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Module #3
COVID-19 Guidelines for Home Health

Module #3 focuses on COVID-19 guidelines in home health, recognizing the need for COVID-19 infection prevention guidance to help home care, home health, and hospice agencies that provide care to clients/patients in their homes. The risk for severe illness with COVID-19 increases with age, with older adults at highest risk. It is important for home health professionals to take precautions to protect their clients and themselves.

Read carefully because at the end of this module is a quiz. There are 10 questions in total and 5 minutes to complete.  7 questions (70%) must be answered correctly. Your results will be forwarded to admin. You have 8 chances to pass this module. 

In-Service Exams provided by Essential In-Services for Home Health, 2021

Upon completion of this module, you should be able to:

Define the virus known as COVID-19.

Identify the risks that COVID-19 presents to home health patients.

Understand how COVID-19 transmission occurs and who is at highest risk.

Understand precautions that should be taken by home health staff to reduce COVID-19 transmission.

Recognize strategies for prevention and management of COVID-19.

What is COVID-19?
Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). A novel coronavirus is a new coronavirus that has not been previously identified. Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, is a respiratory illness that can spread from person to person.

Who is at risk for COVID-19?
Because no vaccine exists for COVID-19, all persons are susceptible to infection with this virus. However, some individuals may be at greater risk, including older adults and those with certain comorbid medical conditions.

According to the CDC, 80% of deaths due to COVID-19 occur in adults over the age of 65. Adults of any age with existing respiratory, cardiac/circulatory, neurologic, endocrine (diabetes), liver or other conditions causing immunocompromise are also at increased risk.

These individuals should not only take all recommended precautions but should limit all possible interactions with others and contact a healthcare provider within 24 hours if experiencing symptoms of COVID-19.

Community Spread of COVID-19
As the spread of this novel coronavirus has grown, has become clear that some there are some living conditions under which COVID-19 spreads more easily. There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation, which may include certain living conditions where persons are in close contact and may already be at risk such as correctional facilities, senior living facilities/housing, skilled nursing facilities (“nursing homes”).

Under these circumstances, scientists believe that the amount of infectious smaller droplet and particles produced by the people with COVID-19 became concentrated enough to spread the virus to other people.

Preventing the Spread of COVID-19

All persons, including healthcare workers, should take steps to prevent the spread of COVID-19 and educate others on prevention as well. According to the CDC, all persons should wash their hands often using soap and water or a hand sanitizer with at least 60% isopropyl alcohol. Also cover your mouth and nose with a mask when around others, including in public and with persons outside of one’s household.

This includes patients and their families in the home health setting. Always cover coughs and sneezes even in your own home and disinfect high-touch surfaces with an approved household disinfectant no less often than daily.

Maintaining social distancing is one of the most important actions to take in preventing the transmission of COVID-19. Social distancing means keeping a safe space between yourself and other people who are not from your household. To practice safe social distancing, both in the home and in public spaces.

  • Stay at least 6 feet (about 2 arms’ length) from other people who are not from your household in both indoor and outdoor spaces.
  • When using rideshares or taxis, avoid pooled rides where multiple passengers are picked up, and sit in the back seat in larger vehicles so you can remain at least 6 feet away from the driver.
  • Only visit stores selling household essentials in person when you absolutely need to and stay at least 6 feet away from others who are not from your household while shopping and in lines. If possible, use drive-thru, curbside pick-up, or delivery services to limit face-to-face contact with others.
  • If meeting others in person (e.g., at small outdoor gatherings, yard or driveway gathering with a small group of friends or family members), stay at least 6 feet from others who are not from your household.
  • If you decide to visit a nearby park, trail, or recreational facility, first check for closures or restrictions. If open, consider how many other people might be there and choose a location where it will be possible to keep at least 6 feet of space between yourself and other people who are not from your household.

Reducing COVID-19 Risk For Home Health Patients & Staff

It is important to practice not only standard infection control precautions but also all measures listed above for prevention of COVID-19 transmission and exposure in the routine care of home health patients. In addition, the CDC has developed guidelines for healthcare providers who care for patients in their homes, as well as guidelines specific to the care and home setting for COVID-19 positive patients.

Appropriateness of Home Health Care for Individuals with COVID-19

The home health setting is often more appropriate for patients with COVID-19, including those patients who are medically stable enough to not require any hospitalization or patients who are discharged home for further rehabilitative care and recovery following hospitalization for confirmed COVID-19. The risk of community spread is lower in the home setting when considering where a person with confirmed COVID-19 should be placed and allows for better isolation of the individual in an environment where that person may be able to work and better access other comforts while in isolation.

The CDC has developed specific guidelines for when a COVID-19 patient is appropriate for isolation and care in the home setting. In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. 

  • The patient is stable enough to receive care at home.
  • Appropriate caregivers are available at home.
  • There is a separate bedroom where the patient can recover without sharing immediate space with others.
  • Resources for access to food and other necessities are available.
  • The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
  • There are household members who may be at increased risk of complications from COVID-19 infection (e.g., older people and people with severe chronic health conditions, such as heart disease, lung disease, and diabetes). If there are and the patient cannot isolate away from these persons or they cannot stay elsewhere, care at home may not be appropriate. 

Using Appropriate Personal Protective Equipment (PPE)

In addition to the application of standard precautions, hand hygiene, and isolation of the individual with COVID-19 in the home, healthcare providers caring for patients who are positive for COVID-19, must also use PPE appropriately to prevent the spread of infection, while providing patient care. When caring for a patient who is COVID-19 positive in the home, healthcare providers should have the following PPE on hand:

  • Isolation gown
  • NIOSH-approved N95 filtering facepiece respirator or higher (use a facemask if a respirator is not available)
  • Face shield or goggles
  • Gloves

Before donning PPE, perform hand hygiene using at least 60% alcohol-based hand sanitizer (or soap and water if sanitizer is not available or hands are visibly soiled). PPE should be donned before entering the isolation room (or home if the patient resides alone) of the patient according to home health agency policy. When removing PPE, always take off the gown facing away from the body. Dispose of all PPE in a garbage bag, seal the bag and remove from the home hold the bag away from the body. Hand hygiene using at least 60% alcohol-based hand sanitizer (or soap and water if sanitizer is not available or hands are visibly soiled) should always be performed after removing PPE.

Additional Precautions
In addition to assuring that a patient is appropriate for care in the home environment, using appropriate PPE and standard infection control precautions, when providing care for a COVID-19 positive patient at home, healthcare providers should:

  • Maintain social (physical) distancing when in the patient’s home around other household members
  • Instruct the patient and household members to disinfect all high-touch surfaces in the home daily
  • Instruct the patient to wear a mask during direct care interaction with the healthcare provider as well as any other interactions with others who have been cleared to interact with the patient during isolation.
  • Instruct other household members to wear a mask during the healthcare provider’s visit.
  • Assist the patient in securing available resources for healthcare needs, including telehealth appointments with other healthcare providers, such as physicians or nurse practitioners, or using telehealth for the delivery of some home health services to assure optimal recovery for the patient.