Joan Murray had been at home with Covid-19 for about a week when she had problems. She had a 103-degree fever and chills that sent chills down her spine. Her oxygen levels were dropping, and the tightness in her chest felt “like someone had tied my lungs with a rope.”
But the 77-year-old registered nurse who lives alone in Westbury, New York, insisted she wanted to fight the disease at home. “As a nurse, maybe I knew too much,” she said. “The last place I wanted to be was the hospital.”
Then the hospital came to her.
Northwell Health, which has cared for thousands of coronavirus patients in its network of facilities in New York State, sent a nursing manager to Ms. Murray’s home in May. Covered from head to toe with protective gear: gown, gloves, mask, shield, and disposable booties, she spent nearly eight hours doing an assessment.
Mrs. Murray was dehydrated and needed supplemental oxygen. Within hours, she was connected to an IV line, installed in her room to replenish her fluids. A phlebotomist wearing an N95 mask came to draw blood, an oxygen machine was delivered to her home, and Mrs. Murray was prescribed a powerful anticoagulant to prevent clots.
Over the course of the next week, nurses came in every day, and a Northwell Critical Care Physician and Lung Specialist, Dr. Gita Lisker, called daily to speak to Mrs. Murray.
“I was always waiting for her call, I would tell her all my problems and she would reassure me,” Murray said. “She was like a girl at the time, and she was my security blanket.”
So-called comprehensive home care services were created, on the fly, by Northwell Health to cope with the surge in coronavirus cases that New York experienced this spring. Now, this model can help alleviate health systems in the Sun Belt and other parts of the United States, where increasing numbers of cases put extraordinary pressure on hospitals, fill intensive care units, and send providers to hire additional nurses and obtain medical supplies.
Northwell doctors are already discussing the program with doctors in Miami, where several hospitals have reached capacity. Florida has more than 300,000 Covid-19 cases, and more than 10,000 new cases were identified Thursday.
The concept of home hospital programs is not new, but they have been used primarily to treat patients with outbreaks of chronic conditions such as heart failure.
In response to the coronavirus epidemic, Medicare relaxed the requirements for such care. Patients are now considered homebound if a doctor advises them not to leave home due to a confirmed or suspected Covid-19 diagnosis or a condition that makes them more susceptible to contracting the virus.
In those situations, if a doctor says specialized services are needed, a home health agency can provide them under the Medicare home health benefit, authorities said.
Since the start of the pandemic, some hospitals have switched to home services to open hospital beds for Covid-19 patients or to provide follow-up care after Covid-19 patients are discharged from the hospital.
Northwell’s scope is different because it focuses on seriously ill Covid-19 patients in the community. A team of Northwell specialists uses telehealth to advise doctors and patients in the community with mild or moderate illnesses.
When necessary, a comprehensive health service sends nurses and teams to the homes of patients with severe symptoms or underlying medical conditions who may need hospitalization without such tight control. Pulmonologists use telemedicine to follow these patients.
During the New York crisis, “80 to 90 percent of patients with the virus never went to the hospital,” said Dr. Thomas McGinn, senior vice president and deputy chief medical officer for Northwell, who helped create the program.
Many Covid-19 patients did not need to be hospitalized, while others, including some who would have been admitted, simply refused to go, saying, “Hospitals were becoming this place that scared everyone.”
With the paucity of diagnostic tests, many sick patients feared that if they did not yet have the virus, they would spread it in the hospital. And they were discouraged to learn that they would be separated from friends and family, because visitors had been excluded from health centers to prevent further spread of the virus.
At first, doctors were nervous about managing patients at home, Dr. McGinn and Dr. Lisker said. Since then, experts have learned a great deal and developed evidence-based protocols that are based on educating patients on how to monitor their temperature fluctuations, track their blood oxygen levels using pulse oximeters, and report changes to your healthcare providers.
Pulmonologists, experienced in caring for very ill patients with lung disease, consulted with patients by phone, Dr. Lisker said.
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“I can have a phone conversation with a patient, and after the first two sentences, I can tell if they are going to have respiratory problems,” he said. “We are trained to listen.”
Any patient with respiratory distress would be hospitalized, he added. But most of the patients were able to cope with their illnesses at home.
Between April 27 and June 1, Northwell enrolled 182 patients in its home care program. They ranged in age from 24 to 100, and many had underlying chronic conditions such as diabetes or obesity, which have been linked to worse outcomes in Covid-19 cases.
Several, like Mrs. Murray, were older and lived alone. But they had been carefully checked by their regular doctors; only two eventually needed hospitalization, Dr. Lisker said.
The program also provides care to patients with Covid-19 who have been discharged from the hospital but have persistent symptoms that require attention. Other hospital systems, such as the Mount Sinai Health System in New York, have also created post-discharge programs that provide care in various specialties to patients with Covid-19 and assess the long-term effects of the disease.
Ms. Murray, who recovered from her illness, said it was “fortuitous” that the hospital team had intervened when she did so, because her condition was deteriorating. “I don’t know what I would have done differently,” he said.
Northwell is now expanding the program, in preparation for a possible spike in cases in New York. “If there is a resurgence in New York, in penny we can get this up and running in large numbers, and other cities can do this, too,” said Dr. Lisker. “It is a victory for the patient and a victory for the health system.”
