Iowa home care staff, clients balance COVID-19 vaccine issues
Iowa home care staff, clients balance COVID-19 vaccine issues

Iowa home care staff, clients balance COVID-19 vaccine issues

Nurse Dawn Batie helps Marleen Boots with her coat at Boots’ home in Marion earlier this month. Batie has been an assistant to Boots for about three years and helps provide help with the work in the house as well as providing transportation and camaraderie. (Nick Rohlman / The Gazette)

Nurse Dawn Batie helps Marleen Boots with her coat at Boots’ home in Marion earlier this month. Batie has been an assistant to Boots for about three years and helps provide help with the work in the house as well as providing transportation and camaraderie. (Nick Rohlman / The Gazette)

Marleen Boots in her home in Marion. Boots, 85, needs home care and has been working with home carer Dawn Batie for about three years. (Nick Rohlman / The Gazette)

Caregiver Dawn Batie takes the trash out to her client, Marleen Boots, at Boots’ home in Marion. (Nick Rohlman / The Gazette)

Nurse Dawn Batie helps Marleen Boots with her seat belt at Boots’ home in Marion. (Nick Rohlman / The Gazette)

CEDAR RAPIDS – Dawn Batie has not hesitated to tell people that she is fully vaccinated against COVID-19.

Batie has been a relative at a Cedar Rapids-based home health agency for several years, saying she has been open to all of her clients about her vaccination status since the day she got her shots. She works for Right At Home, a Cedar Rapids-based home care provider that manages care for about 150 patients.

“I do not want to be responsible for making my clients sick,” Batie said. “By protecting myself, I protect them too.”

It’s a fact that Marleen Boots from Marion, who trusts Batie to help her run errands and do some chores in the house, says she’s grateful.

The 85-year-old woman decided to get the vaccine series and booster because of her age and the risk factors that her health conditions pose. She said it was also very important that people around her have their vaccinations updated for the same reasons.

However, for some caregivers and clients, the vaccination status of the other person is unknown. Many home health authorities say that revealing whether their staff has been vaccinated against COVID-19 violates privacy under the HIPAA, Health Insurance Portability and Accountability Act.

The law does not prevent employers from requesting this information from employees, but it does prevent the employer from passing on this private health information to external parties – such as patients.

Alternatively, there is no requirement for clients to share whether they have been shot with the home care staff in their home.

The conversations must take place between the caregiver and the client, as well as the client’s families, said Stephanie Humphries, owner of Right at home and Cedar Rapids.

“If everyone’s on the same page, that’s fine,” she said.

The Covid-19 vaccination rate among the immediate care staff is unclear. Vaccination rates for home care agencies are not reported at either the state or federal level, according to the Iowa Health Care Association, the trade organization that represents home health agencies and other health centers, such as nursing homes.

Instead, individual agencies will have to keep their own records of vaccination data – which they would not be required to disclose.

Furthermore, many domestic helpers nationwide are employed through private, unregulated channels that make it difficult to track.

Federal vaccine mandates – released in November of the Centers for Medicare and Medicaid Services and affirmed by the U.S. Supreme Court last month – is in place for all Medicare and Medicaid certified home health care providers, according to the latest instructions.

Iowa is among the 24 states involved in the Supreme Court case, which has until March 15 for its home health staff to be fully vaccinated. Workers must receive their first shot by Monday, February 14, if they plan to receive one of the two-dose vaccine series.

However, agencies that rely solely on private pay are not subject to federal mandates.

In addition, the vast majority of home health workers – 91 percent -is employed in agencies with fewer than 100 employees, which means they will not be subject to federal vaccine requirements or regular testing at companies with 100 or more employees.

As a result, the exact vaccination rate among this Iowa workforce is unclear, even with mandates coming into effect next month.

And with agency officials unable to reveal vaccination status to staff, some vulnerable patients face the possibility of having an unvaccinated caregiver in their homes.

‘It’s incredibly dangerous for me’

As a result, an immunocompromised resident of Springville has decided to forgo home help for the foreseeable future.

Emily Johnson is a 31-year-old with a type of Ehlers-Danlos syndrome that affects her vascular function, a serious condition that also lowers her immune system. She was also diagnosed with myalgic encephalomyelitis / chronic fatigue syndrome, a condition that occurs in many long-distance covid-19 patients.

Johnson has gone without a helper since she moved to eastern Iowa last October.

“This is just one example of healthcare I have not been able to access due to the pandemic,” she said.

She receives medical supplies from a local health agency, but otherwise handles her own daily infusions and dressing changes in conjunction with the central venous catheter located on her breast. Johnson’s mother, who is a nurse, helps her with her monthly metabolic health labs at home, which are also connected via the breast catheter.

Johnson was hoping to find a local health agency, but said she did not want to risk interacting with an unvaccinated homemaker after previous negative experiences in Atlanta, where she lived last year.

“It’s incredibly dangerous for me,” she said. “Some home health care companies are willing to appoint a vaccinated employee, but some will not let patients ask the nurses if they are vaccinated.”

Right at Home’s Humphries initially experienced more push back early in the pandemic among clients who wanted to be familiar with the information about whether the caregivers in their homes were fully vaccinated. In recent months, as the pandemic reaches the end of its second year in Iowa, Humphries said she has heard less from clients on this issue.

“I do not hear about it from people as it was a few months ago. I think this has been going on long enough for people to figure out how they can best live with it,” she said.

Humphries has urged her staff to receive the COVID-19 vaccines and believes that anyone who is able to do so should be vaccinated. She also said she believes the new coronavirus “will never go away.”

“We just have to adapt and learn to live life as safely as possible,” Humphries said.

But for people like Johnson, who are immunocompromised, it’s hard to feel safe navigating the health care system while the coronavirus remains so prevalent.

“For a person with severe disabilities caused by severe postviral diseases, I can not afford to get COVID-19,” she said.

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