In view of recent spikes in COVID-19 cases, there is continuing concern that hospitals will be overwhelmed with severely ill patients and that beds in intensive care units (ICUs) may become unavailable. Perhaps the answer is to keep as many patients as possible, even those who are seriously ill, at home.
You may have read an article in The New York Times on July 26, 2020, entitled "Some Seriously Ill Patients Can Be Treated at Home" by Roni Caryn Rabin. The subject of the article, Joan Murray, is seventy-seven years old and a retired registered nurse (RN). She was ill with COVID-19 for about a week when she ran into serious trouble. She had a fever of one hundred and three degrees and her oxygen levels were dropping. She was having trouble breathing and said it felt "as if somebody had bound up [her] lungs with string."
Ms. Murray was adamant that she wanted to be treated at home, so Northwell Hospital sent a nurse manager to her home who did a thorough assessment. In short order, Ms. Murray was on IV fluids. A phlebotomist came to her home to draw blood. Ms. Murray was placed on oxygen and was started on a powerful blood thinner to prevent clots. During the following week, nurses visited daily. A critical care physician and lung specialist also called each day to talk with Ms. Murray. Pulmonologists used remote monitoring to follow Ms. Murray.
Provision of care at home is often consistent with patients' decisions to refuse hospitalization. Patients like Ms. Murray may be fearful about going to hospitals and very concerned about being cut off from friends and family, since visitors are generally barred by health facilities to prevent further spread of the virus. Hospitals like the one that treated Ms. Murray have now developed evidenced-based protocols that rely on educating patients about how to monitor their temperature fluctuations, track blood oxygen levels, use pulse oximeters and report changes to practitioners. These protocols require that patients in severe respiratory distress will be hospitalized.
Between April 27th and June 1st, Northwell treated one hundred and eighty-two COVID-19 patients, ranging from ages twenty-four to one hundred, in its home care programs. Many had underlying conditions, such as diabetes, that are linked to worse outcomes. Most patients, including Ms. Murray, were able to remain at home during treatment of their illnesses. Only two patients were eventually hospitalized. Patients cared for at home also received needed services at home after they recovered, including nursing, therapy and private duty services.
Based upon the above, home care providers may become front-line providers in the fight against COVID-19. Home care providers have the knowledge and experience to fulfill this role. Get ready!
