Home healthcare services in communities during COVID-19: Protecting against and mitigating the pandemics in Taiwan.

Abstract

As of May 6, 2020, the number of confirmed cases of coronavirus disease 2019 (COVID-19) has totaled more than 3 588 773, and the number of deaths has reached 247503.1 Early deaths because of the COVID-19 outbreak have occurred primarily in elderly people.2 Most elderly people are disabled, and home healthcare (HHC) is a service for disabled people.3 In Taiwan, patients receiving HHC are categorized into four resource utilization groups (RUGs) according to the National Health Insurance reimbursement policy: RUG-1 comprises patients needing only medical care or general nursing services; RUG-2 to RUG-4 include patients who need one, two, three or more types of skilled nursing services.4 This population requires regular and long-term health services, even during the COVID-19 pandemic. For RUG-1, alternative management options such as video consultations are advised. For patients in RUG-2 to RUG-4, who need skilled nursing services, some antiepidemic measures are suggested. To protect HHC teams and other patients, all families and caregivers living with patients must be assessed based on their travel, occupation, contact, and cluster (TOCC) history.5 TOCC protocol involves identifying the travel history of each person entering facilities and assessing their occupational history regarding potential encounters with people who traveled abroad. Their contact history must also be analyzed to identify people who may have visited a hospital in the past 2 weeks. Finally, during the community circulation phase, a history of encounters with potential clusters should be identified. Few HHC services in Taiwan use dedicated vehicles for home visits. Most HHC teams typically visit patients by taxi because of heavy traffic and parking problems during work hours. We suggest cooperating with fixed taxi drivers well trained in epidemic prevention measures, including monitoring daily body temperatures, maintaining personal hygiene, wearing masks, and cleaning their cars after transporting every visitor. We highly suggest that patients receiving HHC be treated as people who require home isolation, such as by having independent spaces and restricting visitors. If family members or caregivers are suspected to have COVID-19 infection and need to be quarantined at home, a quarantine hotel or alternative space should be arranged. Furthermore, caregivers should engage in basic daily observation and enhance their personal hygiene, particularly by wearing a mask and washing their hands. HHC teams should be segregated into separate units. They should have separated workplaces away from hospitals. Moreover, Taiwan is currently promoting mutual support among home care facilities by including several part-time physicians in their teams. If any member presents a high risk of COVID-19 infection, another home care team can quickly take over their services. Because the COVID-19 pandemic has caused high case-fatality rates around the world, we have applied these principles to patients receiving HHC to minimize transmission between hospitals and communities and save lives within this high-risk population. The authors declare no conflicts conflict of interest.