With life reshaped in countless ways by the invisible pathogen COVID-19, Ridgefield-based RVNAhealth continues providing needed services but in a more complicated and difficult medical environment.

“About 4 percent of our home health patients have COVID-19 and 37 percent of our hospice patients have COVID-19,” Keri Linardi, chief clinical officer at RVNAhealth, said.

“We’re still seeing sick patients like cardiac patients and respiratory patients, patients who have strokes. All of those kinds of patients that we see in home health, we’re still seeing those,” Linardi said. “Cancer patients, Parkinson’s patients who need therapy at home, we’re still seeing all of those patients.”

Many of RVNAhealth’s traditional patients are people who were hospitalized for various conditions, and then released to home care. Some aspects of this has declined— there’s been a cutback in elective surgery during the COVID-19 crisis, and with social distancing and people staying home there are fewer mishaps that lead to injury.

But hospitals grappling with the COVID-19 situation are moving the people with other medical conditions out faster— so their need for services when they get home is often greater.

“They’re trying to get them in and out of the hospital quickly, so they are coming home sicker,” Linardi said.

“Right now, we have about 450 patients on service,” she said.

“With frail patients, our goal is to keep them out of the hospital system for as long as we can,” she said. “That’s how we’re trying to support the hospital system right now.

In her role as chief clinical officer, Linardi oversees all of RVNAhealth’s clinical service lines — home health, hospice, rehabilitation, and community health — as well as the quality assurance and performance improvement teams.

Working under RVNAhealth president and CEO, Theresa Santoro, Linardi and the organization’s clinical leadership have about 110 workers on the RVNAhealth clinical team, including 43 nurses, 32 therapists, 13 home health aides, three social workers, two pastoral care workers, two medical directors, and one music therapist. The clinical leaders and administrative staff number 14.

Managing PPE

All staff who have to deal with COVID-19 patients need personal protective equipment or “PPE” — facemasks, respirators, gloves, gowns, eye protection.

“It’s something we look at every single day. We have been planning since January for PPE, knowing COVID-19 was coming,” Linardi said. “It is a full time job for our Community Health and Wellness people — they are managing our PPE,” she said.

“The cost of PPE for us has been astronomical, with the skyrocketing cost of buying N95 masks and gowns and hand sanitizer,” she said.

As the COVID-19 crisis was beginning to really hit Connecticut, RVNAhealth spent $40,000 on PPE over the last two weeks of March.

“The cost has skyrocketed on all the PPE we’ve been purchasing,” Linardi said. “A surgical mask which would have cost us 60 cents is now at least $3. The mark-up on this is just unbelievable.”

At the height of demand a full set of PPE to care for a COVID-19 patient — including the “attire” worn by the health care worker and a disposable blood pressure cuff, stethoscope and thermometer — would cost about $65. Although not every patient visit requires a full $65 set of PPE, whatever is used cannot be used again.

So RVNAhealth is grateful for the donations of PPE that have come in.

“Ten masks here, 100 masks here, they’ve all been donated, they all add up,” she said, “...donated by doctor’s offices, community members, by the Rotary.

“We’ve been very fortunate with the donations we are receiving,” Linardi said.

COVID in workforce

According to the RVNAhealth, “a very small handful of our 250-plus team members have become infected with COVID-19” since the outbreak began in Connecticut more than a month ago.

“From the very beginning,” RVNAhealth said, “we have followed strict protocols, including: immediate removal from the workforce and mandatory quarantine — as soon as symptoms appear or concern is escalated; COVID-19 testing through the individuals’ physician; tracking of all potential patient and staff exposures; direct communication to any at-risk patients and staff members; ongoing monitoring of health status.”

An eventual return to the workforce is governed by CDC healthcare provider guidelines, RVNAhealth said.

All RVNAhealth clinicians monitor and must report their temperature twice daily, follow strict hand hygiene and social distancing, and have been wearing PPE since before CDC mandates, the organization said.

“Symptoms and any concerns of exposure are responded to immediately with removal from the workforce and either quarantine or testing,” RVNAhealth said.

Social aspect

The COVID-19 crisis has changed the work not only for staff who deal with physical needs or patients, but those looking after the social, psychological, emotional and even everyday practical needs of patients and their families.

“One of the things we’ve seen change since the COVID-19 crisis, our home health team, we’ve sort of focused some on social work with the social determinants of health: Does our elderly population have a way to get food? How are they getting their medications? Do they have family around so they can get some of the simple things they need?” Linardi said.

Social distancing required to protect elderly patients has also left them with a lot of needs that family may no longer be able to take care of.

“Maybe family can’t come and visit and do the things that they used to do,” Linardi said.

So RVNAhealth fills in.

“Whether it’s having things delivered to them, or accessing things through our pantry, making sure they’re getting food. Setting up mail-order medications for them,” Linardi said. “Making sure those links are in place.

“They might be small, but they make a huge difference in people’s health.,” she said.

RVNAhealth’s workers may also help isolated patients connect with family members through social media.

“They try to do little things they can to try to brighten patients’ days,” Linardi said.

“It’s definitely changed how we provide care in so many small ways.

Tough on staff

It hasn’t been easy for the workers.

“I think it’s definitely tougher on the staff, because you’re used to sort of a flow of patients coming through and what this has done is there’s a higher number of patients coming through at at a much quicker pace, and so it’s just kind of going 100 miles per hour all the time and right now, there doesn’t seem to be an end of in sight and that piece of it is harder on the staff,” Linardi said.

“You’re putting on the PPE and going in to treat people with COVID-19,” she said. “You’re going in as a health care worker, but in the back of your mind you have family you’re going home to. All of that adds onto some of the stress that staff feel.

“It’s never easy to keep seeing patients who are suffering — and with this disease there are patients who are suffering,” she said.

RVNAhealth’s staff has pulled together in the crisis, Linardi said.

“I think it’s been interesting since this happened to see how willing the staff here have been to just kind of step in and say: ‘We’re going to take care of everybody.’ Just the willingness has been really great to see,” she said.

“It’s been great to see the teamwork and everybody roll their sleeves up and support the doctors and hospitals and help the patients we can…

“COVID-19 is challenging, it’s been because of the volume of patients coming all at once. One of the things it has brought is the sense of community … working together to do what’s best for the patients,” Linardi said, “I think sometimes crisis does that.”