During the early days of the coronavirus in the U.S., home health agencies and personal care services providers were largely exploring uncharted territory, learning and adapting on the fly.
As time goes on, however, home-based care operators are increasingly gaining access to new tools, deeper insights and proven best practices — all of which are being used to map out the COVID-19 landscape in greater detail.
Louisville, Kentucky-based BrightSpring Health Services is now making a major contribution to those discovery efforts.
On Wednesday, the company published a detailed account of its coronavirus preparedness strategy and mitigation approach in the academic journal Home Health Care Management & Practice. Specifically, the newly published piece focuses at BrightSpring’s first 100 days responding to the coronavirus while caring for dozens of confirmed-positive patients in their homes.
“Home health and personal home care are really going to be key resources for people with COVID-19 in the community,” Dr. William Mills, BrightSpring’s senior vice president for medical affairs and the lead author of the journal article, told Home Health Care News. “Those services will be central to keeping people out of hospital and nursing home settings, which have obviously been hit quite hard by COVID-19 cases and spread.”
Nationwide, BrightSpring and its affiliates operate across 49 states, delivering care to more than 60,000 clients and patients daily. In addition to home health and personal care, the company’s service lines include pharmacy, hospice, neuro rehabilitation, behavioral health and more.
Backed by PE giant KKR and an offshoot of Walgreens Boots Alliance Inc. (Nasdaq: WBA), BrightSpring’s home health and personal care operations span 25 states.
From Jan. 20 to April 30, BrightSpring and its affiliates provided home health and personal care services to 67 confirmed COVID-19-positive patients, a total that represented less than 0.3% of its census.
Of those individuals, just 20 were referred to BrightSpring following a hospitalization.
The fact that BrightSpring cared for fewer than two dozen COVID-19 hospital discharges during that 100-day window is somewhat surprising, as many experts thought in-home care providers would be overwhelmed by a wave of patients leaving acute care facilities.
“We certainly prepared for substantial discharges out of the hospital with COVID into the home,” Mills said. “But what we’ve seen — and I think this is a trend we’ve seen around the country — is that many patients who have COVID at home never end up in the hospital. They end up recovering spontaneously.”
As for the 47 community-sourced COVID-19 patients BrightSpring cared for, the company was able to confirm their status by working with local partners and health departments, though the availability of testing supplies varied.
“It was a bit dependent on geography,” Mills said. “But we were able to get … these people tested in every case. They were all confirmed by the nucleic acid-swab test.”
Procedures and pain points
Internally, BrightSpring began monitoring the global coronavirus situation daily in early February, leaning heavily on information from Johns Hopkins University, the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC).
Once it became clear that the virus would spread throughout the U.S., company leadership formed a multidisciplinary action committee with representatives from operations, communications, compliance and clinical departments, among others.
It also started implementing enhanced infection-control procedures across its affiliates, sharing guidance via live and recorded web meetings, plus slide presentations, written policies and instructional documents.
“We formalized enterprise infection-control policies specifically for COVID-19 pandemic mitigation,” Mills said. “Then we started meeting both as a committee and with each individual office, each location across our home health and personal home care sites to institute those policies.”
When it comes to personal protective equipment (PPE), BrightSpring formed a new central-supply process, where employees assembled kits with masks, gloves, hand sanitizer and additional materials, then shipped them off to all locations.
For the most part, that helped keep PPE under control.
“Fortunately, our procurement team was able to do a really good job,” Mills said. “We’ve gotten reliable sourcing and haven’t been adversely affected by not having enough PPE.”
On top of the aforementioned actions, BrightSpring also built a cloud-based web application to capture data on confirmed and possible cases across its markets. Insights generated from that application allowed company leadership to visualize coronavirus information in “a real-time situation room.”
Digital screening tools similarly helped BrightSpring monitor potentially asymptomatic caregivers.
“Each day, our home health nurses, therapists and home care caregivers and staff are all entering their temperatures and doing a symptom check,” Mills said. “That then goes into a database, so we’ve been vigilant on that side as well.”
Broadly, Medicare beneficiaries with higher numbers of chronic conditions are the highest utilizers of home health services, with one-quarter of beneficiaries living with six or more chronic conditions receiving 13 or more visits during the year.
BrightSpring’s play-by-play of its first 100 days dealing with COVID-19 offers a somber reminder of the virus’s severity for this population.
Of the 47 COVID-19 patients the company identified within the community, 17 needed subsequent hospitalization. Thirteen of those hospitalized patients died due to COVID-19-related illness.
“The problem is that the virus destroys the functional unit of the lungs in these cases,” Mills said. “It’s really difficult to get enough oxygen to many of these folks. The vast majority have died of respiratory failure.”
Looking ahead at the next 100 days, Mills expects BrightSpring to see more hospital referrals, especially as elective surgeries start to ramp back up.
Other areas will likewise start to stabilize as well, he noted.
“I think in the next hundred days, we’ll see the supply chain largely catching up with the demand,” Mills said. “I think we’re better prepared both as a country and, certainly, [BrightSpring] as a company, with an adequate PPE supply and with robust training on infection-control measures.”
Continued workforce surveillance testing is also likely to play an increasingly important role in home-based care. Along those lines, BrightSpring has started leveraging point-of-care antibody testing as an added precautionary measure.