October 2020, Volume XXXIV, Number 7

Home Health Care

Private Duty

An Essential Role During COVID-19

he world has experienced huge disruptions in this time of COVID-19, and in no arena more so than healthcare delivery.  Parts of it, like hospitals, are under strain as they heroically act to meet the pandemic challenge.  Others, like private duty home care, are stepping up to fill new needs created by the pandemic.  Minnesota is one of the states with the highest number of private duty home care agencies, and these providers are a valuable part of responding to this challenge.

What does private duty mean?

There are significant differences between home health care and private duty care. Home health care visits are coordinated by a patient’s physician and typically covered by Medicare. Home health care provides a wide range of skilled health care services. Visits typically do not last long (under an hour) and treatment is typically complete within after 30-60 days.

Examples of Home Health Care Services

  • Wound care for pressure sores or a surgical wound
  • Patient and caregiver education
  • Intravenous or nutrition therapy
  • Injections
  • Monitoring serious illness and unstable health status

Home health care services are typically offered just during 8-5 business hours, not early mornings, late evenings, overnight or on weekends.  They also do not offer ‘same day starts’ in those crucial first 24 hours after a patient release.  Once discharge orders are given to home health groups, it can take 72 hours just to get out and see the patient for a first-time visit.

Private duty home care is especially valuable in the first 72 hours after a hospital discharge.

Private duty care is available for individuals of any age who require assistance with their day-to-day activities. Private duty aides can assist with tasks such as housekeeping; meal preparation and offering companionship to those who need additional assistance to remain safe and comfortable in their own home. Private duty care is not covered by Medicare and is typically paid for by the client. The goal of private duty care is to help maintain a client’s ability to stay in their home comfortably, offer a respite care to other caregivers or to provide an extra level of care in long-term care facilities or even in hospice.

Examples of private duty care services

  • Personal care – bathing/dressing, hygiene, transfers, and ambulation.
  • Homemakers & Companions
  • Meal cooking and preparation
  • Medication reminders
  • Transportation for doctor’s visits, shopping, etc.
  • Care giving for specialized conditions such as Alzheimer’s disease, Hospice, or other comfort needs.

Patients or their loved ones hire their own private duty provider and use the service for the short term or for long stretches. It is often a preferred choice when there is no immediate family to care for a recently released patient and it also fills the care gaps when home health care is available for only one or two visits per week.  Private duty home care is being tapped more and more for medically complex cases including those that require overnight assistance. Private duty agencies can get an inquiry at noon and have a highly trained professional on site that evening.

Additional benefits

This March, Governor Walz’s executive orders postponed non-elective surgeries to reserve hospital beds and staff for caretaking potential overflow COVID patients.  A key concern now that those regular hospital procedures have resumed is re-hospitalization. Nationally, typical re-admission rates are more than 15%.  When patients receive post-hospital home care, however, readmission rates can drop to 4-5%.  With the aid of dedicated private duty agencies, this rate may be even less than 3%.  Statistically, the first 48-72 hours after discharge are the most crucial to prevent complications. Private duty home care is especially valuable in the first 72 hours after a hospital discharge. Studies show that it more than pays for itself during this time period and many hospitals in the U.S. are willing to pay for it for 3-5 days.

Avoiding medication errors in the home after a hospital stay or surgery and preventing falls are two primary causes of re-hospitalizations and both are positively impacted by private duty home care.

Private duty in the home

Once a patient is released from a medical facility, family members are typically not conversant with post-hospital care needs.  Decisions about parent care during this pandemic are especially fraught with stress.  Having a Certified Nursing Assistant (CNA) there to explain procedures and offer a constant, caring presence can make a world of difference.  The patient recovers his/her strength faster while other family members can get their rest at night and not become worn down themselves.  With the aid of private duty home care, breadwinners are able to maintain their regular schedule rather than take time off because a family member has compromised health.

Private duty home care is being tapped more and more for medically complex cases.

In response to the pandemic, assisted living sites and nursing homes have prohibited non-essential onsite contact with a resident.  Many families are deciding to bring their parent home for care and support.  A private duty caregiver can also offer a viable way to isolate a vulnerable patient or senior within the home, serving as a safety barrier against potentially high virus exposure from multi-generational family caregivers.

Long Term Care Support

In long-term care facilities, the ratio of residents to caregiver aides can be 15-20 to 1. As a result, more and more families are hiring private duty aides to give supplemental attention to individuals living at these sites. It’s heartbreaking when loved ones are prohibited from contact with family members when in a senior community.  Hiring a private duty home care agency to serve a loved one can be a way of addressing the lack of physical and emotional support from those with whom they may have shared a lifetime.

These healthcare professionals can be brought in on a flexible basis - short term or long term - to complement whatever schedules and capacities family members are managing.  Whether it’s just a few hours per day or 24/7 care, the family knows that with private duty assistance they are safeguarding their parent from elevated virus exposure rates in senior living communities while also assuaging anxiety and concern about this indefinitely long period.

Private duty caregivers are now acting in a new role in making adjunct social visits on behalf of families so residents are not left feeling so alone.  Especially in memory care settings where Alzheimer’s and dementia patients don’t understand the reasoning for the new house rules about masks and social distancing, such supplemental caregiving can provide one-on-one companionship to decrease patient stress/depression and provide a sense of normalcy.

Supporting independence

Private duty home care can play an important role in supporting seniors who live alone in their own homes and wholeheartedly want to continue to do so.  Studies show that their lives are extended with high-touch quality care in familiar surroundings.  Accidents in the home are significantly reduced and lessen the need for things such as hip replacements.  This can be as simple as reviewing safety features, tossing out slippery throw rugs or maximizing lighting.  Socialization is another key benefit for seniors. If they happen to need care in while COVID-19 protocols preclude family visits, a private duty CAN, with whom they already have a nurturing relationship, can provide much needed human interaction.

Keeping Safe

Private duty home care agencies have adapted their business models to new CDC/MN Dept of Health COVID-19 guidelines. Staff members wear appropriate PPE and have daily health screenings before going on shift.  Agencies screen new clients coming from a hospital stay and require a negative COVID test.  Families are communicated with virtually and schedules/notes are posted on a family portal site.  Hiring interviews are done by Zoom, as are staff meetings.  Service packages for hospital discharges, transitional care and long term care are fine-tuned to meet the needs of the individual situation. Same-day starts are available and ‘wrap-around care’ can bolster the nursing provided by existing care scenarios.

Closing thoughts

COVID-19 has changed the equation in bringing to light how private duty home care agencies can be an important adjunct to nursing homes and in private residences.  They care for patients with a wide spectrum of needs and stressors. Private duty care is an invaluable resource that is helping to meet the changing health systems needs demanded by the pandemic.  When physicians integrate private duty home care into their range of recommendations to families, they ensure that a continuum of care is provided so that optimal patient outcomes are achieved.

Aaron Stromley, is owner of Touching Hearts at Home, a Twin Cities private duty home care agency focusing on memory care, hospice care and transitional care: www.touchinghearts.com/southmetro

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Aaron Stromley, is owner of Touching Hearts at Home, a Twin Cities private duty home care agency focusing on memory care, hospice care and transitional care: www.touchinghearts.com/southmetro