COVID-19 visiting nurses home care: ‘Extremely rewarding … and extremely scary’

They thought they were prepared. 

After all, they have spent their careers walking into strangers’ homes, helping them recover from illnesses, easing their pain as they die, comforting family members.

But now nurses from the Holmdel-based Visiting Nurse Association Health Group ride to homes in teams of two. They dress head to toe in protective gear. And they stand at the bedside, holding smartphones and tablets so that coronavirus patients, some of whom are near death, can talk and listen to loved ones who can’t visit them because of the quarantine restrictions.

“That’s one of the hardest parts,” said nurse Stephanie Finn, 33, of Hillsborough. “You want to be at the bedside of your loved one when they are passing, and you can’t, which makes it really difficult.”

Finn is part of an eight-person coronavirus team for the Visiting Nurse Association Health Group, a  organization that provides home health and hospice care.

The organization in recent years has been filling a key role in New Jersey’s health care system by helping patients recover at home and keeping them out of the more expensive emergency rooms and hospitals.

But now they are sliding into a new mission: help hospitals free up beds for patients battling the coronavirus.

It has left the staff trying to pick up new skills on the fly, setting aside their own fears.

Finn has teamed up with Florence Maffeu, 37, of New Providence, and they have much in common. They both have embraced a career that places them front-and-center with patients and families coping with death, choosing the field after living through similar circumstances with their own family members.

Even before the coronavirus pandemic, the job could be emotionally taxing. Now, they carefully coordinate visits as a team, sounding more like cops on the beat trying to protect each other.

Maffeu puts on a gown, an N95 respirator, booties and gloves. Finn checks to make sure it all fits. Maffeu heads inside. Finn waits in the car. They communicate with each other throughout the visit. And they said they have an ample supply of personal protective equipment.

Last week, they said, they saw eight to 10 patients who were suspected of having COVID-19. Maffeu monitors nonhospice patients’ health to decide whether they should be hospitalized. And she tries to keep hospice patients comfortable.

More difficult, they said, is helping family members who are separated from the patients. They’ve tried to bridge the gap with technology, urging family members of hospice patients in particular to continue talking since hearing is one of the last senses to go.

“That’s one of the hardest parts,” Finn said. “You want to be at the bedside of your loved one when they are passing, and you can’t, which makes it really difficult.”

They’ve made sacrifices of their own. Brooke Savino, 38, of Kenilworth, a registered nurse with the VNA, said she placed her 18-month-old daughter with her parents out of caution and has only seen her the past three weeks using FaceTime.

“I miss her so much, but I know it’s the right thing to do,” Savino said. “This has been extremely rewarding and extremely trying and extremely scary.”

Savino and her nursing partner Leo Cayanong lean on one other for support. He’s worried about the safety of his own elderly parents, who have underlying health issues.

“Mentally and emotionally, we’re exhausted,” Cayanong said of the toll on the COVID team.

“But you know, we’re still here,” he added. “At the end of the day, I’m out here for them (his patients) to ensure that they remain safe and the community remains safe.”

The VNA Health Group has 3,300 employees and provides care in New Jersey, Ohio and Florida to patients, many of whom are in their 80s and 90s and have trouble with basic daily tasks.

In the age of the Affordable Care Act, it has offered a timely service. Hospitals have been under pressure to improve quality and reduce costs. Medicare, for example, penalizes them when their patients return within a month of first being discharged.

The new law put a spotlight on home health care.

“There’s been a real focus now to deliver health care closer to where they live,” said Belinda Anderson, director of The Institute for Health and Wellness at Monmouth University in West Long Branch.

With coronavirus swamping the health care system, home health care agencies are getting help from Congress. The recently passed CARES Act effectively increased the reimbursement rate from Medicare and allowed physician assistants and nurse practitioners to order home health care. Previously, only doctors could order the service.

Still, Medicare doesn’t cover patients who need around-the-clock care, meals or personal care, whether it is shopping or getting dressed if they are otherwise healthy. 

And the VNA has been uniquely challenged by the coronavirus.

For example, patients needing hip and knee replacements, representing 20% to 30% of the VNA’s business, are postponing their surgeries, Dr. Steven Landers, president and chief executive officer, said. The organization is relying more heavily on fundraising.

Meanwhile, its staff is being trained to care for a new, potentially deadly, disease. They’ve learned about infection control, wearing the proper equipment and limiting the number of times they touch the patient.

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One social worker told Landers about a daughter who was promised her terminally ill mother would wear a special dress at her viewing. Now, there won’t be a viewing.

“It’s another example of the human tragedy, and people aren’t even able to stay goodbye in some instances the way they want to and wish to to their closest loved ones,” Landers said.

“It’s a time of a lot of sadness and despair, but you see people step up and have the courage and energy to help people right now. That’s very inspiring. We’re definitely seeing the best in people.”

Not that these frontline health care providers don’t second-guess themselves.

Said Savino: “I don’t sleep that well because every time I cough, I think I’m sick.”

Maffeu said she had to decide whether it was worth putting her own health at risk, knowing she had a 13-year-old daughter and 11-year-old son at home.

“At the beginning was really tough,” she said. “I had to quickly decide whether I wanted to continue to work with fear or go by faith.”

“It kind of made us sit here and evaluate why we do what we do,” Finn said. “That is ultimately why we got into this role. Our role is to be here for the patient and each other and to be together.”

This article first appeared on app.com.