Emergency departments and intensive care units across Vermont are preparing for a surge of patients with COVID-19, but the front line of the state’s defense against the new coronavirus extends far beyond the walls of its hospitals.
Nurses, personal care attendants and other employees of Vermont’s 10 home health agencies are fighting the pandemic from the living rooms of the patients they treat.
On Wednesday afternoon, Joe Haller was standing on the sidewalk of a sleepy residential street in Burlington’s Old North End.
Haller, a nurse, works for University of Vermont Health Network Home Health & Hospice. He spends his days traveling to the homes of the 35 or so patients he’s responsible for at any given time.
The patient whose home he stood in front of Wednesday is one of the 628 people in Vermont who have tested positive for COVID-19.
“She just returned from the hospital on Monday, and I’m seeing her today,” Haller said.
"They're back at home, with their family, surrounded by the people they love and the things they love." — Joe Haller, home health nurse
Haller said he decided to enter the home health and hospice field about a decade ago, after watching nurses care for a dying friend.
“And I became part of that whole group who are helping them as they transition from this life to the next. And I was hooked," Haller said. "I thought, 'This is what I need to do.'"
As the new coronavirus spreads in Vermont, that calling has taken on new dimensions. Haller, who wore a surgical mask, said he now follows an evolving protocol of infectious disease controls.
“The vital sign equipment I have, anything that I carry into the home, I have to be very aware of what I’m doing with it at all times so that I would not be spreading and being a vector of COVID-19,” he said.
He isn’t the only healthcare worker at UVM Home Health & Hospice who’s treating COVID-positive patients.
Gretchen Bates, vice president of clinical services at UVM Home Health & Hospice, and “incidentally its commander for COVID-19,” said the agency is providing home care to eight patients with COVID-19.
“We anticipate that that number will change as we are part of the surge plan for our area,” Bates said.
She added that in a pandemic, home care is literally just what the doctor ordered.
"Really being at home is the most valuable thing we have right now to help flatten the curve. That doesn't mean that people aren't still sick and that people don't still need care." — Gretchen Bates, UVM Home Health & Hospice
“Really being at home is the most valuable thing we have right now to help flatten the curve," Bates said. "That doesn’t mean that people aren’t still sick and that people don’t still need care, and that’s exactly where Home Health & Hospice comes in."
Delivering that care in the age of the coronavirus has presented new challenges to the 10 home health agencies operating in Vermont.
“Our world has been turned completely upside-down since COVID hit Vermont,” said Janet McCarthy, CEO of the Franklin County Home Health Agency.
Home health agencies, which treat about 8,600 patients on any given day, are currently providing home care to 29 patients who have tested positive for COVID-19. That’s nearly as many COVID patients as hospitals are treating right now.
McCarthy said her organization has had to juggle the technological difficulties of remote working with the epidemiological intricacies of a new and dangerous virus.
“The most current information at 8 o’clock in the morning could be completely flipped around by 5 o’clock in the afternoon, so it’s been a big adjustment for our staff,” McCarthy said.
McCarthy said her agency’s sense of purpose is stronger than ever. She has some concerns, however, about its ability to execute its mission.
“I’ve been very clear that we will be able to take care of our community if our staff is well, and if we have enough PPE,” she said. “And both of those concern me.”
McCarthy said it’s “inevitable” that some of her staff will contract COVID-19.
“Hopefully it’s only a few staff, and they don’t have any significant health impact as a result of it,” McCarthy said.
She said the agency has struggled to obtain personal protective equipment, such as gloves, from its traditional supply chains.
"Our ability to obtain to obtain personal protective equipment has been very challenging." — Janet McCarthy, Franklin County Home Health Agency
“Our ability to obtain to obtain personal protective equipment has been very challenging,” McCarthy said.
She added it’s critical that the healthcare system do all it can to protect nurses like Haller, who knowingly enter homes in which the coronavirus is present.
Haller said whatever personal risk he takes on is far outweighed by the benefits to his patients.
“They are not relegated to being in a hospital setting or a surge bed situation, where they’re in an industrial sort of situation,” he said. “They’re back at home, with their family, surrounded by the people they love and the things they love.”
