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curiousKC: Is COVID Testing Made Available to Those Who Are Homebound? Here’s What a Social Worker, Home Health Providers and Clinical Directors Had to Say.

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Above image credit: When it comes to testing for COVID-19, are home-bound patients left out? (Adobe)
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4 minute read

Getting tested for COVID-19 has become more accessible in the past several weeks, but what about people who are medically homebound

By definition, being homebound means people who rely on supportive devices such as crutches and are unable to leave home without a taxing effort, according to U.S. Centers for Medicare and Medicaid Services

For people who can leave their homes, there are plenty of drive-through testing sites that have popped up. For instance, on the Missouri side, folks can get tested at St. Luke’s Hospital Clinics, Truman Medical Centers and Samuel U. Rodgers Health Center. And on the Kansas side, testing is available at the Wyandotte County Health Clinic, St. Luke’s Hospital-Mission Farms, Sharon Lee Family Health Care center and Swope Health Services. 

But, wrote, one anonymous curiousKC asker, why isn’t there in-home testing? “It’s needed,” they added.    

“The answer to your question … is simply not enough tests,” said Megh Chakrabarti, a medical social worker, disability and community health advocate in Kansas City. “But (home health providers) go to people’s houses for (sexually transmitted infections) for folks who have been exposed so there is a precedent for it.”

She spends her downtime compiling lists of information, such as testing sites, multilingual pamphlets and other resources, especially these days. Chakrabarti says it took her weeks to find and curate the information she shared with us, but it aligns with her motto of community care versus individual care. As a social worker, she refers patients to home health providers in the area. 

For homebound patients, the main risk is being reliant on and in constant contact with family, friends or nurses who have been around people or are infected with the virus. 

So, the precedent to test at someone’s home is there, but do they do it? To understand how various health centers and counties work with homebound patients, we spoke with social worker Chakrabarti, who works directly with patients to navigate the health care system. We also spoke with the Visiting Nurses Association of Kansas City, Johnson County Health Department and Unified Government Department of Health. Interviews have been edited for clarity. 

Here’s what each had to say: 

Megh Chakrabarti, medical social worker:

“The home health (HH) model is a strange one, actually,” she wrote in an email. Here are the key points she made: 

  • “So home health doesn’t have its own physician. It has a medical director, but not it’s own physician.
  • So usually they ask, ‘Who is the doctor that’s going to follow?’ And it’s usually the primary care physician, or sometimes in the case of patients who don’t have a primary care or regular care, sometimes the hospitalist who saw them in the hospital will see them. But they don’t like that. 
  • Why don’t they like that? Oh, because then they have to follow the labs that come back, try to get the patient back into the clinic if the labs are weird, or meds need to be changed, etc. So, they avoid it, and appropriately so. A hospitalist who doesn’t have a clinic or isn’t in the clinic often really isn’t the right fit for a HH patient.” 

Here’s what she said about testing for COVID-19 at home:

  • “They’re a secondary provider. They get patients from the hospital, who have already tested positive for COVID-19 (for which they have COVID-19 home health units and staff who only see those patients) or who didn’t have it/aren’t at risk.
  • So, if they had a patient who was suddenly a risk, or was showing signs, they would a) stop services because now their non-COVID-19 (home-health) staff might be exposed and b) tell them to call one of the testing sites, or call their primary care physician – or the registered nurse might call the primary care physician – to see what to do.
  • There is no cure for COVID-19 or treatment, so unless they need lifesaving or comforting measures… there’s nothing to do. They’ll stop the (home healthcare) and they can go into the hospitals to get care.
  • But aren’t home health patients required to be homebound? Yes and no. They are but medical appointments, trips to the pharmacy and grocery don’t count, and that’s only a rule for Medicare patients. So, they could go to a testing site.”

Connie Grisham, clinical director, Visiting Nurses Association of Kansas City:

“We haven’t run across a patient that’s unable to get out of their home. That’s our experience so far, but that’s not saying we won’t have to regroup. At this point (in-home testing) has not been asked of us, but we have the capacity.”

Grisham said they are able to send nurses to the patients’ homes, however, should the moment arise it would be a learning curve. She adds that the association is currently putting its policy on such testing together.

Dr. Sanmi Areola, director, Johnson County Health Department:

“The agencies that medically support the homebound person should have the capability to test for COVID-19, just like they would test for other viruses and diseases. By the definition of homebound, those persons have less of a chance of contracting COVID-19, unless it is introduced into the home by a worker or family member. 

It would be best to limit the number of people coming into the home and for those that do, consistently wear proper personal protective equipment (PPE) to protect the home-bound person.”

Jill Friesen, public information officer, Unified Government Department of Health

“At-home testing is something that has not been widely available so far, in part because of limited testing resources so far, but also because we needed more evidence confirming effectiveness of self-administered at-home tests. There are some recent studies that show promising results for at-home saliva tests. 

Our medical officers are in some internal discussions about this right now, and have reached out to a local lab we work with to see what is possible moving forward for Wyandotte County.

This is all still in the works, so we won’t have much more info on the topic of at-home testing until after discussions with the local lab.”

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