Vero’s nonprofit healthcare agencies, many of which serve as safety nets for the area’s poor, have been dramatically changing their approaches during the COVID-19 pandemic – honoring the wishes of patients who are quarantined and fearful of contagion, but looking for new ways to serve patients at this time of need.
Under nerve-wracking circumstances, community clinics worry children aren’t coming in for scheduled immunizations. The VNA is afraid patients will regress without in-home therapy. Healthy Start’s counselors worry they might miss a new mom’s subtle signs of struggle that they typically pick up only in face-to-face encounters.
The Senior Resource Association is trying to compensate for the structure and socialization it once provided people with dementia, now restricted to their homes. And the Mental Health Association is treating a new pool of clients: doctors and nurses emotionally taxed by the pandemic.
Not just seniors at the threshold
Senior Resource may be best known for its Meals on Wheels program that in more normal times provides five hot meals a week to the homes of seniors and people with disabilities. These days, with COVID-19, they have expanded on the fly.
Because of COVID-19, the agency is limiting food drop-offs to once a week, bringing one hot meal and four frozen meals instead of the usual hot meals five days a week. “We wanted to limit the number of people going into the home of seniors,” said CEO Karen Deigl.
While Deigl was bracing for a shortage of volunteer delivery people, that has not been the case. “It’s crazy,” she said. “Every Monday, we have ample volunteers.” Last week, 40 volunteers showed up to deliver 2,500 meals to almost 400 people in one day.
Volunteers arrive at the Senior Resource center in their own vehicles and stay at the wheel while staffers take their coolers into the building, disinfect them, fill them with food and bring them back outside. There, the volunteers, equipped with masks, gloves and disinfectant, load the coolers into their cars for delivery. When they reach the home, they’re instructed to ring the bell, leave the food at the front door and back away as the resident opens the door.
“We’re managing social distancing,” said Deigl.
In addition, Senior Resource is delivering boxes of pantry food to seniors to keep them from having to go to the grocery store. Those non-perishables are collected by 35 volunteers who set boxes outside their homes, encouraging neighbors to drop off food.
Deigl has managed to find funding to cover food for “every senior on our waiting list and anyone else that’s calling in need of food. We’re feeding anybody,” said Deigl. “We’ll help anybody that is in need.”
There is also a shopping service for homebound people over 60. Senior Resource will help them put a list together and shop for them with the person reimbursing them afterwards.
In addition, Deigl has mobilized the Community Coach – a bus outfitted with wheelchair lifts that is under her purview, as is the county’s Go Line public transit service – to pick up and deliver prescriptions.
There remains one segment of Deigl’s neediest clients – those in cognitive decline – who are suffering as a result of the pandemic. Senior Resource has had to close its popular Day Away program, where caregivers could drop off clients for some socialization and planned activities, while they themselves get a much-needed break.
The center was seeing 20 to 30 such clients a day when COVID-19 cases began to increase in Florida. When gatherings were limited to no more than 10 people, Deigl said: “Whoa. We can’t do this, this is irresponsible.”
Sadly, those clients now aren’t doing well, she said.
“I have one client who was very active and now her caregiver says it’s difficult to get her to eat. All she wants to do is sleep. Her health is deteriorating during this time. When there is complete change to a person’s routine, for people who have Alzheimer’s, it’s very disorienting.”
Rise in frontline mental health needs
Two weeks into the state’s stay-at-home order, the Mental Health Association saw a 25 percent drop in clients. Since then, though, visits are up 35 percent.
Dr. Nick Coppola, the nonprofit’s CEO, attributes part of the center’s 10 percent rise in visits to medical professionals under stress from the COVID-19 pandemic. “They’re under stress, and that’s OK. They’re doing their jobs,” he said, glad that the caregivers know to seek help.
Now Coppola is concerned that number is going to rise even further as things begin to return to normal, “when we start to see people with time to think about what they’ve gone through.
“Right now, they’re full of adrenaline, the fear is triggering a fight or flight mode. That’s hard. But I’m worried about the aftermath, when people start to have their normal everyday jobs and have a chance to go back to their normal patterns. That’s when I see the anxiety hitting.”
While telehealth has taken over as the mode of choice for psychiatry and therapy, same-day screenings, crisis intervention and group counseling are still provided in person.
Clients are checked for fevers, he said, and the number in group sessions is limited to less than 10. “We keep them six feet apart.”
Healthy Start: Zoom, Lamaze and digital doulas
Healthy Start’s Andrea Berry is used to new mothers being protective, and expectant mothers being fearful. But she is not used to factoring in a deadly virus with all the other risks of childbirth.
Nor is she used to having the glass screen of a mobile device come between her and her clients; she still worries that the nuances of confusion or distress might be missed without the face-to-face contact of their signature home visits.
But worries over the contagion of the new coronavirus forced a quick pivot to online education and counseling, and even digital doulas.
“We went virtual early,” she said. “We were very quick to change.”
Her staff is now using telephonic visits and FaceTime to go over all the curriculum, from maternal and infant care to Lamaze instruction, even help with breast-feeding.
“We haven’t missed one visit to any of our moms since we’ve moved to telehealth. It’s been amazingly successful,” Berry said.
The biggest challenge has been childbirth classes.
For that, Healthy Start went to the Zoom meeting format and it too has been a real success, with pregnant moms and their partners all joining in.
“We just had 10 couples for our hypno-birthing class. That was a pretty good turnout,” she said.
They’ve also taught infant CPR classes on Zoom. As for the couple of clients who haven’t had smartphones or computers, they were provided through donations. “I just asked a funder,” Berry said.
Cleveland Clinic Indian River Hospital has greatly limited visitation. But women having babies are allowed to have one person with them. That usually means a partner or relative. As a result, Healthy Start’s rapidly expanding doula program is now mostly virtual, with doulas – birth counselors – providing extra education to the partners to take over with physical help in childbirth like massage.
Berry points out that doulas can be a critical fall-back if the father or other childbirth partner develops a fever, and the hospital bans them from entering.
Though it has not yet been necessary, the hospital does have a space set aside in case a COVID-19 positive woman goes into labor. And they have agreed to give the mother the right not to be separated from her baby once she delivers, though separation is the medically preferred protocol. That power of choice, Berry said, “speaks a great deal to the leadership there.”
Community Clinics: Vaccines a concern – and not just for COVID-19
Not all services are readily translated to telehealth. Low-cost community clinics like Treasure Coast Community Health Centers and Whole Family Health are trying to convince parents to bring children in for their scheduled immunizations.
“It is hurting our children,” said Treasure Coast CEO Vicki Soule at a recent Hospital District meeting. “Nervous parents are not coming in for vaccinations. I hope we don’t see a surge of measles and mumps.”
Soule also urged patients with chronic conditions to continue with their regular check-ins.
“I think it’s clear health clinics across the country are seeing rapidly diminishing numbers due to stay-at-home,” said Soule.
Several of Treasure Coast’s eight clinics are either temporarily closed or operating on reduced hours. Those that are open are taking extraordinary precautions to limit the spread of disease by screening all patients before they come into the clinics.
Any with possible COVID-19 symptoms are sent to the system’s one clinic offering testing – in the 767 building on 37th Street. Reduced hours at other locations are listed on the clinic’s website.
Soule said CDC guidelines have all but stopped dental services, saying “non-urgent” care should be postponed during the pandemic to save on PPE.
Behavioral health at TCCH is being done through telehealth, Soule said. Medical services are a “mixed model” of telehealth and in-person visits. “They can come in,” she said. “We have a lot of chronic conditions in our adults. They don’t have to go to the emergency room.”
VNA still makes house calls
Of all the agencies, the VNA may have the greatest challenges during the pandemic.
Its nurses, therapists and aides are not just visiting homes of people afraid of catching COVID-19; they’re visiting patients who already have the disease and are recovering at home.
Last week, the VNA was treating six COVID-19 positive patients, plus two more who had been tested but did not yet have their results.
“We had some of the first patients that identified themselves as positive,” said Lundy Fields, VNA’s president and CEO, who said he has worked closely with Vero’s hospital on COVID-19 referrals. “Cleveland Clinic knew we were totally prepared.”
The exhaustive undertaking has involved many of the issues the hospital itself has had to deal with – acquiring adequate personal protective gear; accommodating caregivers’ family pressures; dealing with financial constraints due to fewer patient visits; and perhaps most important: keeping up morale while staving off fatigue.
“I’ve been working seven days a week for weeks now. Every day rolls into the next,” said Fields.
So far, no VNA nurses believe they have been exposed, and Fields says they all have been offered reimbursement for the cost of testing should they choose to have it.
The VNA mobile clinic, which once visited neighborhoods with limited access to care, is now serving as a drive-up clinic, stationed in the Wal-Mart parking lot on State Road 60.
The VNA bus is still staffed by Ashley Baum, a nurse practitioner. These days, she’s helped by occupational and physical therapist assistants, who answer questions and give out information on various services.
Those therapy assistants would normally be on the road visiting patients. But there has been a noticeable drop in volume since the pandemic hit, Fields said.
“That’s one of the more unfortunate things with COVID-19: the misinformation that’s out there,” Fields said. “When we call to book a visit with a home health patient, sometimes we’re getting refusals because they’re scared. People are refusing home health who really need it, and that’s really sad.”
“It’s disheartening to know patients need us and they’re refusing us,” Fields said. “When this is over, we’re going to see a surge way above normal for home health needs. People we’ve helped learn to walk again are going to be back in wheelchairs.
“We try to explain that the VNA from the very outset has been totally prepared. Of all of our caregivers, not one has been COVID-19 positive. They’ve been self-monitoring, taking their temperature, checking themselves to see that they’re feeling fine.”
Along with gloves and the scrupulous hand hygiene that is the VNA’s norm, the caregivers are wearing double masks, a surgical mask with a cloth mask over it. That facial protection is aimed at preventing any asymptomatic infection from spreading to a patient. And goggles have been issued to protect the caregivers themselves, since risks arise with not only the known positive COVID-19 patients they are treating, but patients who may be infected and not showing symptoms.
