By Thomas Goldsmith
North Carolina caregivers have a real hunger for practical answers to difficult questions about COVID-19.
Just consider the 9,000 participants who clicked into a statewide “tele town hall” organized by state AARP Aug. 17. The listeners’ questions about the disease covered a broad range of topics, but many centered on friends’ or relatives’ hospitalization, discharge and the right sorts of care and activities at home.
“I’m 87 years old and my wife is 80,” said a caller named Jonah, worried that his wife might have contracted COVID-19. “She’s legally blind and I’m several miles from a hospital. I don’t know what I should do first.”
Dr. Betsy Tilson, the state health director and one of three panelists, offered Jonah some steps to follow. When considering someone’s hospitalization, a call to the doctor should come first, Tilson said, especially for people in high-risk categories who could develop severe symptoms.
“The very first thing you’d want to do is call your health care provider,” she said. “If you’re having symptoms, discuss your symptoms, discuss how severe they are, and they can help you decide if you need to take immediate action or not.”
Also holding forth from the virtual dais were infectious disease physician and researcher Cameron Wolfe, from Duke University Hospital; and Catherine Harvey Sevier, North Carolina AARP president and an advanced practice nurse.
Wolfe addressed questions that he said should have answers before a person with COVID-19 goes home.
“A clinician would need to talk to family members to decide whether the home is the right place for their care,” he said. “First and foremost is that the patient themselves clearly needs to be stable enough to be taken care of at home.”
Have a good plan
The need for good discharge planning from the hospital is something that’s been talked about for years in health care circles, but the concept took on increased importance when the Affordable Care Act created penalties for hospitals that had too many patients boomeranging back after being discharged.
COVID being thrown into the mix elevates the importance of discharge planning, said Julie Wiggins, from the High Country Area Agency on Aging in Boone. She was not on the call.
“It’s a critical component in someone’s care,” she said when asked about several topics discussed on the call. “There’s different considerations you have to take into account with COVID.
“The classic example is someone not having food or a way to get food when they get home from the hospital,” she said. “If they’re coming home and they either have COVID or they’re still trying to recover, they can’t go to the grocery store, they shouldn’t be going to the grocery store, maybe they don’t have a way to get to the grocery store.
“These are social determinants of health that impact discharge planning and its success. That’s a critical piece of the conversation.”
Another vital factor is the presence of a caregiver in the home — and not just any caregiver because that person’s safety needs attention as well.
Wolfe offered additional tips:
- Identify someone who’s fit and healthy as a caregiver.
- Steer away from people at high risk for complications of COVID-19 for this role, including those who have poorly controlled diabetes or a chronic heart or lung condition.
- Set off a separate bedroom or a separate space for the patient’s recuperation. No roommates, no pets.
- Make sure that the home has plenty of food, medicine and basic necessities.
“We can’t expect that the individual who is recuperating can necessarily leave the home,” Wolfe said. “It behooves people to have a really good conversation with their clinicians to say ‘Look, is this setting safe?’”
Sevier recommended that caregivers and patients with knotty problems reach doctors or staff more easily through the increased access to telemedicine that’s come with the pandemic, whether they have symptoms or if they simply have concerns about their current conditions.
“There is the opportunity to have a telehealth appointment where they don’t have to put themselves at risks to have those conversations,” she said.
The event also promoted a new booklet, Post COVID-19 Care, a project of NC AARP and the North Carolina Healthcare Association.
Rose Hoban contributed to this story.
Correction: This story originally stated that the new booklet on Post COVID-19 care was co-sponsored by the NC Health Care Facilities Association.
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