Home health agencies respond to pandemic challenges

By Patrick Mcardle
RUTLAND HERALD
As it continues into a third year, the pandemic is proving to continue to be a special challenge to the nurses, therapists and staff members who deliver home health care, but the burden has been manageable in Vermont, according to those who work in the field.

Jill Mazza Olson, executive director of VNAs of Vermont, a trade association representing Vermont’s home health and hospice agencies, said in some ways the decentralized nature of home health may be an advantage over workplaces where people more commonly share a space.

“What I’m hearing from my members is that some of them are mostly having staff go about their schedule directly to and from their own homes rather than spend time in the central office,” she said.

Sandy Rousse, president and CEO of Central Vermont Home Health and Hospice, said members of staff who are part of a team are having morning meetings, often remotely, but have all the tools to leave from home and go directly to their rounds.

“That’s part of the flexibility with home health is that you can leave from your home. Granted, they were missing their team meetings and stuff like that, but we transitioned (the meetings) to Zoom,” she said.

Last year, there was a period when staff were able to come together but now they’re back to being more remote, Rousse said, but the agency has found ways to host remote meetings so the staff members can compare notes and share updates.

Some agencies are dedicating staff to serving patients with COVID rather than have a nurse see a patient who has tested positive, and then visit other patients. Another strategy is for a nurse who has a COVID patient as part of their rounds to schedule that as the last appointment of the day.

Olson pointed out that home health includes the nurses and therapists who provide medical care to people at their home, as well as maternal child health and hospice services, also known as end-of-life care.

But some forget that VNA organizations also provide long-term care, which includes helping people who need assistance with everyday tasks like getting out of bed, getting dressed or bathing. Olson said people in that area, known in Vermont as “choices for care,” are especially stressed.

Even before the pandemic, about one in four positions in long-term care were open in Vermont and now it’s one in three. In long-term care, Olson said she’s starting to hear about agencies that can’t accept all patients.

But Olson said she’s not aware of any agencies unable to keep up with the medical needs of the patients in its community.

Sara King, CEO of VNA & Hospice of the Southwest Region, based in Rutland, said there have been days when staff members were unable to work because they had tested positive for COVID.

“Thankfully, we have not had it be in such large numbers that we haven’t been able to see our patients. We have been able to continue to see all of our patients that need to be seen every day. We’re able to meet the demands of the hospital in terms of the referrals we’ve been given. We’re not missing any patient visits,” she said.

CVHHH’s Rousse said they’re seeing some staff out as consequence of sickness, but not many of them have tested positive for COVID.

“Ultimately, we’ve had a very minimal amount of staff (testing) positive, and we really attribute that to a couple of different things. One, when they’re working, the (personal protective equipment) protocols that we’ve followed and the strict adherence we have to following our policy. Secondly, our staff that understands completely that they’re going from home to home, that they can’t control that environment so (they do) whatever they need to do in their personal lives to make sure that they’re protecting the clients themselves as well as their families,” she said.

Olson said that even before the pandemic, staff in home health care understood the environment is more unpredictable than a more controlled site like a hospital, and staff usually work alone during a visit.

“Home health takes place in an environment where anything can happen. There can be lots of people in the home. There can be dogs. There can be all kinds of things. It’s an uncertain environment,” she said.

Staff in the field have learned, with guidance from their agency, the state Department of Health and the federal Centers for Disease Control and Prevention, how to make their situation safer.

“People had to learn how to don a lot more (personal protective equipment) in driveways and in garages and add that element to work they do every day, screening patients to be sure they understand what they’re walking into to the greatest extent possible,” Olson said.

King said the nurses and all the clinical staff at her agency, known as VNAHSR, were doing an “amazing job.”

“Our nurses, our therapists, our (physical therapist assistants) or (licensed nursing assistants,) they are tired like every other health care worker in the industry, but every day, they’re getting up and getting ready and they go there and they take care of our patients. They do that as one of their priorities. They are digging deep for their strength. I’m so proud of all of them,” she said.

The Rutland agency has seen an increase in its patient census since the beginning of the pandemic. Like Central Vermont, VNAHSR has been able to work with traveling nurses to meet the demand, but “we’re still a little short,” King said.

“But (the field staff) are able to pull it up and get the strength to get out there,” she added.

Olson said staffing is mostly a challenge, same as hospitals and other areas of health care both in Vermont and beyond, she said.

“There simply aren’t enough nurses to go around,” she said.

King said her agency was working with VNAs of Vermont and the state of Vermont and its workforce strategic plan. She said they are also offering bonuses to those who join the agency and retention bonuses to keep staff they have.

“We’re taking every opportunity we can,” she said.

Rousse said she would prefer to reduce the use of visiting nurses in favor of staff who “live in our community serving the individuals in their homes in the community (and who) understand what the resources and tools are.”

She said the situation now is like “musical chairs,” with different health care organizations competing for the same small pool of nurses, who may leave one job for another when a better offer is made. The better solution would be more nurses, she added.

The pandemic is continuing with no immediate end in sight. Rousse said central Vermont has had COVID patients on its service going back to March 2020.

Olson said she believes exhaustion over the COVID response goes beyond employees in health care, but said people in her industry are doing their best.

“I think everybody is pretty tired. Keeping up the spirits of everybody who’s being responsive to the pandemic is a thing that I hear my members take very seriously. To really make sure people feel appreciated and also feel like the agency is doing all they can to support them and protect them,” she said.

patrick.mcardle @rutlandherald.com