Author Topic: Wife's Company (Home Health) is Accepting COVID-19 Patients; What to Do?  (Read 2586 times)

ReadySetMillionaire

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My wife is a speech therapist that does home health.  She was advised in a conference call today that the company is now accepting COVID-19 cases, meaning that she (and all the other home health providers at the company, e.g., physical therapists, occupational therapists, etc.) will be expected to go into COVID-19 positive homes.

My wife's text to me earlier today said the manager on the conference call advised that it was a "personal decision as to what each therapist was comfortable with."  I'm not really sure what that means.

Like all other healthcare providers, my wife's company is short on PPE. She has had to basically find N95 masks through other channels.  I'm not sure what her situation is regarding gloves and everything else (I'll talk to her more when I get home).

Our finances are strong.  We have $55k cash and could get by for quite a long time without her working at all (my guess is 2-3 years before dipping into other accounts).

But, my wife absolutely loves her job and her company.  She has never been professionally happier.  Before all this started, she worked three days a week, set her own schedule, etc.  The company was always great to her. She loves her boss and everyone she works with. She loves home health.

I guess this is the reality of being a healthcare worker right now.  Eventually my wife would be on the "front lines" treating people like this, and that time is now.

We are talking later, and I just want to know how I should proceed?  I want to be supportive but I'm worried at striking the right balance. 

What questions do I ask?

What would you do?

Any other home health/nurses/etc. out there?


SunnyDays

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Oh, hell no!
I'm not a health care worker, but did used to go into people's homes for psychology-related work and also worked with SLPs.  There is no way anyone would get me to go into a COVID positive home now for anything short of life or death.  There's no reason she can't do her work virtually through Skype or some other platform.  This is not a hands-on job.  She needs to clarify what she's being told.  Is it truly "what she is comfortable with" or is she "being expected" to go into these homes?  Is there some regulatory body that can support her if it's the latter, such as a professional association or whoever in your state is setting your health restrictions?  At last resort, I would outright quit if needed.  It's totally irresponsible of the company to have that expectation.

Miss Piggy

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She would go into someone's COVID-infected home to provide speech therapy services? Oh hell no. Sorry...not essential.

ReadySetMillionaire

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Well, speech therapy (whether done at home or not) is essential.  Some of these people might have been intubated for weeks, and they need speech therapy soon afterwards or they will have life-altering harm. Irrespective of COVID patients, think about stroke victims.  If they do not get immediate help they will have life-altering delays.

@SunnyDays -- great suggestion.  Your post got me to look at speech therapy during COVID-19 and I stumbled onto ASHA, which is a publication my wife subscribes to.  They have a TON of resources for telehealth.

This in turn led me to Ohio's executive order regarding telehealth.  Apparently speech therapists could not bill for telehealth, but now they can under an emergency order.

I'm going to tell my wife to perhaps propose telehealth to her boss.

Miss Piggy

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My sincere apologies. I typed my reply while on my elliptical trainer, and was using minimal words. They were not effective.

I absolutely agree that speech therapy is essential. I have been the recipient of speech therapy during two periods in my life, and it makes a HUGE difference. What I meant, but did not communicate well at all, was that I did not see it as essential for a speech therapist to go into a known COVID-affected home when other options are available, such as telehealth, that would not give such risk of exposure.

It's still a hell no from me, but hopefully I've explained my thinking better this time. Good luck to your wife with her request to look for alternative delivery methods.
« Last Edit: April 20, 2020, 04:47:26 PM by Miss Piggy »

Kris

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One of my best friends is a speech pathologist/therapist. (Coincidentally, she is currently recovering from Covid, and has been isolated from her partner for the last few weeks because partner is in a high-risk group.)

Telehealth is the solution. It is what she is doing. There is no way your wife should go into a home with Covid present.

Abe

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As a physician, I agree with the others. Telehealth is the best option. Even if the patients have been discharged from the hospital we aren't 100% sure they aren't contagious. If her company cannot provide PPE she cannot safely perform that job and should not be expected to do so. If they insist, don't provide appropriate PPE and are not willing to do telehealth instead, I think she should report this issue to the state Department of Health & Human Services as that is a violation of the company's duties. Let that fire under their butts. As a speech therapist, her job will place her at higher risk of exposure to droplet exposure.

Malcat

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No! Absolutely not!

All front line health professionals here in Canada are completely sidelined except for exceptional emergencies.
My own father is walking around with a front tooth broken off at the gums. There's literally nothing anyone will do until we all reopen.

Dicey

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If she can set her own schedule, why not just set it at zero for the next few months? Otherwise telehealth seems like the only other sane option.

And @Malkynn, sorry about your dad. Hope it wasn't the result of a fall and that he's not in pain.
« Last Edit: April 21, 2020, 06:02:00 AM by Dicey »

BikeFanatic

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I would treat every patient as covid positive. There are no other masks available? I was under the impression that n95 was just for Airesol procedures.

I wonder if every patient can even us a computer I know my mother can not. She can not do telemedicine. But anyway welcome to the front lines. I never expected to be called up but they are taking RN in my company that have not been an Practicing Nurse for years, they just deployed a RN that is 60 and has not worked on the floor in ten years. I think they need people to take the place of the sick staff. I know it is exhausting working in the hospital these days, the PCT, RN, are all reporting exhaustion and plenty are sick.

Malcat

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If she can set her own schedule, why not just set it at zero for the next few months? Otherwise telehealth seems like the only other sane option.

And @Malkynn, sorry about your dad. Hope it wasn't the result of a fall and that he's not in pain.

Oh he's fine, he just looks funny. The other day he was prodding me as to when he could get his tooth fixed and I just bluntly said "A painless, esthetic concern isn't going to be anyone's priority for a very long time, so you better come up with an interesting tale of harrowing adventure to explain it."

I personally can't see any of my patients, and I pretty much only treat pain patients, but they don't rise to the level of what's considered an emergency right now.

dcozad999

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Well, speech therapy (whether done at home or not) is essential.  Some of these people might have been intubated for weeks, and they need speech therapy soon afterwards or they will have life-altering harm. Irrespective of COVID patients, think about stroke victims.  If they do not get immediate help they will have life-altering delays.

@SunnyDays -- great suggestion.  Your post got me to look at speech therapy during COVID-19 and I stumbled onto ASHA, which is a publication my wife subscribes to.  They have a TON of resources for telehealth.

This in turn led me to Ohio's executive order regarding telehealth.  Apparently speech therapists could not bill for telehealth, but now they can under an emergency order.

I'm going to tell my wife to perhaps propose telehealth to her boss.



My wife is a Clinical Psychologist and has been teleworking for the past month. Like your wife, they could not bill for telehealth prior to the COVID crisis. Everyone at her agency is doing it.
It's actually increased productivity, eliminating the client "no shows".

Though it would probably be a more ideal situation to add the human touch element, I don't see why your wife needs to physically be with the patient to do speech therapy. Especially at a time like this.

ReadySetMillionaire

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Well, my wife looked into it, and apparently our federal government is so incompetent that speech therapy is not reimbursable for Medicare under any circumstance. I could see why swallow assessments need to be in person (there's really no other way to do it), but speech and processing exercises could certainly be done remotely.

Basically telehealth is not an option for the vast majority of my wife's cases.

stashja

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If she has more than one patient, she will expose all her patient households to each other. That is community spread. A company in my nearest city (a meat packing plant) did precisely that: requiring work, no PPE, and created a community spread outbreak so serious that the CDC arrived to investigate and charges are pending. Meanwhile many worker families, including breadwinners in other industries, got COVID and were hospitalized.

Your wife does not want to become a vector for community spread.
She does not want to kill others, potentially including you.
If you can afford to avoid risking it, thatís your answer.

ShastaFire

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OP, is there a way for her to wear fresh PPE and see her patients just outside their house, ie on the patio etc?  (I am really out of my depth here in knowledge of care plans, and with PPE being in short supply, may not be an option.) 

honeybbq

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Echoing others- why is telehealth not an option?

wenchsenior

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Echoing others- why is telehealth not an option?

I suspect it's b/c a lot of potential patients are poor and/or elderly and do not have computers/internet access/smartphones. My mother falls into this category. ETA. ...I"m not sure how effective 'voice only' telephone therapy would be; that might be option to consider.

Psychstache

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There are endless amounts of supports (and good research) to back to use of teletherapy for speech and language intervention. There is ABSOLUTELY no reason for an SLP to have to risk exposure.

Psychstache

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Echoing others- why is telehealth not an option?

 
I suspect it's b/c a lot of potential patients are poor and/or elderly and do not have computers/internet access/smartphones. My mother falls into this category. ETA. ...I"m not sure how effective 'voice only' telephone therapy would be; that might be option to consider.

So someone sets up the tech in their home (with a safe distance and cleaning protocols) and then we begin.

Thousands of schools districts have worked with millions of families in all sorts of tech savvy and economic conditions to establish the tech setup for distance support. No reason that can't be achieved on a smaller scale here.

Catbert

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Not an answer, but a discussion of the ethics of medical professionals refusing covid 19 patients.

https://www.nytimes.com/2020/04/17/us/coronavirus-doctors-dilemmas.html

I hope it's not behind a pay wall.

ReadySetMillionaire

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Echoing others- why is telehealth not an option?

I suspect it's b/c a lot of potential patients are poor and/or elderly and do not have computers/internet access/smartphones. My mother falls into this category. ETA. ...I"m not sure how effective 'voice only' telephone therapy would be; that might be option to consider.

This is true, but the bigger issue than this is that, as things currently stand, Medicare will not pay for telehealth visits. So, basically, my wife's company only gets paid from Medicare if my wife does an in-person visit.

ASHA (the biggest speech therapy advocacy group) is trying to get this changed during COVID-19.


wenchsenior

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Echoing others- why is telehealth not an option?

 
I suspect it's b/c a lot of potential patients are poor and/or elderly and do not have computers/internet access/smartphones. My mother falls into this category. ETA. ...I"m not sure how effective 'voice only' telephone therapy would be; that might be option to consider.

So someone sets up the tech in their home (with a safe distance and cleaning protocols) and then we begin.

Thousands of schools districts have worked with millions of families in all sorts of tech savvy and economic conditions to establish the tech setup for distance support. No reason that can't be achieved on a smaller scale here.

Someone being who? And who pays for the equipment? I think that's going to be the sticking point.  If people like my mother could afford that stuff, they'd have it already.

lollylegs

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no, the job is not worth dying for.

use2betrix

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I think thereís an additional concern that hasnít been mentioned. While she will be going into Covid-19 homes, will she also be going into non-Covid homes? The biggest concern to me would be the spread from infected people to heathy people.

If I needed speech therapy (which I did for many years) I sure as heck would not want someone coming in my home that just spent an hour in a home with an infected Covid patient. I feel those patients should have a right to know if they were to be exposed to that.

Apple_Tango

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I am a former SLP who worked in home health. The home health patients that are Covid-19 are going to need speech therapy for breath support (breathing is quite necessary for speaking) and swallowing therapy (especially if they are coming after extubation). The patients tend to be elderly and have a LOT of comorbidities that result in a lack of follow through. In addition, in home health you get Quite a few incredibly poor patients that donít have Internet and certainly donít have access to a tablet for telehealth. The worst I ever saw was a home where the lady had diabetes and would just flick her used bloody test strips all over the floor and her dog used the bathroom inside. I came one day and the mother of the patient was taping up a  window because she had a fight with the neighbor and threw her through it and the floor was so rotted through that you could see the ground. Many of the patients cannot walk or toilet independently- they are very likely also getting PT and OT in addition to speech therapy. Telehealth will not just be very viable in many cases. For every case that I ever worked where I think telehealth might have been successful, I can think of 10 cases where telehealth would have been impossible to get any kind of results.

So. Would I go into a Covid 19 home as an SLP? If the company is giving me a choice, my choice is no. And itís a hell no if theyíre not supplying full on PPE. Iím a former SLP for a reason....itís a freaking hard job. Good luck to your wife!
« Last Edit: April 22, 2020, 06:25:18 PM by Apple_Tango »

SunnyDays

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Wow Apple Tango, I thought I had seen some things in the course of my career, but nothing quite compares to your experiences!  Seems like speech therapy would be the least of the concerns there.

Anyway, still not sure if the wife is being given a choice or not.  If not, I would sure as heck quit, especially since it seems that a lot of US states are not taking this all very seriously and are putting financial considerations above all else.  At least the OP and his wife do not need to do that.

ReadySetMillionaire

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I am a former SLP who worked in home health. The home health patients that are Covid-19 are going to need speech therapy for breath support (breathing is quite necessary for speaking) and swallowing therapy (especially if they are coming after extubation). The patients tend to be elderly and have a LOT of comorbidities that result in a lack of follow through. In addition, in home health you get Quite a few incredibly poor patients that donít have Internet and certainly donít have access o a tablet for telehealth. The worst I ever saw was a home where the lady had diabetes and would just flick her used bloody test strips all over the floor and her dog used the bathroom inside. I came one day and the mother of the patient was taping up a  window because she had a fight with the neighbor and threw her through it and the floor was so rotted through that you could see the ground. Many of the patients cannot walk or toilet independently- they are very likely also getting PT and OT in addition to speech therapy. Telehealth will not just very viable in many cases. For every case that I ever worked where I think telehealth might have been successful, I can think of 10 cases where telehealth would have been impossible to get any kind of results.

So. Would I go into a Covid 19 home as an SLP? If the company is giving me a choice, my choice is no. And itís a hell no if theyíre not supplying full on PPE. Iím a former SLP for a reason....itís a freaking hard job. Good luck to your wife!

Thanks for posting.  My wife has seen similar houses.  To paraphrase her, step just a couple miles outside of our nice little suburb and there is an entirely different world of people that just have different priorities.  They are literally trying to get by day by day; they do not care about appearance, or cleanliness, or whatever. 

To update, though, I (a lawyer) ghost-wrote an email to her boss saying something to the effect of, "I think taking on COVID-19 patients without proper PPE could put us in hot water down the road."  Other therapists apparently also raised concerns.

The company is now declining COVID-19 patients.  They have assembled a task force to acquire proper PPE and come up with a game plan as to how they are going to treat post-COVID patients. 

As @Apple_Tango said, these patients need care.  They have significant breathing and swallowing issues that could be fatal.  We do not want to ignore these people, because that could be a death perhaps not directly caused by COVID, but proximately caused by it. They need care.

We will see how this plays out with this new task force.

Thanks all for the advice and concern.  I was very firm with my wife that most people thought it would be insane for her not to go to patients houses without proper PPE.  This board is full of smart people.

honeybbq

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Echoing others- why is telehealth not an option?

I suspect it's b/c a lot of potential patients are poor and/or elderly and do not have computers/internet access/smartphones. My mother falls into this category. ETA. ...I"m not sure how effective 'voice only' telephone therapy would be; that might be option to consider.

This is true, but the bigger issue than this is that, as things currently stand, Medicare will not pay for telehealth visits. So, basically, my wife's company only gets paid from Medicare if my wife does an in-person visit.

ASHA (the biggest speech therapy advocacy group) is trying to get this changed during COVID-19.

That is weird because I'm in the medical field and we are definitely charging Medicare patients for zoom consults/etc.

ReadySetMillionaire

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Echoing others- why is telehealth not an option?

I suspect it's b/c a lot of potential patients are poor and/or elderly and do not have computers/internet access/smartphones. My mother falls into this category. ETA. ...I"m not sure how effective 'voice only' telephone therapy would be; that might be option to consider.

This is true, but the bigger issue than this is that, as things currently stand, Medicare will not pay for telehealth visits. So, basically, my wife's company only gets paid from Medicare if my wife does an in-person visit.

ASHA (the biggest speech therapy advocacy group) is trying to get this changed during COVID-19.

That is weird because I'm in the medical field and we are definitely charging Medicare patients for zoom consults/etc.

Most other medical professionals have been cleared to do this, but for whatever reasons, speech therapists have not.  So, so stupid and frustrating.