The first sign of the coronavirus outbreak caregiver Maria Cardenas saw was when a longtime client told her to stop coming to his home.
“He lives in an apartment building where there are a lot of people living together,” Cardenas said. “He was concerned for my health and my own immunity, so he told me not to come.”
Cardenas, a 58-year-old Hollister resident, has been a caregiver for 23 years, a profession that’s rising to the challenge of the virus with new concerns for the safety of their patients, as well as the care providers themselves.
A caregiver’s clients already include some of the most vulnerable members of the population, including people recently discharged from the hospital, the elderly, and those otherwise unable to take care of themselves. Caregivers provide a range of services such as housecleaning, meal preparation, running errands, transportation, help with personal hygiene, and simple companionship.
As of 2015, there are an estimated 117 million Americans requiring care, with most care being done by an unpaid family member. According to the American Association of Retired Persons, in 2017 about 41 million family caregivers in the U.S. provided an estimated 34 billion hours of care to adults with limitations in daily activities. There are currently just over 3 million paid caregivers working in the country, according to the Bureau of Labor and Statistics.
Brandy Applewhite has been working as a nurse for seven years and caregiver for 13 years out of Santa Cruz. Unlike Cardenas, her clients were concerned with their exposure to the virus as a result of her visits.
“Initially we saw people cancel over concerns for their safety,” Applewhite said. “However, we have been able to educate our patients that us coming to them is less threatening than them leaving their homes to go to the hospital, which can be life-threatening with the risks of exposure to disease.”
For Applewhite, 35, this has meant finding ways to reassure her clients. “We are careful to let the patient see us cleaning ourselves before and after we take care of them, so they can be less fearful of their risks.”
Preparation for entering a client’s home begins before a caregiver even knocks on the door.
“When I enter a client’s home, I have my gloves and mask on, and I have some hand sanitizer with me at all times,” Cardenas said.
Tracy Morgan, 47, is an in-home supportive services caregiver working out of Hollister. He always wears gloves and a mask when outdoors, and his ritual when coming to a client’s home is similar: “When I come into the house I make sure I dispose of my gloves, come in and use the hand sanitizer that is right at the door, go and wash my face and hands,” he said.
There have also been changes in the initial meetings with prospective clients.
“The biggest change with our interviews has been an extensive questionnaire before we even enter the home in regards to contact with the virus: signs and symptoms, have you been recently released from the hospital, if so did you have a roommate in the hospital, things of that nature,” Applewhite said. “Basically a coronavirus questionnaire.”
Procedures in the home have changed, and bringing along medical equipment presents a new challenge as well.
“Anything that comes into the home starts with cleaning everything, keeping things in antimicrobial bags and using those bags to dispose of things,” Applewhite said. “If the patient has a thermometer or a blood pressure cuff, we will use what is in the home rather than something we brought. We are careful to use only things we know can be cleaned or disposed of.”
Applewhite also uses a Bluerise UV Sterilizer Box, which has a type of ultraviolet light that sterilizes surfaces, to disinfect any equipment she uses.
Morgan runs errands for his clients and is aware of the need to be sure not to bring the virus inside the home with him. Anything coming into the house is treated with care.
“If there is a package, we spray it down and let it sit for a while,” he said. “I clean everything to cut down on any cross-contamination.”
He commented that he notices people ignore protocols for being safe in public when he is running errands for clients.
“It upsets me to see people who do not follow the rules. For someone like me, who does the due diligence to take care of a client, I have to safeguard myself against those who go out and do whatever they want.”
Morgan said that the role of caregiver extends to making sure anyone else entering the house respects and maintains his rules.
“It has really been a learning experience because there aren’t any given instructions,” Morgan said. “I have a strict regimen: take off your shoes, use sanitizer, make sure to wear your mask and gloves. I have gloves if they don’t have any. If it is the first time someone is coming, I will watch them but for the most part people are aware of the situation.”
For people trying to take care of someone at home, Cardenas recommended the same precautions.
“Take better measures to protect both of you,” she said. “Wear your mask and gloves. Be more careful because it can come into the house many ways and you have to protect yourself.”
At day’s end, after visits with clients, the caretakers take care of themselves.
“When I get home, I leave my shoes outside the door, I have my gloves and mask in a bag to dispose of,” Cardenas said. “When I come in I go straight to the shower and put my clothes in a separate basket.”
An increase in new clients requires an increased awareness of the virus and the need for precautions, Applewhite said. One of the first hurdles, though, is building patient confidence.
“These patients are concerned about the virus,” she said, “and they are concerned about letting me in. At the same time they don’t have anyone else coming to see them. So in their minds they are weighing that risk. ‘Do I let this nurse come see me? I need her to see me, but what’s my level of risk?”
With new clients, Applewhite begins the process with a phone call to reassure them that she understands the risks.
“I tell them, ‘listen, I am taking every precaution I can. I am putting on my shoe covers. I change my gloves and mask between every visit,’” she said. “I let them know I have been doing this through the whole pandemic and I’m OK. I feel good. I don’t need to tell them that I take my temperature three times a day, but I tell them that so they know I am taking it seriously.”
Caregivers’ increased client load is partly due to family concerns over spreading the virus to a vulnerable loved one.
“We have been seeing many new patients, parents who cannot be seen by their sons or daughters because of the risks coming from being essential workers,” Applewhite said, adding that she thinks caregivers will continue using the coronavirus precautions long after the outbreak is over.
“I believe that a lot of these precautions would be kept in my mind. I would be more careful about people coming into the house and continue to spray packages. It is something we are going to have to stay prepared for. I am working with the idea that the virus is always going to be with us.”
Applewhite said the pandemic is “a wakeup call everyone needs to take seriously.”
“The virus is here and we are doing everything we can to protect our patients and ourselves,” she said. “We do not want the patient to be fearful of us coming into their home. A month or so ago it was scary, but now it has just changed the way we do things for the better.”
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