Unleashing home healthcare as part of the solution to the COVID-19 crisis: a step in the right direction

By Ike M. Okoye

Just recently, while speaking at the daily press briefing by the Presidential Task Force on COVID-19 in Abuja, the Director-General of NCDC, Dr. Chikwe Ihekweazu, announced that there is a high possibility of patients outstripping the 3,500-bed spaces available for COVID-19 management in the country. He said that the Federal Government is considering the option of home care treatment for the COVID-19 patients as a means to contain the over burdening of available facilities.

The NCDC alert evidently is just a tip of the iceberg. Unlike in the climes of America, Europe, and Asia, the real COVID-19 assault is yet to hit Nigeria, and indeed the whole of Africa. From merely the numbers; infected cases, fatalities, and the so referred “index cases”, the COVID-19 war is yet to commence. We are still at the phase of preparations for war.

From this alarm raised by the apex COVID-19 management structure, the Presidential Task Force, the NCDC etc. it is without doubt that the COVID-19 challenge has already started testing the limits of our entire healthcare ecosystem and creating severe over-capacity issues, even when the COVID-19 invasion is yet to hit full swing. With the possibility of patients exhausting the bed spaces , the overflow would be unleashed directly into the communities. Can our structure contain community transmission on such invasive scale? The outcome is unthinkable. Is there a testing and treatment capacity at the community level?

In the circumstances, the proposition of taking healthcare to the patient at home is not just in our country’s best interest, it has become a national imperative. Healthcare at home, also termed Home Health allows for the provision of highly skilled and physician-led clinical nursing and therapy services to patients in the comfort of their homes. Home Health will ensure our health system have the capacity to handle a potential surge of COVID-19 patients through expanded testing in communities where there may be people infected who may not be symptomatic.  Can it work? What is the feasibility? And what really is Home Healthcare?

Simply defined, Home Healthcare is the delivery of healthcare services to the patient in the comfort of the home..  Medical care that was once offered only in a hospital or clinical setting can now be safely, effectively and cost efficiently provided in a patient’s home by skilled healthcare professionals. Home health care is usually less expensive, more convenient than and just as effective as care you get in a hospital.

Presently, in the more developed climes of Asia, America and Europe where Home Healthcare is popular and more established, the home healthcare providers have joined forces with other healthcare leaders, as well as local governments and federal agencies, to help resolve patient care challenges associated with COVID-19.

Home health is equipped to care for those confirmed COVID-19 patients who no longer require in-patient care and those whose symptoms are manageable at home with close monitoring and care delivered by a skilled clinician. Our facilities already full of patients will soon become inundated with new patients who can only be cared for via hospitalization. With home healthcare these facilities can free up capacity to prepare for the eventuality of  increasing influx of COVID-19 patients into the community.

With many states in Nigeria still recording what is referred to as “index cases”, it is certain we do not have the real COVID-19  indices at the community level. In the circumstance, wide spread testing directly at homes by the Home care practitioner is key to helping communities quickly identify infected people, and trace and isolate their contacts.

At this time, when most Nigerians are being asked to stay at home for the unforeseeable future, home health will help hospitals and facilities alleviate overall capacity issues in locating and treating patients safely in their homes. It can also help prevent the spread of the virus to the overall community, especially our most vulnerable population — the frail and elderly.

Home healthcare providers are also ready and able to care for patients with chronic illnesses or post-acute challenges, who are well enough to be discharged from in-patient care but still require close monitoring and ongoing care—especially to help avoid unnecessary hospitalization, which will only exacerbate the pressure on the system, as home health would expose far less people to COVID than hospitalization.

Although the sector is still in its infancy stage in Nigeria, Home healthcare can become the new front in the national fight against COVID-19. To confront and break the imminent dead lock, the Nigerian government should reach out and strategically engage the home healthcare providers who are uniquely qualified, to assist in the battle to curb the transmission and the impact of COVID-19, and to protect the health and well-being of our people.

Action steps needed to maximize the use of Home Healthcare in Nigeria will include:

1. First and foremost, we have to recognize that we are not in any manner meeting testing benchmarks. The government must engage the Home Health care practitioner to facilitate reasonable testing capacities to capture the infected people in our communities.
2. We need our hospitals and physicians to be able to rely on home healthcare for the treatment of patients who can be treated effectively and safely at home. This will make room in hospitals for the sickest and more critical cases.
3. The government in collaboration with the home healthcare providers and other key players should develop a comprehensive Clinical Care Guidance for treating and managing the COVID-19 patients at home, incorporating already established industry protocols for delivering quality care at home.
4. The Government should through the Home Health Care providers massively recruit experienced clinicians who can effectively work in the home environment, again using tested and already established home health care recruitment protocols.
5. The Government will then ensure that the specially recruited home health care clinicians undergo basic training and proper orientation on the practice of home healthcare including timely reporting and documentation. More importantly, that the clinicians must understand and be conversant with the Clinical Care guidelines for Coronavirus Disease 2019 (COVID-19). The NCDC will equally update the Clinical Care Guidance as more information becomes available.
6. Ensuring home health provider’s access to adequate Personal Protective Equipment (PPE). The Federal Government and NCDC must provide guidance on how to get the most out of PPE and ensure enough PPEs and safety equipment are readily available to the home health care personnel. Home Health needs adequate PPE to be part of COVID-19 response.
7. Ensuring clear and effective communication across all of the healthcare levels. A key component of managing any crisis is effective communication. To win the war against COVID-19, timely, balanced and factual information is critical.

With the increasing cases of COVID-19, home healthcare providers are well prepared to help alleviate the growing stain on the system by caring for the patients in the home. The Federal Government would need quick action to unleash home health to be part of the solution to contain the over burdening of available facilities.

The home healthcare sector is committed to caring for patients safely and effectively. Collectively, we need to take immediate action to maximize the ability of nurses, therapists, and other front-line home healthcare clinicians to care for people in the safest setting possible—the home. Lives depend on it.

• Ike M. Okoye is the MD/CEO of Prompt Home Health Ltd. He is a Universal Health Care advocate, a co-convener of All Things Medical (ATM) Conference and The Nigeria Women and Healthcare Symposium.