Is it safe to have home health aides?

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A new member question from Ask the Doctor.

A member wrote to Dr. Warren:

My mother was admitted to the hospital. She was delirious and was tested for Covid 19. She was negative but tests showed that she suffered a Transient Stroke. She is feeling better but she does have some lingering effects such as slurred speech and has difficulty remembering words. Unfortunately, she is living alone and I don’t want her to go to a rehabilitation center at this time. Ideally I want her to go back home but not sure if she is able to safely stay at home by herself at this time. How safe is it to hire home health aides to help her while she regains her strength? I am concerned about having anyone who could be a carrier be with her for an extended period of time. I am currently out of the country and cannot get back before the end of May. What are my options for caring long-distance for my mom? We don’t have any family in the area.


Dr. Warren replied:

My gosh, this is a difficult situation.  From what you’re describing, your mother has definitely had ischemic injury and technically this would not be a “transient” stroke even though she will hopefully improve. 

At this time, I agree that admission to a rehabilitation center is of concern since we all know that many COVID-19 cases are occuring in nursing facilities. I would recommend a rehabilitation admission only if it were clearly the best option.

On the flip side, she is at increased risk for a recurrent stroke, especially within the first 3 months.  With the history that you describe, I would be very concerned to make sure that she is taking her medications correctly.  It is also important that she be monitored frequently throughout the day and night.

Here are some thoughts I have:

If she is a Medicare beneficiary, there is a good probability that she qualifies for short term “skilled” level home health care services which provide a variety of nursing and rehabilitation services. Unfortunately these services are “visits” and do not provide monitoring throughout the day. The Medicare site rates home health agencies

https://www.medicare.gov/homehealthcompare/search.html

Longer term home health aides are not covered by Medicare and can be quite costly unless covered by a longterm care insurance policy or Medicaid.  Some home care agencies are accredited by the Joint Commission.

https://www.jointcommission.org/accreditation-and-certification/health-care-settings/home-care/

In addition, look for a rating from the Better Business Bureau.

Depending on your mother’s functional and cognitive status, one other thought is to figure out if remote monitoring might help. Remote monitoring means that you can use video cameras to monitor activities remotely via the internet.  Systems have continuously improved.  Some seniors don’t like being watched on a camera but other seniors are quite comfortable with it. 

https://www.senioradvisor.com/blog/2018/02/how-to-buy-a-home-monitoring-system/

Would your mother be able to manage a medical alert system? My personal experience with these systems is that they are much improved but still a mixed bag with both “false alarms” and failure to notify when notification is needed.  

https://www.consumerreports.org/medical-alert-systems/how-to-choose-a-medical-alert-system/

https://www.aarp.org/caregiving/home-care/info-2017/medic-alert-systems-options.html

Larger cities often have available private hire “case managers” to do the detailed work of finding the best options. This is sometimes very useful but another cost. Some case managers are at “no cost” to the customer but receive a referral fee from agencies; this is less desirable. Sometimes the local Area Office of Aging, https://www.n4a.org, is able to make suggestions about good resources, a phone call might be helpful.

Ultimately, the question is whether it’s safer for your mother to have no professional help or safer to have professional help with an unclear risk of contracting COVID-19.  Just from your general description, the risk of stroke related problems is significant and the need for at least frequent monitoring is high.  

What a challenging situation. I hope this helps.

Aloha,
Dr. Warren

Be Connected, Stay Strong

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