COVID-19 pandemic: Many ways of caring

For Mitch, his mornings start with a team huddle to look ahead at what the day has in store. This includes a transition of duties from the on-call staff from the evening before, reviewing the daily schedule and routes, and determining priority patients on the schedule for the day.

Next, Mitch goes to the fill room to fill tanks of oxygen for two to three drivers who deliver to patients at home. Drivers then head out on their routes to deliver oxygen and supplies to patients in need. Like other health care workers, they wear appropriate personal protective equipment (PPE) and follow physical distancing precautions when delivering oxygen and equipment to patient homes. However, while Mitch notes that the addition of PPE and new precautions has been an adjustment to say the least, the most drastic and challenging implication of COVID-19 has been the increase in patients needing oxygen.

“We’ve had to learn to pivot and shift for sure,” said Mitch. “The demand for oxygen for patients at home with or after a COVID-19 diagnoses has increased, which has meant our overall workload has increased.”

Since January 2020, the number of patients needing oxygen at home has grown by more than one hundred people and the number of calls after hours has more than doubled just from November 2020 to January 2021. An important factor that has attributed to an increase of patients needing oxygen at home is the overwhelming number of patients requiring hospitalization.

“In order to balance and keep beds open for the sickest at the hospital, we have cared for more patients at home who need oxygen,” Mitch said. “Plus, in some circumstances, patients opt to be at home with oxygen instead of being in the hospital if they can do so safely.”

In order to ensure patients are being cared for appropriately at home, closely working with care managers who coordinate safe discharge, home health caregivers and hospice teams has been more important than ever. Mitch also noted that while now they have the equipment and supply they need to care for all patients who need oxygen on their schedule, it wasn’t always this way.

“It was really concerning when the equipment we needed for patients was on back order due to high demand nationwide with no accurate information about when it would come, “ Mitch said.

Today, nearly a year after the pandemic began, the stock and supply of oxygen equipment is sufficient. The team still feels the impact of COVID-19 in part because of the number of patients who are considered “long haulers”, or patients who experience symptoms from the virus for weeks or months after diagnosis. When asked if there was one silver lining in recent weeks that has kept Mitch and his team members motivated, he said it was just the fact that he knew most patients needing his services were getting something they needed to survive– oxygen.

“Patients with COVID-19 are typically going through a lot of unknowns so it is somewhat of a silver lining to know that what we’re offering is helping them.”

In Helena, the St. Peter's Health Community Paramedicine Program serves a wide variety of people. Since April, they've conducted over 700 visits and over 300 individuals have been referred to the program.

"We serve folks who may not qualify for home health care but who have barriers to accessing health care for a variety of reasons," said Angie.

The community paramedicine team provides care in various settings, from the home to the street. The care is just as diverse as the locations the care is delivered.

The team offers many types of medical care and education, including but not limited to:

• In-home lab draws

• Monitoring international normalizing ratio (INR) for anti-coagulation patients

• Basic wound care in line with established wound care plans

• Medication reconciliation and setups

• Home safety and welfare checks

• Vital signs monitoring

• Chronic illness monitoring and education

• Facilitation of virtual care visits

• Vaccinations

Community members are primarily referred to the program by local care managers, who identify patients that will benefit from services.

"We've seen patients from a month old to one hundred years old," said Andrea. "The care that we provide depends on the needs of the community. It is very rewarding."

COVID-19 has significantly impacted the team's work. As COVID-19 cases increased in the community, St. Peter's saw more patients diagnosed with the virus who also had on-going health care needs that needed monitoring during the time they were ill and in isolation.

For example, some patients with COVID-19 need blood draws to monitor a chronic condition. In response to this new need, the community paramedicine team started visiting patients' homes to complete the blood draw. The patient does not have to go into the clinic, decreasing the potential to expose others to the highly contagious virus in the health care setting. The team has provided care to patients across the St. Peter's Health service area throughout the pandemic.

"We served one family who had a very young infant with COVID-19. The family lived in a remote area and had no cellphone coverage at their house. The mother was referred to the St. Peter’s Community Paramedicine Program because she just wanted a quick check on the infant to make sure the baby was doing OK," said Jennie. "We went out to their home and did a quick assessment and general exam, checking the infant's blood oxygen saturation and providing education to the family on signs and symptoms to look out for as well as tips and tricks to alleviate symptoms like nasal congestion for their tiny baby."

While the team does not provide the emergency, life-saving care they once did, their daily work still improves people's wellbeing and has helped save lives.

"There have been several times when I have visited the home of a patient with COVID-19 to help monitor their condition and realized that they needed immediate medical care," said Angie. "In some cases, they've gone to the hospital and ended up being admitted because they were experiencing serious, potentially deadly complications.”

When the team encounters a patient in need of immediate or higher-level care, they either call 9-1-1 for ambulance transport or advise the individual/family to go to the emergency department. While Jennie, Andrea, and Angie fondly recall their days of providing emergency care (Andrea still does work part-time on the ambulance), none regret making the shift to community paramedicine. They're excited to be part of a new, innovative program that helps improve the community's health and wellbeing.

According to Andrea, "We're seeing people when they need help, and the care and the compassion the patients and the family members show solidifies why we do what we do...To be part of the team is spectacular."

The St. Peter’s Community Paramedicine Program is a referral based program, and is available to people who are referred to the program for eligible services from a medical provider. The local health care system is dedicated to identifying funding sources to sustain the successful, growing program so it is available to eligible community members for years to come.

The St. Peter's home health team has continued to care for patients throughout the COVID-19 pandemic. However, the pandemic has drastically changed how they do their job and their care on the job. The team has seen an approximate 30 percent increase in patient census, or number of patients they care for, since the start of the global pandemic.

Like all health care providers, home health team members have adjusted to wearing additional personal protective equipment (PPE) when visiting patients' homes. However, the addition of face shields, masks, and gowns can make delivering care physically and mentally challenging. They also screen patients for COVID-19 symptoms, asking whether patients or household members have had contact with anyone who has been diagnosed with the virus.

"We are in and out of people's homes and our personal cars each day," said Jennifer. "Like health care workers in other settings, we are cautious about infection prevention. Each day when I get home, I am sure to take a shower before being with my family, and we diligently wear our PPE."

Jennifer and the home health team deliver care to a wide variety of patients, including patients hospitalized due to complications from COVID-19. According to Jennifer, "The biggest thing that we see with COVID-19 patients discharged from the hospital is ongoing respiratory issues. People who have had severe cases of COVID-19 often need ongoing oxygen support, even after they are discharged from the hospital."

The home health team – which can include home health nurses, physical therapists, occupational therapists, social workers and home health aides– provide care to most patients who are discharged from the hospital who have COVID-19, even if it is just for one or two home visits. In at least one instance, Jennifer identified a patient with COVID-19 whose condition deteriorated at home; she immediately ensured the patient sought emergency medical care. The patient was readmitted to the hospital for COVID-19 complications.

The Regional Medical Center's care managers work closely with the home health team and other health care teams to ensure they prepare patients for a healthy transition from the hospital to home. They work closely with in-home physical therapists, occupational therapists, home oxygen, and palliative care teams, depending on the patient's individualized needs. Jennifer's home health patients vary widely in age, from pediatric patients to the elderly. Home health nurses provide education to patients, deliver care, set up in-home IVs, or complete lab work. They are often the eyes and ears for the patient's medical providers from outside the hospital or clinic walls. The team works exceptionally closely with patients' primary care teams as well.

The primary care teams appreciate home health and vice versa because it helps ensure the team can deliver whole-person care, looking out for the full spectrum of the patient's physical and mental health care needs. The patients are also appreciative, making being a home health nurse one of the best jobs that Jennifer has ever had.

"I've been a home health nurse for about two and a half years now. It has been a great fit for my life," she said. "I am still able to deliver patient care, and the patients are so incredibly grateful that you're coming to their home. They're also so grateful that they're able to at home. Somewhere that they will heal faster."