Gentle trained nurse helping cane-using mature patient
HealthNovember 30, 2020

Adapting to a new normal in home health care

By: Katherine Bortz
In March, the World Health Organization declared pandemic-level spread of a novel coronavirus (Covid-19). The rising number of cases in the United States tested our health care system and resulted in shortages of both personal protective equipment and ventilators in our health care facilities.

The United States continues to lead in transmission of Covid-19, with nearly 11,000,000 cases since its emergence early this year.

Nurses in all health care settings have had to adapt to the everchanging needs related to the pandemic, but home health nurses have had the additional challenge of caring for people in the home—a setting that may not be properly disinfected and may have residents who have not followed isolation guidelines properly. A national survey conducted by the National Association for Home Care and Hospice in April 2020 demonstrated that the potential exposure in this setting only increased as the pandemic continued, with 41.5% of home health agencies actively serving patients with Covid-19. By May, these numbers rose to 62.7%.

Dangers of the home health setting

According to Sheila Miller, RN, MSN, COS-C, BCHH-C, these risk factors for transmission mean that extra time is now needed to ensure that no one is in the home that shouldn’t be there and preparing for the mental stress of caring for patients with Covid-19.

“There’s stress when gowning up outside in someone’s front yard and entering a home where you can’t use human touch to communicate or lip-read since mouths are covered up,” Miller explained. “The other fear is carrying the virus on to other patients or home to our own families. Carrying germs around is always a risk for home care staff, but we’re so much more fearful of this virus since it’s spread so easily.”

With a “second wave” of the pandemic in full swing in the U.S., Miller said that Covid-19 precautions are now on every patient’s care plan. Home health nurses are increasingly teaching about droplet precautions, effective use of masks, handwashing, and appropriate infection control.

What’s remained the same

Despite the changes that have needed to occur to keep patients safe, Miller stressed that some things have remained the same for the home health nurse throughout the pandemic.

“What remains the same is our concern for our fellow Americans,” Miller said. “We continue to teach so that each patient has every opportunity to improve. We continue to do dressing changes, even with PPE sticking to our skin in a home with no air conditioning. We continue to make our care plans with the new twist of telephonic visits for us or the primary care provides. We are nurses and continue to give our all for each patient.”

Katherine Bortz
Content Editor, Lippincott Solutions, Wolters Kluwer Health
Katherine has several years of health care writing experience and has focused on topics including physical therapy, occupational therapy, infectious diseases, and pediatrics in these roles. She currently edits content for Lippincott Procedures.
  1. Centers for Disease Control and Prevention. (2020). “United States COVID-19 Cases and Deaths by State.” Accessed November 17, 2020 via the Web at https://covid.cdc.gov/covid-data-tracker/#cases_casesper100k
  2. Johns Hopkins University & Medicine. (2020). “Coronavirus Resource Center: Maps and Trends – Mortality Analysis.” Accessed November 17, 2020 via the Web at https://coronavirus.jhu.edu/data/mortality
  3. National Association for Home Care & Hospice. (2020). “National Study Shows Home Health Care is in a Fragile State.” Accessed November 17, 2020 via the Web at https://www.nahc.org/wp-content/uploads/2020/03/NATIONAL-SURVEY-SHOWS-HOME-HEALTH-CARE-ON-THE-FRONTLINES-OF-COVID-19-AND-CONTINUES-TO-BE-IN-A-FRAGILE-FINANCIAL-STATE.pdf
  4. Ranney, M. L., et al. (2020). “Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic.” New England Journal of Medicine, e41(1)-e41(3). Accessed November 11, 2020 via the Web at https://www.nejm.org/doi/full/10.1056/NEJMp2006141
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