Home health workers emerge on the front line in COVID-19 battle

ADDISON COUNTY HOME Health & Hospice CEO Deb Wesley sports a homemade face shield and brandishes a swimming noodle during a recent interview with the Independent. The face shield protects ACHH&H workers from potential COVID-19 exposure, while the swimming noodles are a playful way agency workers make sure there’s six between feet them and their nearest colleague. ACHH&H has thus far cared for nine COVID-positive patients.

“Our work can rarely be done at six feet. You can’t give someone a shower at six feet, you can’t do wound care at six feet, you can’t teach someone how to get out of a bed at six feet. It is intimate, what we do. We have to take care of our patients and staff at the same time.”
— Deb Wesley, ACHH&H

NEW HAVEN — When you see one of those roadside signs thanking healthcare workers for their massive contributions during the COVID-19 pandemic, make sure your positive thoughts extend beyond the Porter Medical Center campus and into the very homes of the patients. That’s where you’ll find a lot of unsung heroes — Addison County Home Health & Hospice (ACHH&H) workers — who are helping COVID patients recover from the disease where they live.
ACHH&H’s 107 full- and part-time aids, nurses, social workers, speech therapists, personal care assistants, homemakers and other professionals have cared for a total of nine COVID-positive patients thus far. That’s in addition to their many other clients who need constant help for other ailments, ranging from wounds to post-operative care.
Addison County, as of the last Vermont Department of Health count, has had a total of 61 COVID-positive patients since the outbreak began in mid-March.
Every member of the ACHH&H crew has performed admirably during the pandemic, according to agency CEO Deb Wesley.
“This team is very special and has been since the day I arrived,” she said. “It was the unknown, and no one knew what to expect (with COVID). Not a single person has said, ‘I’m not going.’ We lined up, met as a team, and discussed precautions.”
Most of that meeting has had to take place remotely, through Zoom and other social media platforms. Roughly half the ACHH&H staff continues to work in the agency’s New Haven headquarters while abiding by social distancing protocols.
Wesley and ACHH&H Director of Development Maureen Conrad agreed to meet with this mask-wearing reporter last week. They each brandished what has become a fun social distancing tool — a swimming noodle (one of those long, colorful pieces of foam used for floatation). If the nearest person is closer to you than an arm’s length and a swimming noodle, you get to bop that person with the noodle.
“It adds a little humor to the day,” a smiling Conrad said.
A little humor can be huge during a pandemic that has touched almost 900 Vermonters, so far. It had tragically killed 46 in our state as of Monday.
Home health officials began preparing for the pandemic in early March. They held staff meetings to pore over the latest news from the CDC and Vermont Department of Health.
“Now we’ve settled into a ‘new norm,’” Wesley said.
“We made a decision early on not just to protect our patients, but to protect our staff. Because if any one of our staff gets sick, we can’t provide care for the community.”

And the new norm has meant shortages in vital health care supplies, including protective equipment like face shields, facemasks and disposable gowns.
“In 35 years of working in home care, I have never faced a supply line limitation,” Wesley said. “I never had to enter a home maybe not having enough (equipment). But we’ve worked really hard to make sure our staff have everything they need. We worked through every supply chain in and out of the state to make sure our staff are safe.”
She credited the ingenuity of her workers and a caring community for helping beef up equipment reserves.
Conrad and Wesley modeled what they called the “Tru-Roy” face shield — a sheath of plastic surrounded by foam and elastic. It protects the wearer from potential saliva spray while working in a COVID home. The device was designed by (and named for ACHH&H workers Cynthia Trudeau and Chris Roy.
Conrad was put in charge of sourcing the face shield material.
Community members stepped forward to help with the cutting, stitching and assembly of the face shields, as well as facemasks, disposable gowns and booties.
“We made a big effort to source a lot of what we’re using locally,” Conrad said. “Carla (Berno) at the Middlebury Quilters Corner has been invaluable in helping us get material that we need.”
So far, they’ve assembled more than 100 of the facemasks that are rotated out when the show the slightest amount of damage.
“We figure we’re going through around one mask per employee per week,” said Wesley, who’s committed to making sure her employees have everything they need when going into the field.
And it’s a front line that is entering environments with a lot of unknowns.
Home health workers place an initial phone call to their patients, asking them their symptoms, family symptoms and contact with anyone else who’s had symptoms. If any of those answers raise a red flag, they have to call their supervisor. The agency treats those homes as potentially infectious and workers add additional gear when visiting, Wesley said.
She noted hospitals and health care provider offices can control their respective environments, in terms of ensuring all surfaces are sanitized.
“With home care, we don’t have that luxury,” Wesley explained. “We are entering their home, and we have to respect that. So we don’t get to control the variables of who’s coming and going, who’s been in the home, who has contact with who.”
That additional equipment includes isolation overalls, booties, surgical cap, and a surgical mask over their N-95 mask. This equipment is removed at the patient’s door when the home health worker leaves.
Caregivers are, of course, encouraged to maintain a six-foot buffer between themselves and the patient whenever possible.
“But our work can rarely be done at six feet,” Wesley explained. “You can’t give someone a shower at six feet, you can’t do wound care at six feet, you can’t teach someone how to get out of a bed at six feet. It is intimate, what we do. We have to take care of our patients and staff at the same time.”

All the precautions are paying off. Not a single home health worker has contracted the virus as a result of performing his or her duties.
“I think the biggest challenge for this team is being socially isolated from each other,” Wesley said.
Home health workers have seen the toll that COVID has taken on the emotional well being of patients — and not only the ones that have tested positive.
“They’re afraid,” Wesley said. “It’s difficult to watch TV and see what’s going on in all the hot-spots, and be terrified that may happen to you. The average age of our patients is over 80.”
Some patients have been too afraid to let health care workers in, thinking it will reduce the risk of contagion, according to Wesley said. As a result, some patients end up becoming sicker and needing more services.
Others welcome the workers with open arms — metaphorically speaking.
“For some of our patients, we’re all (the socialization) they have,” Wesley noted. “They are an incredibly vulnerable population we need to take care of.”
ACHH&H workers have not only done all they’ve been asked; they have made a lot of sacrifices as well.
“We have single moms who chose to have their sons stay with their families because they can’t do this and worry about (their children becoming infected),” Wesley said.
One of them is RN Emily Jenkins, who’s assisted some COVID-positive patients who’ve been discharged from the hospital, according to Jenkins.
A single mom, Jenkins made a painful decision in order to protect her family from potential COVID infection. She elected to send her 9-year-old son to temporarily live with her sister’s family in the Springfield area. Her sister and her husband have teaching experience and have been able to provide the lad with room, board, love and educational help while mom is assisting COVID patients in Addison County.
“I couldn’t work full-time and provide him with everything he needed for school,” Jenkins added. “My sister and her husband have stepped up and become a private school for my son. I’m very lucky.”
Mom and son are united electronically whenever possible.
“I guess technology is the next best thing,” she said wistfully of the separation.
Jenkins knew she couldn’t leave her patients high and dry.
“You go into the nursing field knowing you don’t get to run from a crisis,” she said. “We’re all there to do the best we can do for each of our patients.”

John Buonincontro has been an RN since 2003. He carries a patient load of around 20, one of whom was COVID-positive. This was a person who was discharged from a hospital and required monitoring at home.
Several the of Buonincontro’s patients have been tested for COVID due to potential exposure from other individuals. Thankfully, those tests have come back negative.
Per ACHH&H protocols, Buonincontro wears the requisite face shield, facemask and other protective attire when dealing with a confirmed or suspected COVID-positive patient.
“Like most people, at the very beginning when there was a dearth of reliable information on what we could do to prevent the spread of (COVID), it was difficult to tell patients there was no exposure risk to us coming in,” he said. “The most scary part has been wading through the unknown while still trying to provide the care we have to do.”
He knows his work is important — not only for homebound patients, but for all of Addison County’s health care providers.
“Home health is where the rubber hits the road,” Buonincontro said. “If we don’t provide that care, people end up back in hospitals or nursing homes.”
John’s spouse is a nurse at UVM Medical Center, so they both are well versed in how to stay safe from contagion. If either household member has worked closely with a potential coronavirus patient, they adjust their domestic life to minimize the chances of passing long the virus.
“We’ve done some isolation in the house at times,” he said. “We also both practiced not seeing our own families. I haven’t been into my mother’s house for more than a month.”
Wesley knows that each of her workers has a story similar to those shared by Jenkins and Buonincontro. It makes her realize how pivotal they all will be in the county’s emergence from the veil of COVID-19.
“When this started, none of us predicted that home health would actually be that ‘front line,’” she said. “We are the front line.”
John Flowers is at [email protected].

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