As WellSpan VNA Home Care nurse Kelsey Toscano makes the drive to Red Lion to see her patient, her car is stockpiled with personal protective equipment. Before entering the home of her first patient for the day, Toscano must put on the gown, gloves, face mask and face shield sitting in the back of her vehicle.
“During the COVID-19 pandemic, before we even make a visit to a patient’s home, we have to call them and ask them the common screening questions – do you have a cough, fever or shortness of breath?” said Toscano. “Even if the answers to those questions are negative, we still have to wear the personal protective equipment. We need to make sure that everyone involved is safe.”
Toscano has worked at WellSpan Health for four years but has spent the last 18 months as a home health nurse with WellSpan’s VNA Home Care agency. They include visiting nurses, aides, therapists and specialized caregivers who work with physicians to care for patients who don't need to be hospitalized but do need health care at home.
“A lot of the patients we help are just getting out of the hospital, and our goal is to give them the proper care at home in order to prevent re-hospitalization,” said Toscano. “We can help a wide range of patients, from those with long-term illnesses like congestive heart failure or COPD, to someone who just had a knee or hip replacement.”
“Our VNA team does tremendous work in making sure patients are given high-quality care in the comfort of their homes,” said Sandra Bennis, vice president of home care for WellSpan Health. “With the COVID-19 pandemic, we have made it a top priority to continue providing this essential care while making sure we are taking every step possible to keep our staff and our patients safe.”
A plan in place to safely provide care for all
WellSpan’s home health nurses drive to the patient’s home to provide care. For the last few weeks, Toscano has been carrying some extra supplies in her car. Inside her trunk is a specialized care kit for COVID-19 patients.
"Whenever we have a COVID-19-positive patient, we bring in a care kit for that first visit,” said Toscano. “That includes a blood pressure machine, a stethoscope and a thermometer. It’s all disposable equipment that stays in that one patient’s home, so we don’t have to cross contaminate anything by taking that equipment from home to home.”
In preparing for the spread of COVID-19, WellSpan VNA Home Care created a special team of clinicians who can visit the homes of COVID-19-positive patients or patients who are awaiting COVID-19 testing results. Toscano volunteered to be a part of that team.
So far, she has cared for four COVID-19-positive patients in their homes. The WellSpan VNA team has cared for roughly three dozen COVID-19-positive patients overall.
The protocol for entering a COVID-19-positive patient’s home is very similar to what she now wears for her other in-home patient appointments. Toscano must wear a mask, face shield, gown and gloves. If a patient is using a nebulizer or anything that could produce a cough, Toscano will use an N-95 respirator instead of a surgical mask.
“Our leaders have done a great job of checking in on us to make sure that we have everything we need, like enough personal protective equipment,” said Toscano. “As the pandemic evolves, policies continue to change, and they have been on the ball with keeping us informed, and even just reaching out to make sure we’re all doing okay.”
There is a different routine for each piece of equipment Toscano wears, all with safety in mind. Gloves are disposed of. If a patient is COVID-19-positive, the gown is also thrown away. An N-95 respirator, however, can be used for a week in line with CDC guidance. The face shield must be disinfected after every patient.
Because Toscano may see both COVID-19-positive and non-COVID-19 patients in one day, she plans out her day accordingly, seeing any patients who are positive or may potentially have COVID-19 at the end of her scheduled day.
“That decreases the risk of any cross contamination,” said Toscano. “The safety of our patients is always our number one priority, and our entire team has taken a lot of time and effort to make sure we are doing everything we can to help our patients while keeping them safe.”
Continuing care for all patients in the midst of a pandemic
Toscano’s first patient on this day does not have COVID-19, but she has been screened. Mary Davis, 69, has been suffering from various infections for almost a year. Toscano has been working with Mary’s primary care physician and other specialists to coordinate her care and visits Mary’s Red Lion home twice a week to check up on her.
Mary suffers from dementia and relies on her husband, Jack, to keep up with her appointments. Having a WellSpan home health nurse visit their home directly helps them avoid frequent hospital trips.
“We have such a great relationship with Kelsey, and she takes excellent care of my wife,” said Jack. “The work these VNA nurses do is so important. I would be lost without being able to talk to someone else, to convey our concerns, and to have this team to look after my wife and find out what is going on. This has also allowed us to continue quarantining, while still making sure my wife gets the care she needs, so this service has been a real blessing.”
After drawing blood from Mary, taking her vitals, and attending to her needs, Toscano takes off the personal protective equipment, discarding her gown and gloves, gets back into her car, and drives to the next patient.
WellSpan VNA Home Care provides at-home health care assistance to patients who are disabled, or those battling chronic or terminal illnesses. WellSpan VNA Home Care sees an average of about 1,300 patients at any given time in York, Lancaster, Lebanon, Adams and Franklin counties. Toscano’s patients have been grateful to have her during this crisis.
“We just can’t thank her enough for what she has done for us,” said Jack. “My wife was a nurse for many years, so we understand the hard work they put in. The VNA nurses being able to come to our home and care for my wife during these times only increases the appreciation we have for them.”
For more information on WellSpan VNA Home Care, visit www.WellSpan.org/VNA.