Over the last eight months, the Visiting Nurse Association of Greater St. Louis’ (VNA) Advanced Illness Management (AIM) program has introduced new protocols to keep patients safe during the pandemic. AIM is for people who need palliative care, but not end-of-life palliative care, because of serious chronic illnesses, hospitalizations or acute illness. Therefore, it’s been imperative for VNA to make service safety adjustments quickly, without disruption of care.
The AIM team continues to develop innovative ways to help patients manage their symptoms in between doctor visits and treatments while at home during COVID-19. Learn more about the updates made to AIM’s care approaches and ways the program will continue to evolve in 2021:
General COVID-19 Protocols
Early on in lockdown, to keep in line with CDC guidelines, VNA adopted TapCloud, a new telehealth platform that allows VNA staff to connect with patients remotely during COVID-19. TapCloud is a free app that securely and privately allows patients and their caregivers to remotely let VNA know about symptoms and health needs. It also allows for video calls for patients and caregivers to easily connect with clinicians.
“We had not done a single virtual visit prior to lockdown,” says Deb Jeffery, Director of AIM. “We were in the process of purchasing a secure HIPAA compliant virtual platform, but none of us had used it, so when we went to lockdown, we had to scramble to learn it and help patients and staff get on board with it.”
This meant they were only going to the homes of people who didn’t have basic smartphones, tablets or computers because that’s all that patients need to connect. The virtual platform helped VNA follow social distancing guidelines from the onset of COVID-19 by giving patients, caregivers and staff a powerful, simple tool to facilitate visits remotely and safely.
There are requirements for how VNA conducts in-home visits, including that everyone in the home wear a mask, all VNA staff wear full PPE and the number of people in the household is limited to patients and those who are able to give immediate caregiving feedback. They also ask standard pre-screening questions of patients and caregivers regarding whether or not they’ve had a cough, experienced shortness of breath or have been exposed to COVID-19.
New Care Approaches
Integrated Client Visits
Even as more people have allowed VNA into their homes, TapCloud has proven to be an invaluable tool to integrate in order to make sure that symptoms are managed and reported on in between in-person visits.
“One of the things for AIM is that we’ve always been high-touch,” says Deb. “We’ve found that with this virtual platform, we can do additional visits to keep in touch with people virtually in between our in-home visits, so we’re able to keep a better eye on people that way. It also gives us a symptom management tool that people can use from a smartphone or their computer to send us information about how they’re feeling on a daily basis if they want to. If they have a problem, they can send it through a secure email.”
This platform will continue to expand so that everyone can use it. It’s simple, and a great way for VNA to make sure nobody falls through the cracks and everybody is getting the care they need. If somebody reports they’re having a bad day, they can set up a virtual visit right away and take care of the problem before it becomes a more serious issue.
Extensions to Mental Health Focus
“I think the mental and emotional stress of the situation is not fully coming to light yet because we’re not out of it,” says Deb. “The longer that we are keeping people isolated, the more it’s going to be noticeable to us that people are declining more rapidly.”
The main imperatives are to catch mental health issues early and address the whole person in coming up with a plan for care. This can mean finding companions for seniors experiencing loneliness, isolation or depression through VNA’s Visit-A-Bit program. It also means connecting seniors with spiritual counselors and other community resources who can bring things like church, things homebound seniors aren’t able to experience, to the home.
2021 Program Priorities
The AIM program has always prided itself on being flexible to the needs of patients and the community, and this ability to change as needed is something that will need to continue as COVID-19 continues into 2021. Especially when a vaccine for COVID-19 is developed and available, it will be important that the AIM program adapt to get it to homebound patients to ensure they’re staying safe and healthy in any ways they can.
“Just trying to change, keep ahead of things and give people what they need to age in place is still the goal,” says Deb. “Most of my patients will still say they want to die at home, so our job is to make sure that happens as the world changes.”