How Can Long-Term Care Providers Navigate COVID-19? 5 Ideas.

The past few weeks have been a whirlwind of news and information. What began as a seemingly minor report of a new coronavirus in China’s Wuhan city and Hubei province has escalated into an international health crisis. Now we are living in a pandemic and the United States, like many other countries, is facing a potential crisis in its health care system, with many states, hospitals, and other care providers fearing collapse under the number of new cases.

As key members of the health care system, direct care workers are on the frontlines of the COVID-19 pandemic response, struggling—often with limited information, supplies, and support—to maintain services and keep their clients and themselves safe. For this article, we consulted COVID-19 guidelines from the Centers for Disease Control and Prevention, the National Institutes of Health and the World Health Organization to distill five immediate steps that long-term care providers can take to support direct care workers during this unprecedented crisis.

Implement Feasible Infection Prevention and Control

The guidelines for minimizing the spread of COVID-19, which continue to evolve as we learn more about the virus, are rooted in long-standing practices for preventing the transmission of airborne diseases. Here are some key lessons from those guidelines for long-term care providers to share with direct care workers:

• Practice strict hand hygiene by washing hands with soap and water for at least 20 seconds
• Use gloves when providing personal care to a client, as usual
• Wear masks when less than six feet apart in order to prevent the spread of droplets—but when masks are not available, limit the amount of time spent with the client
• When possible, stay six feet away from others, including client’s family members

During this high-risk time, long-term care providers can also modify care plans to take into account the need to prevent and control infection, the availability (or lack) of personal protective equipment (PPE), and the needs of individuals.

For example, a home care agency, nursing home, or other long-term care provider may decide, when assigning a direct care worker to a client who is asymptomatic and is not suspected to be infected, that the worker may not need to wear a mask, but should only come closer than six feet when providing hands-on personal care. Further, the clients’ care plan may be modified to maximize the safety of both the client and the direct care worker, for example by allowing the worker to set up a bed bath rather than assisting with a shower.

Ensure Clear and Supportive Communication

During this time of uncertainty, clear and supportive communication is essential for easing fears. Providing clients, their family members, and workers with up-to-date news and guidance will help them make safe, informed decisions.

Home care clients, for example, want to know if their home care worker is still coming—and whether they should continue to receive services. Direct care workers across long-term care settings are concerned about protecting the health of the clients they support, especially in the absence of adequate PPE. Some home care agencies have begun calling their workers daily to ask whether they have developed symptoms. While the purpose of these calls is to prevent infection transmission, they are also an opportunity to check in with workers, provide emotional support, and share new information. Nursing homes and other residential care providers can provide frequent updates to workers about the virus and their plans to protect residents and workers. As many facilities no longer permit visitors, facilitating virtual communication between residents and families would also provide comfort and reassurance.

Provide Extra Support for Workers

COVID-19 will result in immediate financial consequences for many direct care workers, due to reduced hours, unpaid time off, loss of a partner’s income, and more—and these workers already struggle to make ends meet on their low-wage jobs. Long-term care providers can play a critical role in connecting workers with information and referrals to help them through this difficult time. It may be helpful to task a staff member with staying current on—and communicating—changes in unemployment benefits, food stamps, childcare services, and other policies and community resources.

Expand Sick Leave Policies

Many agencies require a medical note for any sick leave over three days. Normally, this is a reasonable policy; however, these are not normal times. In order to comply with social distancing guidelines, many doctor’s offices are turning to telemedicine and discouraging people from visiting clinics in person. Instead, people with suspected COVID-19 infection who do not require immediate hospital admission are being told to go home and self-isolate. In these circumstances, long-term care providers should strongly consider waiving the requirement to obtain a doctor’s note when taking sick leave.

Long-term care providers must also comply with federal and state emergency paid leave policies, where applicable, and consider what options they have as an organization to financially support workers who need to take time off due to COVID-19.

Get Creative with Scheduling

Long-term care providers are accustomed to managing staffing issues in short-term, weather-related emergencies such as blizzards and hurricanes. The COVID-19 pandemic is broader in terms of impact and potential duration—making the usual strategies, such as temporarily re-deploying staff based on geography, less feasible. For example, with schools closed, parents must now secure care for their children at home. A worker who can usually clock in at nine in the morning may need to start work later, to allow time for someone to arrive to watch her children. Other workers may no longer be able to work full time due to family responsibilities. By responding creatively to these staffing challenges, long-term care providers can strengthen staff loyalty rather than exacerbate workforce gaps. Scheduling solutions for home care agencies may include negotiating revised schedules with clients, clustering cases together to minimize travel time, and temporarily reducing client hours where safe. Nursing homes and other residential care providers can stagger shifts and allow workers to work different shifts than usual.

Although it is too early to know all the ways in which this pandemic will change the world, it is fair to say that our current responses will inform the future. There will be time to reflect, to examine what worked well and what could have been better, and to plan ahead. In the meantime, success will rest on implementing time-tested strategies while applying critical thinking and creative problem solving. We are in this together!

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