit. Put the best safety precautions you can in place, each step of the way. Educate patients and families of the practices you will take to keep them safe and the practices you will expect them to take through an informed consent document. Communicate about where you will work, how you can work together to achieve physical distancing, and any other concerns. Recognizing that most pediatric clients under age 2 would not be wearing masks (per CDC guidance), SLPs would want to raise their level of protection and that of the others in the home. Use family members/caregivers as models or extension of clinician's hands or use videos or images for a demonstration to limit hands-on contact, if possible. Determine if PPE negatively affects services and consider whether a remote or hybrid approach to therapy is possible.
3. Stay vigilant to decrease risks of transmission. Always keep an adequate supply of PPE with you, changing it frequently to decrease the risk of transmission. Maintain hand sanitizer, hand washing supplies (i.e., hand soap, paper towels), and antibacterial wipes in your car and your work bag. Plan to have time between visits to sanitize materials, wash your hands and just to breathe without a mask on.
"In my personal experience working in home health, I used a washable work bag, cleaned my car frequently, left my work shoes at the door or outside, placed my scrubs in a separate hamper and did not wash them with other laundry," Harley said.
Consider an alternative to home health visits
For many allied healthcare professionals doing home visits, Harley suggested that when possible and appropriate, telehealth is strongly encouraged for speech-language pathology services to mitigate COVID-19 transmission risk. However, Harley noted that SLPs and other healthcare professionals may not always have the option to provide telehealth services, due to various considerations and requirements by states and payers.
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