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Geriatric Home Care During the COVID-19 Era
In this episode of Better Edge, Anna Liggett, MD, discusses geriatric home care and how the practice has made a resurgence during the COVID-19 era.
Featured Speaker:
Anna Liggett, MD
Anna Liggett, MD, is an assistant professor of Medicine in the Division of Internal Medicine and Geriatrics. Liggett earned her MD from Ross University in 2015 and completed her residency in family medicine at United Health Services, Upstate Medical University in 2019 before joining as geriatric medicine fellow at McGaw Medical Center of Northwestern University. Her clinical work focuses on home care and using integrative medicine to treat older adults. Her academic focus is on using data to improve post-acute care outcomes and improve efficiency in long-term care facilities. Transcription:
Geriatric Home Care During the COVID-19 Era
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I’m Melanie Cole and today, we’re discussing geriatric home care and how the practice has evolved during COVID-19. Joining me is Dr. Anna Liggett. She’s an Assistant Professor of Geriatrics and a new member of the Northwestern Medicine Geriatrics Team. Dr. Liggett, welcome to the show. I’m so glad to have you join us today. Start by telling us a little bit about yourself and your role in the Division of Geriatrics and how you came to Northwestern Medicine.
Anna Liggett, MD (Guest): I just recently finished the Geriatrics Fellowship at Northwestern and transitioned to faculty member on July 1st. My role is going to be about expanding geriatrics, our geriatrics group up north. So, I’ll have a clinic in Deerfield and working with some long term facility places associated with Lake Forest Hospital such as Lake Forest Place. I’ll also have clinics at the downtown campus. Before I came to Northwestern, I did a Family Medicine residency at SUNY Upstate Medical Center in Binghamton, New York. There, I had the opportunity to practice some integrative medicine where I got certified in Medical Acupuncture and Osteopathic Recognition which I hope to help treat older adults.
Before that, I went to Ross University and before that, I grew up in Connecticut.
Host: Well thank you for that. That is great that you’re an integrative medicine for senior citizens. That’s just an amazing part of your field. So, tell us how home care for geriatric patients has changed since the onset of the COVID-19 pandemic.
Dr. Liggett: At first, it was put on hold a little bit while we were getting everything sorted out but home care has turned out to be vital during this pandemic to decrease the exposure of adults having to come down to an inpatient visit especially if they are currently sick of if they haven’t been seen before and can’t partake in Telemedicine or they can partake in Telemedicine, it’s just difficult to see a patient for the first time via Telemedicine. So, it’s a great opportunity to visit a patient in need for the first time, rather than having to do it all over the phone.
Host: It is so interesting how healthcare providers across the board have really had to think outside the box and get creative in the healthcare setting now in these unprecedented times. So, give us a little bit of a profile of the patients you see for home visits Dr. Liggett and why it’s so important for them to continue that home care, this continuum of care that’s so important versus being seen in the clinic setting.
Dr. Liggett: Right, so, there definitely is typical home care patients. They are usually due to physical limitations or mental cognition problems with end stage dementia that it makes it way more difficult and less beneficial to come down to the clinic as opposed to a home care visit. So, it’s not for every patient. If a patient can go about their regular day and make it to the grocery store and make it to other appointments easily; then they should be seen in the clinic. But there is a certain patient who it would require an ambulance to come to a primary care visit or with the severe dementia, they would need a family member to take off work and really struggle to get them in for a primary care visit. Those patients can really benefit from a home care visit. And also, even if a patient is acutely sick but not quite sick enough to go to the emergency room or risk COVID exposure in an Urgent Care; we can do a home visit and address their minor illness at that time and skip the in-person visit for them at that time.
Host: So, as you are doing these home visits, Dr. Liggett, what precautions are you taking to limit exposure for yourself and your patients during these visits? Some of them have outside caregivers or family members living there. Tell us how you are taking these precautions.
Dr. Liggett: Right. So, we are wearing medical masks from the start of the visit. We are sanitizing our hands with Purell or alcohol sanitizer before we even enter the home and throughout the visit and at the end of the visit. We are sanitizing any equipment we use during the visit like our stethoscopes, or our thermometers or pulse oximetry. We’re also vigilant in practicing social distancing throughout our lives to decrease the exposure to ourselves and therefore decreasing the chance of transmission to our patients when we are entering their home.
Host: As far as long term care facilities, they’ve seen some of the highest mortality rates during this pandemic Dr. Liggett. Based on this information, do you think home care could play a larger role in geriatric care in the future as we’re growing older as a nation and there are so many more? What do you see happening in the future?
Dr. Liggett: Yeah, that’s interesting. It’s hard to say about the future but even with the pandemic, we’ve seen some patients be taken out of the long term facilities because their families were scared about the visitor restrictions or they were just scared that the COVID virus would enter their facility. Unfortunately, it’s not always an option for every patient. If the patient requires so much extra support that more than the family can give without causing increased caregiver burden; sometimes it is safer option for the patient to be in along term facility where they can receive all the support that they need. But home care can bridge that gap for the patient who can get enough support at home and aren’t really isn’t easy for them to make it into a clinic visit. And that’s where home care can really come in and fill that gap.
Host: It certainly can and what aspects of the current COVID-19 situation, rapid on demand testing, access to PPE, symptom checking apps. What current aspects of this do you think need to change to make this successful as this plays the larger role of geriatric care in the future?
Dr. Liggett: It will be imperative to have rapid and frequent onsite testing to identify anyone who might have the virus but may be asymptomatic and unknowingly spread it. And not just to the patients already in the facility but all of the staff and employees from the kitchen to cleaning staff that are in the facilities on a daily basis. Rapid and frequent testing is very necessary and also just the adequate PPE to change it in between patients who might appear to have exposure but aren’t testing positive. It would be nice to have enough PPE to decrease their risk of exposure and not have to reuse any PPE.
Host: Well thank you for that and as we talk about geriatric care, Dr. Liggett, protecting mental health, such a major concern for seniors, especially during this pandemic. I have a 96 year old father and I know he’s feeling depressed, stuck in an assisted living. How does home care help protect mental health and can you share some of the unique approaches your team has implemented to help seniors that are feeling fearful, lonely, depressed at this time.
Dr. Liggett: Yes, it is a difficult time right now especially for mental health and our seniors who are getting further isolated with the COVID pandemic and it has created a lot of innovative ways. Our group utilize the use of medical students and Dr. Lindquist had a recent study reducing social isolation of seniors during the COVID-19 through medical student telephone contact where medical students mostly first year would reach out to senior and talk to them about home they were feeling and explaining the current status of the pandemic and it turned out to be really quite beneficial not only to the med students but to the seniors breaking up the isolation that had been imposed on them for their safety but also was impacting their mental health.
Also, it’s forced us to use virtual platforms such as Zoom and helping seniors get on Zoom so they can see their loved ones and medical providers through at least a video screen which helped break up the isolation. Home care visits, we were still allowed to go into the facilities and see those patients who are in assisted living or in the skilled nursing facility which breaks up that isolation. So, it is very needed, more than ever to help combat the isolation that seniors are feeling with all the restrictions.
Host: Well it certainly is so, as we wrap up and I’m so glad you joined us today because what a great topic as we admire and respect our seniors and they’re going through a tough time right now. What advice do you have for your colleagues at other institutions about geriatric home care amid this unprecedented pandemic?
Dr. Liggett: Right, I would just recommend to remain flexible and still trying to look for innovative ways to get through to our patients and this COVID pandemic has also forced us to embrace some positive changes. Now Telemedicine is at the forefront of how we practice and hopefully that’s hear to stay because that was even needed before the pandemic just for quick visits or quick issues that could be addressed, but they weren’t reimbursed properly before the pandemic. We’ve been force to use Telemedicine, hopefully that platform is actually here to stay. And that now that a light has been shown on how valuable home care visits are, hopefully that practice will be able to grow because it was very valuable now and there’s always been a need for home care visits that medicine has kind of gotten away from is now coming back unfortunately because of a pandemic. But at least, there can be positive changes that come about the situation.
Host: Well I couldn’t agree more and thank you so much for joining us today and sharing your expertise. That wraps ups this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on COVID-19, please visit our website at www.nm.org to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I’m Melanie Cole.
Geriatric Home Care During the COVID-19 Era
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I’m Melanie Cole and today, we’re discussing geriatric home care and how the practice has evolved during COVID-19. Joining me is Dr. Anna Liggett. She’s an Assistant Professor of Geriatrics and a new member of the Northwestern Medicine Geriatrics Team. Dr. Liggett, welcome to the show. I’m so glad to have you join us today. Start by telling us a little bit about yourself and your role in the Division of Geriatrics and how you came to Northwestern Medicine.
Anna Liggett, MD (Guest): I just recently finished the Geriatrics Fellowship at Northwestern and transitioned to faculty member on July 1st. My role is going to be about expanding geriatrics, our geriatrics group up north. So, I’ll have a clinic in Deerfield and working with some long term facility places associated with Lake Forest Hospital such as Lake Forest Place. I’ll also have clinics at the downtown campus. Before I came to Northwestern, I did a Family Medicine residency at SUNY Upstate Medical Center in Binghamton, New York. There, I had the opportunity to practice some integrative medicine where I got certified in Medical Acupuncture and Osteopathic Recognition which I hope to help treat older adults.
Before that, I went to Ross University and before that, I grew up in Connecticut.
Host: Well thank you for that. That is great that you’re an integrative medicine for senior citizens. That’s just an amazing part of your field. So, tell us how home care for geriatric patients has changed since the onset of the COVID-19 pandemic.
Dr. Liggett: At first, it was put on hold a little bit while we were getting everything sorted out but home care has turned out to be vital during this pandemic to decrease the exposure of adults having to come down to an inpatient visit especially if they are currently sick of if they haven’t been seen before and can’t partake in Telemedicine or they can partake in Telemedicine, it’s just difficult to see a patient for the first time via Telemedicine. So, it’s a great opportunity to visit a patient in need for the first time, rather than having to do it all over the phone.
Host: It is so interesting how healthcare providers across the board have really had to think outside the box and get creative in the healthcare setting now in these unprecedented times. So, give us a little bit of a profile of the patients you see for home visits Dr. Liggett and why it’s so important for them to continue that home care, this continuum of care that’s so important versus being seen in the clinic setting.
Dr. Liggett: Right, so, there definitely is typical home care patients. They are usually due to physical limitations or mental cognition problems with end stage dementia that it makes it way more difficult and less beneficial to come down to the clinic as opposed to a home care visit. So, it’s not for every patient. If a patient can go about their regular day and make it to the grocery store and make it to other appointments easily; then they should be seen in the clinic. But there is a certain patient who it would require an ambulance to come to a primary care visit or with the severe dementia, they would need a family member to take off work and really struggle to get them in for a primary care visit. Those patients can really benefit from a home care visit. And also, even if a patient is acutely sick but not quite sick enough to go to the emergency room or risk COVID exposure in an Urgent Care; we can do a home visit and address their minor illness at that time and skip the in-person visit for them at that time.
Host: So, as you are doing these home visits, Dr. Liggett, what precautions are you taking to limit exposure for yourself and your patients during these visits? Some of them have outside caregivers or family members living there. Tell us how you are taking these precautions.
Dr. Liggett: Right. So, we are wearing medical masks from the start of the visit. We are sanitizing our hands with Purell or alcohol sanitizer before we even enter the home and throughout the visit and at the end of the visit. We are sanitizing any equipment we use during the visit like our stethoscopes, or our thermometers or pulse oximetry. We’re also vigilant in practicing social distancing throughout our lives to decrease the exposure to ourselves and therefore decreasing the chance of transmission to our patients when we are entering their home.
Host: As far as long term care facilities, they’ve seen some of the highest mortality rates during this pandemic Dr. Liggett. Based on this information, do you think home care could play a larger role in geriatric care in the future as we’re growing older as a nation and there are so many more? What do you see happening in the future?
Dr. Liggett: Yeah, that’s interesting. It’s hard to say about the future but even with the pandemic, we’ve seen some patients be taken out of the long term facilities because their families were scared about the visitor restrictions or they were just scared that the COVID virus would enter their facility. Unfortunately, it’s not always an option for every patient. If the patient requires so much extra support that more than the family can give without causing increased caregiver burden; sometimes it is safer option for the patient to be in along term facility where they can receive all the support that they need. But home care can bridge that gap for the patient who can get enough support at home and aren’t really isn’t easy for them to make it into a clinic visit. And that’s where home care can really come in and fill that gap.
Host: It certainly can and what aspects of the current COVID-19 situation, rapid on demand testing, access to PPE, symptom checking apps. What current aspects of this do you think need to change to make this successful as this plays the larger role of geriatric care in the future?
Dr. Liggett: It will be imperative to have rapid and frequent onsite testing to identify anyone who might have the virus but may be asymptomatic and unknowingly spread it. And not just to the patients already in the facility but all of the staff and employees from the kitchen to cleaning staff that are in the facilities on a daily basis. Rapid and frequent testing is very necessary and also just the adequate PPE to change it in between patients who might appear to have exposure but aren’t testing positive. It would be nice to have enough PPE to decrease their risk of exposure and not have to reuse any PPE.
Host: Well thank you for that and as we talk about geriatric care, Dr. Liggett, protecting mental health, such a major concern for seniors, especially during this pandemic. I have a 96 year old father and I know he’s feeling depressed, stuck in an assisted living. How does home care help protect mental health and can you share some of the unique approaches your team has implemented to help seniors that are feeling fearful, lonely, depressed at this time.
Dr. Liggett: Yes, it is a difficult time right now especially for mental health and our seniors who are getting further isolated with the COVID pandemic and it has created a lot of innovative ways. Our group utilize the use of medical students and Dr. Lindquist had a recent study reducing social isolation of seniors during the COVID-19 through medical student telephone contact where medical students mostly first year would reach out to senior and talk to them about home they were feeling and explaining the current status of the pandemic and it turned out to be really quite beneficial not only to the med students but to the seniors breaking up the isolation that had been imposed on them for their safety but also was impacting their mental health.
Also, it’s forced us to use virtual platforms such as Zoom and helping seniors get on Zoom so they can see their loved ones and medical providers through at least a video screen which helped break up the isolation. Home care visits, we were still allowed to go into the facilities and see those patients who are in assisted living or in the skilled nursing facility which breaks up that isolation. So, it is very needed, more than ever to help combat the isolation that seniors are feeling with all the restrictions.
Host: Well it certainly is so, as we wrap up and I’m so glad you joined us today because what a great topic as we admire and respect our seniors and they’re going through a tough time right now. What advice do you have for your colleagues at other institutions about geriatric home care amid this unprecedented pandemic?
Dr. Liggett: Right, I would just recommend to remain flexible and still trying to look for innovative ways to get through to our patients and this COVID pandemic has also forced us to embrace some positive changes. Now Telemedicine is at the forefront of how we practice and hopefully that’s hear to stay because that was even needed before the pandemic just for quick visits or quick issues that could be addressed, but they weren’t reimbursed properly before the pandemic. We’ve been force to use Telemedicine, hopefully that platform is actually here to stay. And that now that a light has been shown on how valuable home care visits are, hopefully that practice will be able to grow because it was very valuable now and there’s always been a need for home care visits that medicine has kind of gotten away from is now coming back unfortunately because of a pandemic. But at least, there can be positive changes that come about the situation.
Host: Well I couldn’t agree more and thank you so much for joining us today and sharing your expertise. That wraps ups this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on COVID-19, please visit our website at www.nm.org to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I’m Melanie Cole.