Home care for people recovering from Covid

Being discharged from hospital and returning home after recovering from Covid is undoubtedly a relief.

Although most people will make a full recovery, the nature of the virus means that some may experience lingering effects.

This can include long-term damage to the heart and lungs, difficulty swallowing, weakness and fatigue. In addition, skin damage, confusion and, importantly, mental health problems are also known to affect a person recovering from Covid.

In light of this, the Social Care Institute for Excellence (SCIE) has developed guidance for the Department of Health and Social Care (DHSC) to help home care workers across the UK provide the best possible care.

The guidance has been developed to help care workers and personal assistants to understand what to expect, look out for and do when they visit and provide support to a person recovering from Covid.

It also informs those who are recovering from coronavirus of the possible long-term health implications and how they may receive treatment.

The guidance outlines various ways a person’s overall health and wellbeing can be affected and what treatments and/or devices are available to supporting their full recovery.

The guidance is in addition to the infection control and PPE guidance already in place.

How will recovering Covid patients be cared for at home?

If you are a recovering Covid patient who have returned home, you will first be assessed to find out what your specific needs are to create a tailored care and support plan.

Depending on the physical, psychological and social impact the virus has had on you, you will be cared for accordingly.

For example, some people may experience difficulties with breathing which means that they have to follow an exercise routine set by a lung rehabilitation specialist to help recovery. 

Personalised care plans following discharge from hospital

A patient discharged from hospital will be assessed by Community health care services (CHS) and social care professionals to create a personalised care and support plan.

The plan outlines the outcomes, the ongoing care and support the person needs, including home care support, and how it should be carried out.

Some may have difficulties with daily living, such as personal care, household tasks or other activities that allow a person to be independent. The assessment will look at a person’s overall wellbeing, their strengths, needs and how they can remain connected with family and friends.

The personalised care and support plan will include agreed outcomes, what is important to the person receiving care and what support they need to make the plan achievable. People may be able to receive personal budgets, which combines health and social care funding to purchase the care and support they require.

Treating the impact on the lungs

Coronavirus can make it more difficult for people’s lungs to get enough oxygen into the blood. If untreated, this can cause long-term damage and breathing problems.

To combat this, you may need to follow an exercise routine set by a lung rehabilitation specialist to help them recover. Care workers will be able to help you carry these out.

While people are unwell, they may develop blood clots in their lungs, which reduces their functioning. This may be treated with blood-thinning medication.

The medication can, however, lead to you bruising easily. If you or your care worker notice any unusual or repeated bleeding, you should seek medical attention as soon as possible.

Monitoring oxygen levels and storing oxygen in the home

There may be cases where you do not realise your oxygen levels are low. This means it is important to have a way to monitor how much oxygen your body is getting. You can check your oxygen levels yourself using a device known as a pulse oximeter.

You may need oxygen therapy, which will be provided to you at home by a specialist team.

Storing oxygen at home could pose a serious fire hazard and the risks need to be identified and managed. Your care and support plan should outline who will be responsible for managing the oxygen, including support from family members or care workers.

Treating the impact on the heart

During the period of illness, you may have suffered damage to your heart which could cause cardiovascular problems. This could mean you need supportive measures to help your heart recover.

Coronavirus impact on diabetes

Severe viral infections can make diabetes more severe, meaning people with diabetes are at higher risk of health complications if they have had COVID-19.

If you have diabetes and are recovering from coronavirus, you may need to have your treatment reviewed. Any support you receive to manage diabetes should be outlined in your care and support plan.

Training and ongoing support should be provided for your care worker or personal assistant.

Difficulties with swallowing and mouth care

Those who became particularly ill in hospital due to COVID-19 may have needed artificial breathing support. This could result in difficulties with swallowing and a risk of choking on food.

If you have to make changes to what you eat during recovery, this should be outlined in your care and support plan.

Artificial breathing could also cause damage to soft tissue of the mouth or throat. This means your care worker may need to establish a routine of looking after your teeth, mouth or dentures.

The importance of communication

Good communication between health professionals and patients is key to build positive relationships.

Some people may have trouble speaking which can be distressing or isolating. For example, those living with dementia may be less able to report symptoms, making non-verbal communication even more important.

Your care and support plan will inform care workers how to best communicate with you, helped by a range of PPE face masks with transparent fronts to aid lip reading.

Tracheostomy wound care following hospital discharge

Some patients may have had a tracheotomy in hospital, which is a small cut made in the neck to allow a tube to be inserted into the windpipe to help with breathing.

Normally, the tube will be removed before discharge, but the wound may become infected or the patient may find swallowing more difficult. These issues will be assessed and described in your care and support plan. 
 
In cases where the tracheostomy tube is still in place after discharge, community health teams will provide support and appropriate care. This may mean that your care worker has to wear a different type of PPE.

Treating damage to the skin

Being cared for in hospital could result in damage to your skin, including pressure sores, pressure ulcers or moisture legions. This damage can also occur at home where mobility is limited and there is continual pressure on a part of the body.

Your care and support plan should outline different strategies your care worker can use to prevent damage to the skin, such as pressure ulcers.

Muscle weakness and fatigue following hospital admission

It is not uncommon for muscles to lose size and strength during a hospital stay due to COVID-19, particularly after long admissions.

Muscle weakness can lead to falls, pressure ulcers and a reduction in the ability to move around and carry out daily activities.

The recovery of strength and mobility can take a long time but is helped by good nutrition and support to carry out everyday tasks.

You may also experience extreme tiredness or exhaustion after your illness, which can have an impact on how long it takes you to recover.

Those who experience fatigue can receive support at home with daily activities and everyday living.

Confusion and delirium 

During your admission to hospital, you may have suffered from acute confusion from delirium. This is not uncommon, and these episodes may continue for some time once you have returned home.

Delirium, which is described as ‘a disturbed state of mind’, can lead to people being more easily distracted and confused than normal. This includes not being able to think or speak clearly, not knowing where they are or becoming agitated.

People living with dementia are more prone to develop delirium and the increased risk will be noted in their care and support plan.

The support that will be provided for people who suffer from delirium should be clearly documented and agreed with the person or their representative. This should include views of family members and carers.

Care workers and personal assistants should be informed and trained appropriately.

The impact on mental health 

It can be difficult to cope with recovering from coronavirus and it is common for people to experience fear or anxiety following a serious illness. The challenges of recovery can also have an impact.

Some people may develop persistent mental health difficulties, such as anxiety, depression or symptoms related to post-traumatic stress disorder as a result of COVID-19.

People can access mental health support through their GP surgery and their family and support network if they have concerns. If care workers notice changes in a patient’s mental health, they will encourage them to seek help.

If mental health problems persist, patients can refer themselves to talking therapies through the NHS. The NHS Volunteers Service can also provide support through a ‘check in and chat’ service at 0808 196 3646.

Mental capacity issues

People should as far as possible be in control of their own care and have their wishes respected. Unless proven otherwise, each individual has the capacity to make decisions under the Mental Capacity Act.

Care workers who have concerns about the person they care for should contact the relevant professionals or the local authority for a mental capacity assessment.