Home Care Agencies Starting to ‘Wake Up’ to Infection Control

Home health agencies have always had to prioritize infection control as part of Medicare’s Conditions of Participation (CoPs). But that hasn’t always been the case for non-medical home care providers.

That quickly changed after the coronavirus began spreading across the country in March and April. Now, infection control is likely something non-medical home care providers will have to think about for the foreseeable future.

Broadly, infection-control protocols are aimed at halting the spread of germs and infectious diseases in health care settings, including the home.


When it comes to the COVID-19 emergency and infection control, most of the nation’s attention has been directed to hospitals and long-term care facilities. That’s not surprising, as nursing home residents account for nearly one in 10 of all the coronavirus cases in the U.S. and more than one-quarter of coronavirus-related deaths, according to a recent Associated Press analysis.

“Much of the burden of COVID-19 on older adults has rightly been focused on long-term care facilities, where the majority of deaths have taken place,” Dr. Madhuri Reddy, co-founder and chief medical officer at CareAcademy, told Home Health Care News. “Home care has been an overlooked area, but now we’re at the point where many people with COVID-19 — or those recovering — will also need home care. The most important thing we all need to look at is how home care workers and those they care for can stay safe.”

Boston-based CareAcademy is a training platform for home care professionals. The company, which recently raised $9.5 million in Series A funding, currently serves roughly 1,000 home care clients and has trained over 110,000 caregivers.


If anything, the COVID-19 emergency brought to light that caregivers working in the home care space face many of the same risks as clinicians and other medical professionals. Oftentimes, caregivers have to travel to multiple homes on a weekly basis, increasing the likelihood of infection exposure.

Additionally, some caregivers have to simultaneously work for several agencies. Others juggle working for nursing homes to earn an additional income as well, according to Reddy.

“That, of course, increases the risk of bringing the virus into the homes of frail, older adult clients,” she said.

For home health providers, maintaining an infection control protocol is nothing new. Medicare CoPs stipulate that all home health providers must maintain and document an infection control program.

As part of the home health requirements, those programs must include staff education, as well as a system allowing agencies to identify any infectious and communicable disease problems.

In the home care space, where there is less regulatory oversight, these new COVID-19-related risks have forced some providers to come up with infection control plans for the first time.

This is a new reality made more difficult due to home care’s sometimes overlooked role in the larger health care continuum, which typically also means less federal support and fewer resources, according to Reddy.

“Home care needs immediate support from the federal government and policymakers, including testing and personal protective equipment (PPE) for workers,” she said. “Agencies and workers don’t just need guidance from the federal government. They need the actual tests and actual PPE.”

Despite these roadblocks, one home care company has kept infection control top of mind from the onset.

The public health emergency has prompted Roseville, California-based Always Best Care to double down on its efforts to decrease the spread of infections across its expansive franchise network. Currently, Always Best Care operates across 209 territories in 30 states.

When it comes to infection control, the COVID-19 emergency has been a wake-up call for providers across the spectrum, Sheila Davis, senior vice president of area operations at Always Best Care, told HHCN.

“Before COVID-19 really broke out, the non-medical world always dealt in a hypothetical worst-case scenario of things that would happen,” Davis said. “I believe that COVID-19 really woke up not only the non-medical industry, but the entire health care industry as a whole.”

Over the past few months, Davis has seen a larger shift in the home care industry.

“I think [like] we used to take gloves, hand sanitizers, gowns and face masks for granted — feeling like those were needed more in acute health care settings,” she said. “We are actually seeing now that it’s more important in non-acute settings, because that’s where the infection is spread. It’s being spread in the general population.”

For Always Best Care — whose services include personal, veteran’s care and more — COVID-19 has made the company favor a “preventative approach” to infection control over a “reactive approach,” according to Davis.

“I think we didn’t deal with infection control until the incident was already confirmed, and then we went forward to prevent any further exposure,” she said. “What we have to do going forward is to treat infection control in a preventative manner, rather than an after-the-fact [issue].”

So far, Always Best Care has accomplished this by training its staff and armoring caregivers with the appropriate PPE. The most important infection-control measure Always Best Care has focused on is making sure supplies are being used correctly — as the improper use of a face mask, for example, is sometimes the same as having no face mask at all.

“Agencies can no longer make the assumption that employees and caregivers know how to properly use PPE,” Davis said. “In the past, everybody supplied PPE, and we thought they knew how to utilize it. When it comes to preventing the spread of the infection, there is a proper way to don and doff PPE. Many of the caregivers who we thought were proficient in it had no idea about the proper way to decrease the spread of infection.”

As a response to this newfound consciousness in the home care industry, CareAcademy has taken on the task of training providers and caregivers. The company has introduced a number of classes where topics range from infection control and the appropriate use of PPE, to COVID-19, in general.

So far, the company’s free COVID-19 class, released in early March, has generated 80,000 views.

In addition to educating its caregivers, Always Best Care established a company-wide quality assurance and performance improvement plan. This meant taking a step back and building plans based around past performance to better hold itself accountable.

Looking ahead, Davis believes that the home care industry’s focus on infection control will not only promote safety, but create a marketing opportunity as well.

“As a marketing strategy, the community and the public knew that we were making sure that our caregivers were adequately equipped and knowledgeable about everything that was going on, she said. “And that [we focused on] the proper steps that they should be taking.”

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