Program helps New York home health agency face coronavirus challenges in real time – Pressconnects

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It’s 6 a.m. As the sun rises in Rochester, senior home health aide Elaine Duckey mentally checks off the coronavirus symptoms she does not have this morning — no cough, shortness of breath or sore throat — and scrolls through the series of questions on her company-issued phone.

Do you have a fever?

No.

Have you been tested for COVID-19?

No.

Have you come in contact with anyone who has tested positive for COVID-19?

No.

Duckey, 50, sends her daily self-assessment questionnaire to her supervisor and quickly rereads the text messages detailing the first two homes she’ll visit today. She has thrown on a pair of clean, red scrubs. Her black tote bag packed with gloves, hand sanitizer, paper towels, hand soap and a mask sits ready to go.

All that remains is her supervisor’s OK.

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Manhattan based Selfhelp Community Services trains Home Health Aides to serve elderly and vulnerable New Yorkers. Rockland/Westchester Journal News

Duckey has been in this job for 30 years. This is a new reality — checking in with her supervisor every morning, wearing a mask on each visit — but her trust in the support of her employer, UR Medicine Home Care, keeps any fears at bay.

In an effort to retain employees, leaders of UR Medicine Home Care in Monroe County, part of the University of Rochester Medical Center system, have implemented closer communication policies to ensure their employees are well and able to work. From this outreach, they’ve been able to address employees’ real-life concerns, from child care to flat tires.

It’s considered a critical effort because home health aides across the country are in short supply — one estimate predicts over 4 million job openings in a 10-year span — and the pandemic has exacerbated the shortage. Since public gathering bans have halted large in-person training programs, bringing more caregivers into the workforce is a slow, difficult process.

For some home health care workers, the kind of support UR Medicine Home Care has initiated can be the difference between staying on the job and dropping out — the profession is known for inconsistent hours, physically and emotionally demanding work, and stagnant pay. On average, the U.S. Bureau of Labor Statistics reports New York home health aides make $12.62 an hour. At UR Medicine Home Care, the year-to-date retention rate is much higher than the national average. 

Money is one reason not every health system can turn immediately to this kind of retention effort. Jodi Sturgeon, CEO of the nonprofit organization Paraprofessional Healthcare Institute Inc. (PHI) based in New York City, says most agencies lack the infrastructure and the staff capacity to commit to daily contact with their workers.

Yet PHI, which works with long-term care agencies and local and national leaders to improve conditions in the direct care workforce, conducted a survey and found that consistent communication is second only to securing personal protective equipment as the biggest challenge for agencies. 

An extensive effort like UR Medicine Home Care’s is made possible through its connection to a large health system, stable infrastructure and adequate staffing. About a dozen members of the management team were each assigned 12 to 15 of the agency’s 150 home health aides to check in with daily. Without those resources, other agencies may require additional funding to replicate the same individualized outreach.

And UR Medicine Home Care’s existing infrastructure, which includes advance Medicare cash, stimulus dollars, and some grants they’ve applied for (they’re hoping to earn Federal Communications Commission dollars in support of their telehealth program), has put the agency in a good position to address their employees’ concerns.

They’ve also necessarily turned to volunteers, posting social media appeals for help after senior centers closed and the number of people in need of meals skyrocketed. They received donations and supporters for their Meals on Wheels of Monroe County program, and volunteers have also donated masks and supplies.

“We’re piecing it together,” said Jane Shukitis, UR Medicine Home Care CEO. “We’re finding ways to get it done every day.” 

Helping employees outside of work 

When schools, child and adult day care facilities and local businesses started closing in March, UR Medicine Home Care faced the challenge of keeping their therapists, nurses and home health aides working while the world around them shut down.

On the clinical side, employees were led through a training course on donning and doffing full protective gear including face shields, shoe covers and gowns to keep them safe in homes where someone has tested positive for COVID-19. Agency leaders have been keeping a close eye on their burn rate of masks and gloves, and a group of people Shukitis refers to as her “supply heroes” found donated resources to fill any gaps. 

New protocols have been established, including daily health screenings of employees and clients over the phone. In some cases, telehealth units, previously used in conjunction with a home visit, have replaced home visits altogether.

UR Medicine Home Care leaders have also addressed some of their employees’ “real life” concerns.

When schools closed, three of the agency’s 160 home health aides were left without child care. Through its affiliate, University of Rochester, UR Medicine Home Care has provided that care to their staff for free. There’s also the ICARE fund, an internal program affording small grants to employees or patients. It’s a fund that has helped some home health aides pay an electricity bill or repair their car. 

“The world turned upside down overnight,” Shukitis said. “(We are) trying to help people still maintain their lives but still respond to the needs of our patients.”

The coronavirus, Sturgeon says, has noticed that confounding tension.

Clients, either fearful of the virus or with more access to family caregivers now working from home, have refused care. Some home health aides in New York City, living in tight quarters with multiple generations of family, are concerned about bringing sickness home. Others have faced harassment on public transportation. Because they were wearing scrubs they’ve been targeted, Sturgeon says, as “people spreading the virus.”

The nature of home care calls for in-person training, but bans on large group gatherings have suspended those efforts.

While a city-wide, long-term care planning group PHI participates in has considered removing regulatory barriers to open the workforce, it’s a delicate balancing act to ensure competent care.  

“This pandemic is highlighting the challenges and inequities in healthcare at large,” Sturgeon said, “and certainly in long-term care.”

Communication helps home health aides thrive

Lissette Marrero, 37, of Brooklyn, is a home health aide with SelfHelp in New York City. She’s also a peer coach, a mentor position she takes seriously. It didn’t exist when she started the job as an 18-year-old, fresh off a training course and feeling like she’d been “thrown to the wolves.”

More: Fixing the caregiver shortage: Why these health aides are twice as likely to stay on the job

In that first job, there was no one to help her deal with the daily challenges many home health aides face, and she ended up leaving it. Now that the pandemic has added extra challenges to an aides’ daily routine, communication with a trusted mentor, in Marrero’s opinion, can make all the difference.

“It’s the best feeling to have someone you know you can go to and may be able to give you a solution,” she said.

UR Medicine Home Care holds monthly staff council meetings to check in with all departments and an annual employee engagement survey through the Press Ganey platform will be conducted later in the year, but keeping in touch with home health aides on a daily basis is a new policy. 

It began with a mandate — daily wellness screenings for all healthcare professionals to stop the spread of coronavirus — and has evolved into policy.

UR Medicine Home Care pulled in extra staff members across specialties to assist the handful of direct home health aide supervisors making daily calls to their 150 aides on staff. Each caller was assigned a dozen or so home health aides to check in with every day and, at the agency’s monthly staff council meetings, they’ve discovered the outreach has been beneficial not only to monitor staff symptoms but to keep employees feeling connected.  

“This daily touch has been tremendously successful,” Shukitis said. “This has been a real lesson learned for us. We’re able to create a real sense of engagement.”

Nationwide, PHI reports the home health aide turnover rate hovers between 40% and 60%. As of April, UR Medicine Home Care’s year-to-date turnover rate is 13.4%. Staffing and infrastructure are key to this retention effort, and it’s been a great success for UR Medicine Home Care, but other agencies may lack the infrastructure and staff to commit to daily contact with their workers.

UR Medicine Home Care also employs a life skills advocate and has opened a hotline for any staff or family member who is experiencing high anxiety or stress to speak to a skilled mental health professional at no charge. It’s anonymous, so Shukitis doesn’t know how many employees have made use of the hotline, but it’s another resource that’s there to help.

“Mental health and stress and anxiety is a big deal not just with home health aides, but across the entire spectrum,” she said. “To have that expert resource there 24/7 — it’s a great value.”

Shelley Boyd, director of licensed agency services at UR Medicine Home Care, is still working from her office, which shares a wall with the aides’ supply room. When they’ve come in to pick up what they need, Boyd asks questions to check in: “How are things? How are the patients? How are things going out there?”

Duckey has told Boyd she doesn’t feel afraid to go to work. She’s been trained to use precautions, knows she’s well-supplied to keep herself safe, and she knows there’s someone to talk to if she begins to feel uncertain.

“We have a very good support system,” Duckey said.

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As of mid-June, Shukitis says none of their clinicians have contracted COVID-19 from a patient. Guidelines, policies and conditions are changing every day, and Shukitis has started sending daily company update emails to keep her staff informed.

“I think the anxiety goes down when people are being kept informed of what’s happening,” she said.

While the industry slowly moves back to in-person training, UR Medicine Home Care can plan sessions with just two or three trainees at a time, at least six feet apart in the classroom. 

Facing the same ever-present challenges of the home health workforce, they’ll continue this new, closer communication policy to address the needs of their current employees as they continue to navigate life during a pandemic.

More support, communication key to morale

Sitting in her 2003 Honda CR-V, parked in front of her last client’s home that day, Duckey takes a glance at her dashboard.

171,790 miles.

Most of those miles were accumulated through this job.

As a senior home health aide, Duckey isn’t assigned cases, she fills in as needed. Her assignments take her all over the city and into the suburbs. She makes sure her clients are taking their medication. She gets them ready for the day.

In some cases, while most of the world is kept at a distance, she’s the only person keeping them company. 

These days she has to pack more protective gear in her car each day, wake up a little earlier to take her temperature and take extra precautions to ensure she doesn’t bring any sickness home.

But she has enough supplies for now, a company-issued cell phone to keep in touch and the ICARE fund helped her put new tires on her vehicle not too long ago. She jokes that after 30 years, UR Medicine Home Care is stuck with her.

“I love my job. I love the people that I work with,” Duckey said. “I just feel like we’re family.”

More caregiving efforts: This unique program is helping people who care for their loved ones with dementia and more

About this series:

African American and Hispanic families tend to take care of their own, especially when it comes to caring for a loved one with dementia or other health issues. And the pandemic has hit communities of color especially hard.

The Democrat and Chronicle has been reporting on solutions for caregivers of color in our community, both professional and those who care for loved ones in their homes.

This is the third and last in our latest installment of solutions-oriented stories on the topic of caregiving. The first story looked at outreach done by service agencies to help those in need with everything from emotional support to free grocery deliveries. The second story looked at a grassroots effort to get iPads in the hands of people in under-served communities to promote telemedicine and to reduce isolation. The third story will look at an effort to help professional caregivers stay on the job by addressing whatever challenges that arise amid the pandemic.

This project is funded by a grant from the Solutions Journalism Network.

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