Introduction
As we’ve moved past the one-year anniversary of the onset of the COVID-19 pandemic, the time is being marked by recognition of the devastating loss and suffering caused by the virus, as well as the drastic changes it triggered for the delivery of healthcare. Jennifer Southwell, onehome’s VP of Home Health, reflected on the company’s response to the public health crisis and its ongoing impact on care in the home.
Q: The early days of the COVID-19 crisis overwhelmed the healthcare system in so many parts of the country. What stands out regarding onehome’s role at the start?
JS: onehome’s home health nurses and support staff were asked overnight to become frontline workers, and we rose to this historic challenge. I can say that now with tremendous pride, but it wasn’t an expected or an easy task at the time. The infectious and lethal nature of the COVID-19 virus presented challenges to our home health professionals on a scale we’ve never experienced, with unknown risks that couldn’t be dismissed. The nature of the patients we served changed. Home health has always been the site of care for stabilized patients on the road to recovery. We were now asked to see the unstable patients, the ones who may not make it. This was a big shift for home healthcare. I fielded lots of calls, had countless meetings and emails about how we were now the frontline. This was now our role.
Q: What did people want to know?
JS: At first, my people were scared. For the first 20 or so COVID cases that came to us, I had to reconcile quickly the sensitivities involved in asking people to put themselves in situations in which they felt vulnerable with the urgent health needs of our patients. I spoke with experienced home healthcare nurses at length about their fears and how following the PPE and public health protocols could calm those fears. They wanted to know would they be infected? Would they be putting their family at risk? Patients were going to possibly die in their care from no fault of their own. Would they be held responsible? I had nurses and therapists saying, “This patient shouldn’t be home,” but it was the safest option. Doctors were doing anything to avoid having to admit post-acute care patients to SNFs or rehabilitation facilities. As a result, our direct-to-home admission numbers increased, so we had to come to terms that people’s lives, and, in a sense, the larger healthcare system, were relying on home health to help them survive this crisis. We understood our role as the best line of defense in containing the virus’s spread and keeping people alive, so we made the home the safest place to be in an unsafe time.
Q: What changed as the pandemic went on?
JS: On an individual level, we learned early that adhering to the safety protocols worked, and that gave confidence to our frontline and secondary staff. onehome was prepared with PPE at a time when there were inventory shortages making care riskier. It was a time when you learned not to take the basics for granted. But on a bigger level, regarding the industry, I think our pandemic experience on the frontlines made clear we’re in the midst of a major shift for how and where people receive care — moving from facilities to the home.
Q: What is behind the shift?
JS: onehome has always understood that the home is the best place for healing. That’s guided us since our founding eight years ago and is the mission driving our business nationally. However, there’s no question that COVID has been an accelerator. The move to the home is one of those things that seemed to happen gradually and then all at once. It’s the quality and the range of care available in the home making it possible. When I began my home healthcare career 20 years ago as an Occupational Therapist, it would have been unthinkable that home-based care could be a viable alternative to hospitals or SNFs. Home healthcare was largely considered a billing concept for Medicare and Medicaid patients rather than an option for post-acute care. As I progressed to become the owner-operator of a home healthcare agency, home-based care consisted mostly of physical therapy, basic nursing skills for insulin and Lovenox injections, and some easy wound care. A physician would not recommend a hospital-to-home discharge for a patient requiring more specialized care. Yet, now, what we at onehome call “enhanced home health” has evolved with more complex interventions: wound VACS, clinical services for surgical wounds, stage 4 ulcers, IV antibiotics, Dobutamine infusions, even chemotherapy, with home-care nurses receiving training and certification that gives doctors greater security for direct-to-home discharge. That level of trust wasn’t there when I started, or in most cases, even five years ago.
Q: As a result of onehome’s experience during COVID-19, where do you see home health going?
JS: There’s no question that the pandemic changed where people get their healthcare — at home — and the role of technology in making that possible. Expectations have changed for patients, as well as for healthcare plans and physicians. There’s no turning back. Enhanced home care will continue to evolve, augmented with bluetooth technology for monitoring blood sugar, blood pressure and other vital signs. Plans don’t generally pay for remote diagnostics now, but the incentive to do so may not be far off. The expansion of remote services in home health will be important to onehome’s growth as we serve more patients who want to stay healthy and independent at home. That will be a welcome change for millions of people.