Home Nursing Care and Covid

[Anonymous]

Does anyone with a loved one who relies on home nursing aides have a good plan for Covid?

Obviously the best thing is to NOT get it, but in the worst case scenario all I can think is we would have to try to find a nursing facility that would take a Covid-positive patient for a few weeks?

I don't think our home aides would keep coming and we don't have the right equipment to protect them (just surgical masks and gloves, no N95s nor the training to use them properly). I'm imaging if the patient was positive but not sick enough to need hospitalization, but still needing skilled care for daily living. Do hospitals keep such patients? I've always understood hospitals to move you out unless you're critically ill.

I am drawing a blank honestly. Spouse is also elderly and can't do all the care alone, even if already exposed to the virus. Plus, what if they are both sick?

[Anonymous]

Nursing homes are taking new residents, but most are not taking Covid-19 positive residents.

[Anonymous]

Hi OP,

I am currently at home with 85 year old Mom who has home nursing aids.

I suspect if Mom got Covid and if I could not do her care I would call 911 and she would go to the hospital for a day or so at which point she would be discharged to a nursing home that would take Covid.

My understanding is the ER will not treat/keep the extreme elderly that long and try to discharge them pretty quickly to a nursing home (even with Covid).

If she were to survive all of this then I'd bring her back to the house with outside caregivers again.

I don't feel like there are really great options but I'm at peace with what I am doing and know that Mom may not survive all of this.

In the meantime she is still Covid free and just ate salmon, rice and green beans for lunch in her own home and just did exercises with her caregiver.

We take temperatures of each caregiver and ask and log the CDC nursing home entry questions upon entry.

We also have latex gloves and masks on hand. Typically we don't wear masks but the caregivers wear gloves when they need to. I'm getting ready to buy some of these
shields https://hardwirellc.com/products/hardwire-face-shield just to have on hand. I don't plan on having staff wear them daily but want to have them on hand along with the gloves and masks. The shields are made in Maryland in Pocomoke City.

We do a lot of cleaning at the house.

My sister wanted me to put Mom in a nursing home before all of this started. Of course the nursing homes were on lock down so I sat in parking lots of nursing homes evaluating them from the parking lots.

I have Mom's DNR and State of Maryland MOLST paperwork on file at the local hospital.

I don't feel like I have a good plan but this is my plan:

1. Take temps at every shift change and log. We also ask all of the CDC nursing home questions at the temp check and log answers.
2. I gave a stack of masks to each caregiver for their personal use and for their family members.
3. I have a blank Healthcare POA form in case I get sick and I have to give Mom's healthcare POA signed over to head caregiver temporarily.
4. I'm going to buy the shields to have on hand.
5. I say a prayer each morning and night that each caregiver and caregiver family stays safe.
6. I've dropped off Mom's DNR and Molst Maryland form at the local records office at local hospital.
7. I have Mom's initial paperwork on file at 2 local nursing homes, sent from PCP's office at start of this situation.
8. We get all groceries via Instacart from ACme. We have good service in this area. All groceries are wiped down.

Big picture Mom may not survive this. I am at peace with the situation. If she gets Covid and I can't staff with myself and caregivers (I can't lift) then I'll call 911.
I figure she will be at hospital for a day or so and social worker there will figure out options from there.

I'll be interested to see what your other replies are.

[Anonymous]

OP, I'm poster at 14:02.

The other thing I've considered would be temporarily raising pay for caregivers if Mom becomes Covid positive.

That is what the nursing homes are doing.

Mom's caregivers are getting texts from nursing homes offering pay of $36 per hour for CNA's. They are also getting calls from medical recruiters to work the nursing homes.

Normal nursing home pay in my town on the eastern shore of Maryland for a licensed CNA is $17 per hour.
We are paying $22 per hour. Mom's workers are getting heavily recruited for nursing home work but I don't think we will lose any due to pay.

I think the nursing homes that have the Covid patients are paying the $36 per hour.

[Anonymous]

I’m a Hospice Chaplain. We have long-term care both in our faculty and at home. Our nurses, aides, chaplains, and social workers are still seeing patients both in our facility and at home. We are taking extra precautions with patients and families. I would call and ask the agency what their policy is.

[Anonymous]

This all makes sense, I'm just worried that the hospital would kick us out and not provide a nursing facility since he wasn't in one before. I'm honestly more worried about mild illness - if really sick, the hospital makes more sense.

[Anonymous]

Hi Hospice Chaplain,

Thank you. I'm 14:02. PP I also called hospice at the start of this and they said they would sign Mom up in her home if she got Covid and come out. I am in a rural county and Mom was in hospice 2 years ago so I know the drill. Sign up was about a 30 minute interview when she was in hospice last time.

[Anonymous]

OP, hospice requires a decline of any measure for payment for medicare. We had a weight loss, pretty substantial, and referred my MIL to hospice and they came in. (in our situation hospice made a positive difference and helped us advocate for medication and food changes and she got better until they left and then a quick decline and then she passed so quickly they couldn't get in fast enough). But, if you are seeing a decline refer as worst they can say is no.

Get N95 masks. You can get them but they are pricy. Both for staff but for your parents.

This company has the pulse ox and masks. They are slower to ship but they manufacture equipment and are legit. We got a pulse ox and a box of the 50 surgical masks. A lot of the amazon and eBay companies are questionable. Gloves you can get on amazon if you keep checking. And also, get a face shield for each one on Amazon.

https://ihealthlabs.com

[Anonymous]

We're definitely not ready for hospice. I'm not even that worried about what happens if he gets severely ill. I'm worried about what happens if he gets mildly ill, but still needs nursing care.

[Anonymous]

OP I think if one or both of them take ill you can take a 2 week leave from work and still get 2/3 pay for taking care of parents ill with coronavirus.
Verify the Cares Act for the information.

[Anonymous]

Such a difficult time with no great answers. Wouldn't having a positive patient coming from the hospital into a nursing home just spread it more there? They don't seem to be isolating these patients.

We know that it's spreading from workers going from facility to facility.

[Anonymous]

Anonymous wrote:Such a difficult time with no great answers. Wouldn't having a positive patient coming from the hospital into a nursing home just spread it more there? They don't seem to be isolating these patients.

We know that it's spreading from workers going from facility to facility.

In Maryland Covid cases are required to be quarantined to a certain area/wing of the nursing home all together.

[Anonymous]

Anonymous wrote:Such a difficult time with no great answers. Wouldn't having a positive patient coming from the hospital into a nursing home just spread it more there? They don't seem to be isolating these patients.

We know that it's spreading from workers going from facility to facility.

Nursing homes are doing a number of things to prevent the spread of Covid-19. They stopped visitors except for end of life situations and then limited it to only one. All residents are pretty much quarantined to their rooms so there is no interaction between residents - no group meals, no activities, etc. Covid-19 positive residents are quarantined in a different area. If a resident goes out for any reason, then they are quarantined for 14 days after return - but as a practical matter, this doesn't look different than everyday life. They take the temperature of staff and do a health check whenever a staff member enters the building. Many/Most will only accept their own Covid-19 positive residents on readmission from the hospital - no new residents who are positive.

You are absolutely wrong when you say that they don't seem to be isolating patients. First, they are called residents, not patients. And, they are isolating all residents plus separately isolating Covid-19 positive residents.

[Anonymous]

Anonymous wrote:OP I think if one or both of them take ill you can take a 2 week leave from work and still get 2/3 pay for taking care of parents ill with coronavirus.
Verify the Cares Act for the information.

That couldn’t possibly be safe. I have no equipment.

[Anonymous]

OP, I’ve been able to get KN95 masks quickly and reliably from snowjoe.com

We just went through this with my mom (she died a few weeks ago) so I know what you are going through. There are no good solutions. If she’s admitted to the hospital, the social worker will work with you to find a placement for her post-discharge. I think she has to be admitted, not just in ER, for Medicare to pay. Check on this.