We are so proud of the children of our staff members who are graduating this year from area high schools and colleges! Also a big congrats to one of our own nurses who passed her APRN test this week. The future holds great promise for each of these graduates.
Aiden, NW Regional HS #7 Ariel, U of Southern MaineAsher, NW Regional HS #7 Ben, NYU School of Nursing Dawn Erlingson, APRN, Walden University Daniel, US Navy Boot Camp Jacob, NW Catholic HS Josh, NW Regional HS Kate, Simsbury HS Katelyn, U of Vermont Lucy, Simsbury HS Maddie, Granby Memorial HS Maia, Williams College Sarah, Simsbury HS Xsia, Windsor HS
Home health care is becoming a new front in the national fight against COVID-19 as some patients come back from hospitals and others strive to stay out of them
By Jennifer Peltz • Published April 26, 2020
Ruth Caballero paused outside an unfamiliar apartment door, preparing to meet her new patient.
She covered the knob with a plastic bag. Put on a surgical gown, then a heavy-duty N95 mask, a lighter surgical mask on top. Cap, face shield, shoe covers. Hand sanitizer between each step of the process. Finally, the nurse donned two sets of gloves and knocked on the door with her elbow, ready to care for her first coronavirus patient.
After about three weeks in a hospital, the man was home in his New York apartment but still so weak that sitting up in bed took some persuading.
“You made it out of the hospital, so you are a miracle,” Caballero told him. “Now let’s keep you out of the hospital.”
Home health care is becoming a new front in the national fight against COVID-19 as some patients come back from hospitals and others strive to stay out of them.
Home care nurses, aides and attendants — who normally help an estimated 12 million Americans with everything from bathing to IV medications — are now taking on the difficult and potentially dangerous task of caring for coronavirus patients.
How Coronavirus Has Grown in Each State — in 1 Chart
New York has quickly become the epicenter of the American coronavirus outbreak. This chart shows the cumulative number of cases per state by number of days since the 10th case.
While Americans are being told to keep to themselves, home health providers and their clients still largely have to engage in person, often intimately. Many agencies are ramping up phone or video visits but can’t always get paid for them, and even the smartest phone can’t physically dress a wound or get someone to the bathroom.
Like their colleagues in hospitals and nursing homes, home care workers have faced a scarcity of protective equipment, but with a lower public profile. Some agencies have scoured for masks at nail salons, auto body shops and tattoo parlors, said William Dombi, president of the National Association for Home Care and Hospice, an industry group.
The crisis is testing the industry, but it’s also a moment of pride for workers who have often felt under-recognized.
“It is a challenge to keep the business operational, but it’s an opportunity,” Dombi said. “We’re getting a chance to establish what can be done.”
Coronavirus care at home has expanded rapidly in the last few weeks. At least some agencies in most states are now taking COVID-19 patients referred after hospitalization or nursing home care or as an alternative to them, Dombi said.
Still, some patients have struggled to get care. After being diagnosed with coronavirus-related pneumonia late last month, Penny Wittbrodt contacted multiple agencies around her home in Winchester, Kentucky. None was then accepting COVID-19 patients, she said, though her doctor was able to arrange home oxygen. Wittbrodt, who has asthma and a history of respiratory hospitalizations, is still not well, though she’s had some relief at times.
A retired home health nurse, Wittbrodt feels such care is especially valuable in the pandemic.
“Home health would expose far less people to COVID than hospitalization,” she said.
New York-based Americare Inc. has taken about 100 COVID-19 patients released from hospitals, and over 200 of the agency’s other patients also have tested positive or shown symptoms, VP Bridget Gallagher said.
Every corporate staffer including the CEO is calling protective gear suppliers, but the agency still counts its stock of N95 masks every day.
“We’re doing what we can, but I have to be honest: None of it feels like enough,” said Gallagher, who’s also on the board of the Home Care Association of New York State.
For many agencies, chronic staff shortages are amplified by absences due to illness or quarantine. And workers are grappling with patients’ fears while reckoning with their own risk.
The surgical mask and gloves that Washington home health aide Adassa Clarke now wears rattle her patient, who has Alzheimer’s disease and relies on a wheelchair. The patient doesn’t have COVID-19 but can’t retain what she’s been told about an illness going around.
“What’s going on? Do I have a germ? Am I dying?” she asks, according to Clarke. Sometimes, the patient breaks into tears.
At 65, Clarke herself is in an age group at higher risk of severe cases of COVID-19, and she’s trying to stay home as much as she can.
But patients “come first,” said Clarke, a certified nursing assistant.
“I just feel like the more I help, the more I keep going,” she said.
A home health nurse with Chicago-area patients with COVID-19, Vanessa Pepino-Adraneda is extra-vigilant about protective gear and other precautions. Pepino-Adraneda also girds herself by focusing on caring for her patients and allowing herself moments of sadness, frustration or exhaustion.
“I try my best to protect my sanity amidst all this chaos,” she said.
For some people, especially older adults and people with existing health problems, the virus can cause severe illness or be fatal. For most people, it carries mild symptoms or none at all, meaning some patients could have the virus and not know it.
The Visiting Nurse Service of New York, one of the nation’s largest home health agencies, currently has nearly 400 COVID-19 patients, and another nearly 300 referrals await, Executive Vice President Dan Savitt said. Separately, about 80 confirmed and presumed coronavirus patients are getting hospice care.
As an industry, “I do feel like we’ve risen to the challenge,” he said.
When the agency first told Caballero and other nurses in late March that COVID-19 patients were coming, “I won’t say that I wasn’t nervous,” Caballero says.
She was relieved, though, to see the protective equipment the agency issued. And her first visit, to the man in the apartment, went well. When she called later that night, he was not only sitting up but had gotten into a chair.
The person who would have been her next coronavirus patient died before visits began.
Caballero is now caring for several COVID-19 patients. They came home debilitated and fearful, afraid that hospitals “sent them home to die,” she says.
She encourages them to take step after small step: to sit on the side of the bed, to walk to the bathroom, to have a meal at the kitchen table.
“It is a challenge. This disease has taken so many lives,” she says, but “I’m so blessed and so honored and so grateful that these patients are coming home.”
“Think about it — there but for the grace. It could be I.”
We are proud to announce that Jean Pickens, BS, RN, Manager of Community Health Programs, is a recipient of the highest award in nursing, the Nightingale Award. Given to nurses who represent the best of talent, service, compassion and care, Jean has dedicated her career to healthcare and currently manages the Community Health Program at the VNA. Jean is instrumental in area health education, the immunization program, and local blood pressure and blood sugar testing.
“It is through the unlimited compassion and talent of our nurses that we are able to meet the unique needs of individual patients and their families in the towns that we serve,” said Nancy Scheetz, Executive Director of the Farmington Valley VNA. “Nurses are extraordinary advocates for patients. Jean Pickens has touched thousands of lives in her daily interactions with patients, families and their communities. When Jean is out with her staff in the area immunization centers or monitoring blood pressure and sugar levels, she is reaching our own communities right where it counts.
Visitors are always a bright spot when you are not feeling well. Even more special is a visit from a very large soft dog who patiently allows you to pet his soft thick fur and look into his understanding eyes.
Vikahn and Yulee were a father and son team of a breed called Leonbergers, very very large dogs, who have worked as hospice companion volunteers along with their owner Vic Neumann at the Farmington Valley Visiting Nurse Association. Sadly, the dad Vikahn recently passed away from age related disease. He was an amazing dog who provided so much love to many. Vikahn even provided comfort to the families in Newtown following their school tragedy.
Yulee is now visiting solo, following well in his dad’s footsteps and providing companionship to the homebound, hospice patients, Connecticut Children’s Medical Center, nursing facilities and schools. He brings fond memories of patients’ own pets and the enjoyment of his company is obvious on the faces of those he visits. He often calms those who are upset and brings company to the lonely.
Leonbergers weigh up to 170 lbs. and can be over 30” tall. They are a lush-coated giant breed of German origin and have a gentle nature and serenity well suited to providing companionship in many situations. They truly enjoy the companionship and attention and will sit or stand patiently enjoying the moment. Yulee is so tall that patients can pet them right at their bedside and his gentle nature encourages interaction with all people. All dogs who visit hospice patients need to be certified pet therapy dogs and Yulee is certified through Therapy Dogs International.
The VNA is now offering blood sugar testing along with our other community health services of blood pressure screening and seasonal flu shots. As high blood sugar can often go undetected, these free clinic tests can be a key in preventative health care. View our Calendar at http://farmingtonvalleyvna.org/wp/events/h. (Fasting for 2 hours prior the test is recommended.) Why should you get tested?
Here’s why: Glucose, or sugar, is the fuel that powers cells throughout the body. When something goes wrong—and cells aren’t absorbing the glucose—the resulting high blood sugar damages nerves, blood vessels, and organs, possibly setting the stage for dangerous complications. High blood sugar causes no obvious symptoms at all, at least at first. About 29 million people in the U.S. have diabetes, but one in four has no idea. Another 86 million have higher-than-normal blood sugar levels, but not high enough to be diagnosed with Type 2 diabetes. That’s why it’s a good idea to get your blood sugar tested if you are at risk for diabetes. That includes people who are overweight, physically inactive, have high blood pressure or have a family history. A single high blood sugar test isn’t enough to diagnose diabetes, because blood sugar can spike if you are sick or under stress. But if repeated tests are elevated, it’s a sign you have a problem. The good news is that catching it early—before you have signs and symptoms such as excessive thirst, frequent urination, weight loss, headaches, fatigue, dry mouth, dry itchy skin, or difficulty concentrating, can help you get treated and avoid serious complications down the road. The VNA is here to help. So please stop in to one of our clinics.
When it comes to Alzheimer’s the precise number of stages is somewhat arbitrary. Some experts use a simple three-phase model (early, moderate and end), while others have found a granular breakdown to be a more useful aid to understanding the progression of the illness.
The 7 Stages of Alzheimer’s Disease
The most common system, developed by Dr. Barry Reisberg of New York University, breaks the progression of Alzheimer’s disease into seven stages. This framework for understanding the progression of Alzheimer’s disease has been adopted and used by a number of healthcare providers as well as the Alzheimer’s Association.
Here is summary of the seven stages of Alzheimer’s disease based on the ideas of Dr. Resiberg:
Stage 1: No Impairment During this stage, Alzheimer’s disease is not detectable and no memory problems or other symptoms of dementia are evident.
Stage 2: Very Mild Decline The senior may notice minor memory problems or lose things around the house, although not to the point where the memory loss can easily be distinguished from normal age related memory loss. The person will still do well on memory tests and the disease is unlikely to be detected by physicians or loved ones.
Stage 3: Mild Decline At this stage, the friends and family members of the senior may begin to notice memory and cognitive problems. Performance on memory and cognitive tests are affected and physicians will be able to detect impaired cognitive function.
Patients in stage 3 will have difficulty in many areas including:
-Finding the right word during conversations -Remembering names of new acquaintances -Planning and organizing -People with stage three Alzheimer’s may also frequently lose personal possessions, including valuables.
Stage 4: Moderate Decline In stage four of Alzheimer’s disease clear cut symptoms of Alzheimer’s disease are apparent. Patients with stage four Alzheimer’s disease:
-Have difficulty with simple arithmetic -May forget details about their life histories -Have poor short term memory (may not recall what they ate for breakfast, for example) -Inability to manage finance and pay bills
Stage 5: Moderately Severe Decline During the fifth stage of Alzheimer’s, patients begin to need help with many day to day activities. People in stage five of the disease may experience:
-Significant confusion -Inability to recall simple details about themselves such as their own phone number -Difficulty dressing appropriately -On the other hand, patients in stage five maintain a modicum of functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.
Stage 6: Severe Decline Patients with the sixth stage of Alzheimer’s disease need constant supervision and frequently require professional care. Symptoms include:
-Confusion or unawareness of environment and surroundings -Major personality changes and potential behavior problems -The need for assistance with activities of daily living such as toileting and bathing -Inability to recognize faces except closest friends and relatives -Inability to remember most details of personal history -Loss of bowel and bladder control -Wandering
Stages 7: Very Severe Decline Stage seven is the final stage of Alzheimer’s disease. In stage seven of the disease, patients lose ability to respond to their environment or communicate. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of the illness, patients may lose their ability to swallow.