In mid-March, Alliance Homecare attempted to acquire 400 COVID-19 tests from Lenco, a Brooklyn, New York-based lab. While the private-pay home health and home care provider was initially told it had a very strong chance of receiving those tests, its request was ultimately denied by the New York State Department of Health.  

Now, more than two weeks later, Alliance and other New York-based in-home care agencies are still struggling to acquire coronavirus testing materials.

Serving COVID-19-positive individuals in the epicenter of the U.S. public health emergency, Alliance has been looking for the best ways to assure both patients and employees that their exposure risk is controlled in every way possible. Founded in 2006, Alliance has multiple locations in the New York City area.

Currently, Alliance can order individual tests under physician approval. But the New York-based agency’s quest to get its hands on a larger supply remains unwavering, CEO Gregory Solometo told Home Health Care News.

HHCN recently connected with Solometo to discuss why large-scale testing is such an important resource, how Alliance is dealing with COVID-19 patients, and why he feels home health and home care agencies are being left behind.

Highlights of that conversation are below, edited for length and clarity.

HHCN: How are you dealing with COVID-19-positive patients?

Solometo: We only admit COVID-19-positive people into our nursing program. That program solely provides registered nurses — who are fully geared with personal protective equipment (PPE) and following extreme protocols — to treat those patients. And that’s just because they’re a lot more comfortable working in a higher-risk environment. We’re not yet comfortable with home health aides or caregivers servicing positive patients right now.

The way that we operate is that for a 10-to-14 day period, until somebody is tested and no longer contagious, they are treated under a nursing program. Then, after that, they would step down to a home care platform, so a home health aide could care for them after they are no longer contagious.

We’re basically consolidating nurse caregivers who will be on those cases and actively testing those individuals, along with the clients. That way, we’re being secure as we can be. But it’s obviously very difficult when we are not allowed to obtain our own testing. So that is a challenge.

It seems like widespread testing would be as vital for in-home care agencies as for physician offices or hospitals. Correct?

That’s exactly correct. The reality is home health and home care providers are on the front lines of this crisis just as much as the hospitals are. They are very essential components of the health care system. And unfortunately — and for whatever reason — they’re not treated as such.

I’m in the Tri-State Area, so I see addresses from New York Governor Andrew Cuomo, New Jersey Governor Phil Murphy and Connecticut Governor Ned Lamont. Home health doesn’t come up on any of their radars or get any recognition. It’s all about the hospital systems.

What has to be understood is that the majority of people being taken care of in their home, those are the sickest and the most vulnerable. And if we take care of them, do a good job, and we proactively get in front of the testing and the symptomatic individuals that are in their homes, we can keep them out of the hospital system. We can very much help this flattening of the curve that they’re talking about.

So, you feel that home-based care agencies are being left behind in the process?

Yes. That is 100% the case. There was a letter that went out on March 20 from the NYS DOH that talked about the prioritization of supplies, and it basically listed that prioritization would go to hospitals, followed by nursing homes, followed by emergency medical services (EMS) workers, followed by dialysis centers. And that’s where it ended. So there was no mention of home health organizations or home care organizations, and no real recognition that it’s even top-five on the list of health care organizations to be focused on and to support.

In general, there’s deeper ties that need to be developed with the government after this.

So, yes, I feel like we’re being left behind.

Do you think government officials will look back on the crisis and regret not investing more in home-based care?

I think it’s very possible. It’s obviously a very complicated issue.

We have had the luxury of learning from other geographies ahead of us. And I don’t know for sure that any of those other geographies engaged the home health sector, but I can say for sure, if we do, we will add another helpful lever on the overall system that leads to a better result. That is for sure.

I imagine that in a few months time, we’ll look back and see that we probably could have done a lot more by getting the right equipment and testing in the hands of home care and home health agencies. Again, these are the health care organizations that are truly on the front lines, serving the most vulnerable cohort of Americans.

Moving forward, what does your agency’s priority list look like in the context of COVID-19?

The No. 1 problem that everyone is dealing with right now is a shortage of PPE supplies. We need supplies badly. Next, behind that, is the ability to test our patients and our caregivers in a larger-scale fashion. There’s a lot of work around that being done right now.

Some of our peers are using thorough screening protocols. People Care — another New-York based home health agency we have been in contact with — has set up an app that all of its caregivers are given. It basically enables them to ask, at the beginning of each shift, seven questions for the caregiver and seven questions for the patient. And if the answer is “yes” to any of those questions (do you have shortness of breath, fever, cough, etc.), they go to a dashboard. And then a clinical person reaches out to them and decides on next steps.

We’re doing something similar, but they have it a bit more vetted at this point. But all home care companies are having to scramble and figure out things on their own. There are guidelines from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the NYS DOH. But they’re not abundantly clear. Everybody is kind of just trying to figure it out on their own.

But without supplies, we can’t protect our caregivers. So what could happen — and I hope it doesn’t — is that as more home care workers, nurses and home health aides begin to test positive and get sick, they’ll have to isolate, and they won’t be able to go into work. Then the patients won’t have caregivers looking after them. So then if those people get sick, they’re going to end up in the hospital.

Many patients, also, are not willing to take new caregivers into the home if they don’t know them. Everybody’s very nervous, even about the caregivers they do know. If that caregiver gets sick, that’s going to be a big problem.

Acquiring testing is all about being proactive instead of reactive, right?

Exactly right.

Right now, the only thing that we can do is test symptoms, so we’re arming everyone — and there’s been a shortage of these, too — with thermometers and pulse oximeters. So that’s what people are doing — just testing symptoms and using that as an indicator to see if someone potentially has the virus.

Then, if there are respiratory problems, you treat them as high alert and send the critically-ill ones to the hospital. We do our own version of triage.

How are you moving forward to acquire resources?

Right now, we’re looking to acquire tests and PPE. And without those two things, we’re in tough shape. And the entire industry is saying the same thing.

We’ve actually had a lot of our operation reaching out and just trying to be creative in looking at different suppliers of PPE. There’s a lot of price gouging going on. There’s a lot of worry about places not being able to deliver. It’s not helpful when a place will take an order but not actually send you resources without a severe delay. Luckily for us, we just received a large shipment a few days ago and also scored a supply of well needed face shields from a retooled factory in the Brooklyn Navy Yards.

Additionally, we’re looking to acquire antibody tests. We would essentially use those as something that would enable us to clear somebody that has already had the virus and has developed the antibody. That means they can go ahead and work. We still would use all proper PPE and protocols just to keep things stable. But essentially, they would be able to get back into the workforce and be able to help with more rigor.

It would give them the confidence as well. Both nurses and caregivers are rightfully worried and nervous. But we’re seeing that with caregivers, the worry level seems to be a lot higher. The fear factor is a lot higher on the caregiver population than on the nursing side. And again, that’s perhaps because the nurses are in hospitals and they’re used to that environment a little bit more. Everyone, still, is worried about it in health care.

The more we can test people and give them the comfort and the confidence to get back in and fight, that is going to really help everybody’s situation

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