GENERAL GUIDELINES AGAINST SPREAD OF COVID -19

Part 3: Suggested Best Practices for Home Health Care for Elders

Challenges for Home Health Care & Means to Overcome Them

(a) Elder Care

(i) Challenges Elders are vulnerable to various age/ health related issues, with the Covid 19 pandemic increasing its impact with every passing day the vulnerabilities and health related issues are increasing manifold. Various challenges likely to be faced by elders during these times are enumerated below:

(aa) Restricted in-person visits to hospitals owing to lockdown restrictions.

(ab) Difficulty in managing essential supplies.

(ac) Minimal Physical mobility.

(ad) Likely Cross infection from caregivers.

(ae) Emotional disturbances and depression.

(af) Prolonged separation from children/NOK due to travel restrictions.

(ii) Means to Overcome Caring for our elders is an important task for the entire society.

Although all challenges cannot be resolved, however their impact can definitely be minimized. Some common practices which can be adopted are given below:

(aa) Postpone unnecessary doctor visits and adopt online health consultation.

(ab) Stock up essential supplies and medications.

(ac) Limit in-person visits by friends and family.

(ad) Adopt best practices against disease transmission.

(ae) Adopt measures to improve immunity and mental health under medical supervision.

(af) Practice social and physical distancing but not social isolation.

(ag) Prefer Video chat/calls with loved ones over visits in person.

(ah) Switch to indoor recreational & spiritual activities.

(b) Caregiver

(i) Challenges Caregivers have a crucial role to play in home health care setup. The Covid-19 pandemic has however multiplied their responsibilities and challenges to an exponential level. Key challenges faced by them are as follow:

(aa) Restricted transportation movement owing to lockdown.

(ab) Difficulty in managing essential supplies.

(ac) Unforeseen medical emergency.

(ad) Dealing with emotional requirements of an elder.

(ae) Likely Cross infection from elders/family.

(af) Isolation/ loneliness of the Caregiver.

(ii) Means to Overcome A health care worker faces numerous problems while operating in isolation. Limited transport & curtailed visits by Care Coordinators due to ongoing pandemic have further increased their responsibilities. The emerging situation demands improvisation in common practices which were followed hitherto.

(aa) Prefer ‘At Home’ services over ‘Visiting’ Services.

In case of visiting services, caregiver must take a shower, change the clothes and ensure that he/she doesn’t have any flu like symptoms or fever before going into an elder’s room.

(ab) Stock up essential supplies and medications.

(ac) Following points must be kept in mind by the caregiver:

(aaa) Regular monitoring of elder’s vital parameters.

(aab) Keep in contact with NOK/ Family & Friends.

(aac) Keep note of emergency contacts (Hospital/ Ambulance/ Homecare Care Coordinators).

(ad) Engage elders in various recreational activities and maintain contact with friends/family on video calls/ texts.

(ae) Adopt best practices against disease transmission as per organization SOP.

(af) Improve self-immunity and mental health as per organizational guidelines.

(ag) Recommended actions by caregivers:

(aaa) Video chat/calls with loved ones.

(aab) Engage elders in board games/recreational activities.

(aac) Access to online services and outreach for spiritual solace.

(aad) Write notes or send cards to lift spirits of elders.

 Prevention & Control

Various methods to provide best home health care to the elderly duly keeping in mind the health and safety of the caregivers must be worked out. Policies and measures which may be adopted keeping in view the current situation and its critical impact on the elderly population are enumerated below:

(a) Physical & Mental Health The physical and mental health of both elders as well as the caregivers be regularly monitored. Elders must be recommended various health care activities under strict supervision based on their medical history and the caregivers be advised based on their past conduct and stress taking capabilities.

(i) Elder Healthcare

(aa) Suitable active exercises & yoga for elders, depending upon their health conditions, under supervision of Physiotherapist/Caregivers.

(ab) Bed-ridden elders to be passively exercised by the Caregiver under online supervision of physiotherapist.

(ac) Engaging elders in household chores helps in movement, removes boredom and gives them a sense of fulfillment.

(ad) Video calls with loved ones, use of social media and indulgence in other recreational activities like painting & listening to music would prevent isolation and loneliness.

(ae) Sleep of 6-8 hours is vital for normal body functioning. An afternoon nap would be helpful for an elder.

(ii) Caregivers Healthcare and Mental Health

(aa) Routine check-up and psychological evaluation.

(ab) Video conferencing with doctors and care coordinators.

(ac) Routine checks and regular updates for any symptoms of Covid-19.

(b) Nutrition. It must be ensured that the elders are recommended best quality of food and supplements under strict consultation of the doctors as well as nutritionist. The details of the same, keeping in view the present situation and elderly’s health, are recommended as below:

(i) Ensure proper nutrition of elders through freshly prepared home cooked food.

(ii) Personalized diets must be recommended on case to case basis under supervision of a nutritionist/ dietician. These diets are mainly aimed at immunity boost of the elders with due care to their health conditions. Various food supplements, fruits and vegetables (Rich in beta Carotene, Vitamin C & E and Zinc) recommended by our experts are as under:

(aa) Vegetables like Carrots, Sweet Potatoes, Capsicum and Green leafy vegetables like spinach.

(ab) Superfoods like broccoli, mushrooms and kale.

(ac) Foods rich in omega-3 fatty acids like beans, flax seeds and even some nuts.

(ad) Fruits like orange, kiwi, lemon, guava, grapefruit, berries and apricots.

(ae) Certain herbs like garlic, ginger and black cumin are immunity boosting and gut friendly.

(iii) Hydrate adequately and frequently to prevent dehydration. Eight glasses of water are  must to keep mucous membranes moist which further minimize chances of catching flu.

(c) Infection control & Hygiene The caregivers should be adequately trained and strictly operate under given guidelines of maintaining an infection free and hygienic environment while handling an elder.

With the outbreak of COVID-19 Pandemic, further instructions should be issued to the staff to minimize the chances of cross infection there-by maintaining a hygienic environment. Key policies & guidelines with respect to infection control are listed below:

(i) Hand Hygiene Strict hand hygiene for both elders and caregiver involving 20 seconds contact of skin with the soap to be ensured. Alcohol based hand sanitizer with 70% alcohol should be used only when hand washing not possible.

(ii) Disinfection of Surfaces & Articles Soap solutions or Alcohol based sanitizer must be used regularly to clean following contact surfaces at elderly homes.

(aa) Door handles/knobs, bed rails, furniture & metal surfaces.

(ab) Other assistive articles like wheel chairs, canes and crutches.

(ac) Personal items of elders such as like spectacles, mobile phone, ear phones, remotes & other such items be sanitized at least twice a day.

(iii) House Upkeep & Sanitation

(aa) Twice daily mopping of an elders room, washroom and surroundings with disinfectants.

(ab) Shoes and slippers must be removed outside the house and should be brought in only once they are cleaned with disinfectants /soap solutions.

(ac) All articles brought from outside must be sanitized before getting inside the house.

(ad) Regular change of linen in elder’s room. The linen and clothes of an elder should be washed with detergent and warm water (60 degree centigrade).