As the number of Covid-19 cases in New Zealand climbs and with the country in lockdown, home care workers are still visiting thousands of elderly and disabled people every day – without protective clothing, and are pleading for help
Home care workers say they have still received no word from the Ministry of Health or the District Health Boards when – or even if – they will get the masks, gowns, gloves, goggles and hand sanitiser they need to keep themselves and their clients safe, and to prevent them inadvertently spreading the virus in the community.
Sonya (not her real name) works for one of the largest community healthcare providers. Every day she visits at least four elderly people in their homes; on a busy day it’s up to eight. She helps them shower and dress, gives them their medication. With bedridden patients she washes and turns them, feeds them, deals with soiled sheets.
She’s not naturally a panicker; she worked for a decade in an hospital accident and emergency room.
But now she’s scared.
“Please help us,” she wrote in a message to Newsroom after we raised the issue of unprotected homecare workers in an article on Tuesday.
“We are so worried, not only for ourselves and our families, but also our very vulnerable clients.
A prime route of transmission
Everywhere there are concerns about personal protective equipment, or PPE. There are the obvious needs for hospital staff and GPs; Prime Minister Jacinda Ardern talked about banking staff in her press conference on Tuesday; Director of Health Ashley Bloomfield yesterday mentioned masks for supermarket checkout workers.
No one seems to be talking about home care workers.
“This is a prime route of transmission of Covid-19,” Sonya says. “Thousands of support workers going through goodness knows how many tens of thousands of homes every day.”
One problem is that home support workers aren’t seen as part of the health establishment. Some contract direct to their clients; others work for agencies like Nurse Maud, Geneva or Miranda Smith.
But agencies are struggling to get supplies from the District Health Boards and the Ministry of Health, neither of which appear willing (or perhaps able) to give out information about what stocks of protective clothing they have and whether there are national shortages.
Homecare service provider Manawanui is calling for people to donate old pillowcases and t-shirts and is employing seamstresses to make masks for its workers.
And Geneva wrote to staff saying they should only use PPE if their client’s pre-Covid care plan requires it, or “if there is a suspected, probable or confirmed case of Covid-19, or where there is a high risk of infection.”
No mention of people who might not know or even suspect they have Covid-19.
Geneva chief executive Veronica Manion told Newsroom that there was an unprecedented demand for PPE and the Ministry of Health was working on the issue.
“Measures to address immediate needs, which include a limited urgent release of equipment and accompanying guidance, will be announced within 24 hours,” she said. “These measures are in addition to a longer term solution which is also being worked through. The safety of staff is a top priority as we work through this fast-evolving and challenging time.”
Yet she didn’t say when or how this equipment would get to staff, many of whom work remotely, without access to an office or supply depot.
Sonya says carers who have stocks of aprons, gloves and masks are giving some to their colleagues. But many have nothing, and even the lucky ones don’t get given full gowns, which cover their arms.
No one has been given the high-quality P2 masks that give full protection against Covid-19.
The vexed issue of masks
There’s even debate about whether home care workers need masks at all, Manion says.
“The safety of our staff and the people we support is very important to us and whilst we await the distribution plan from the MoH we are and will continue to follow Ministry of Health and World Health Organisation guidelines on the use of PPE.
“They do not currently recommend the wearing masks for people who are not infected with Covid-19.”
This is correct. However Newsroom understands this applies to your average healthy citizen walking about on the street – not carers who could be in very close proximity to vulnerable elderly and disabled people, when either party may have inadvertently been exposed to the coronavirus.
We have to make sure we aren’t the cause of transmission through the community.
It’s that uncertainty that is stressing care workers “beyond endurance”, Sonya says.
“We are desperately worried. We are doing our best to maintain the safety of our clients, but people at the ministry and the DHBs don’t understand the details of how we do our job.
“They don’t provide hand sanitiser; they say washing our hands with soap and water is enough. But they don’t realise that you can’t get out of the client’s house after you’ve finished without touching the door handle.
“We have to make sure we aren’t the cause of transmission through the community.”
Manion says it’s a question of waiting for direction and advice from the Ministry of Health about how much stock they are going to get – and when.
“We are not saying we won’t give staff masks at any stage, but we currently have a limited stock. This advice is expected today. How we use any stock, limited or not, must be considered carefully and not in a reactive manner.
She says priority at the moment is going to people working at the airport, and at quarantine accommodation sites.
“All staff in these high risk situations are given special masks, gowns, and sanitiser. We are currently working on the logistical roll out and systems for issuing any form of protection across NZ – for the entire home and community sector, not just for Geneva.
“I can confirm to date not one of our clients or staff is considered a suspected, probable or confirmed case of Covid-19.”
Waiting for the Government
Manion says the sector now needs information from the Government.
“We absolutely understand the anxiety our staff are facing, they face enough risks on a normal working day let alone a pandemic. We also understand the difficulty of not knowing if either party has come into contact with someone who could infect them.
“Once we have clear instructions from the Ministry of Health, we will be providing our staff with additional instructions to further reduce the risk.”
Kirsty McCully, home support coordinator at the union which covers homecare workers, E tū, says the Government must move quickly.
“I am aware the ministry is doing urgent work on PPE guidance and supply and it would be good to get this query to them today,” she told Newsroom when we enquired about progress yesterday.
Around the same time, Ashley Bloomfield said 600,000 masks were being released from the national pandemic stockpile to DHBs and that local mask production had now reached 200,000 a day.
“It’s important that our health workers and people working in essential services – at least some of them – are able to access PPE, so we have a number of measures in place to ensure PPE is available to those people,” he said.
Protective equipment was already available to health workers and there was “a separate stream of work to make sure supplies were available to essential workers like, for example, staff in supermarkets”, Bloomfield said.
It is not reassuring that the Director-General of Health is prioritising supermarkets – where there are increasingly perspex screens between staff and customers – over home care workers, Sonya says.
“Someone [in the Ministry of Health] has to find out what this work entails and what the risks are. They have to talk to the people doing the work on the ground, not their managers, or the people in the DHB, because they don’t have a clue.
“We need to be able to get protective equipment today,”