Infection risk from unprotected home carers

The scramble to find and distribute medical protective gear seems to have left off thousands of workers who visit the elderly and disabled in their homes daily, prompting fears of a walking spread of Covid-19.

Thousands of homecare workers are visiting some of the country’s most vulnerable people during a coronavirus pandemic without wearing the masks, gloves or gowns they need to keep them and their clients safe. 

And it’s not because they don’t know that’s crazy. It’s because they simply can’t get the gear they urgently need. 

Worse, no one in the Ministry of Health or DHBs seems to be able to tell them who’s responsible for providing personal protective equipment (PPE). It’s hard to find out why some homecare workers have not received any gear at all, and others have received less than they need. 

It’s not even clear whether the lack of PPE for homecare workers is because they aren’t seen as a priority, or because there just aren’t enough masks, gowns and gloves to go around. 

It’s not like homecare workers can just maintain a two-metre distance with their clients. 

Their job is to help the tens of thousands of disabled and elderly people living at home with basic tasks. Eating, showering, toileting, sometimes even suctioning - when a caregiver removes mucus from someone’s mouth or throat.

These tasks are up close and personal.

“We’re running into a brick wall.”

Marsha Marshall is chief executive of Manawanui, a company that facilitates the provision of homecare services for around 5000 people with disabilities all around the country. She has around 4000 workers on her books. 

Two weeks ago, as Covid-19 started to spread in New Zealand, she started asking how to get PPE for her workers. But she just got the run-around, she says.

“We asked the Ministry of Health where to go and they said the DHBs were providing this. So we sent an email out to our clients and said the Ministry of Health says you can source your PPE from the DHBs, but the DHBs told some of them it’s Manawanui’s responsibility.

“So we went back to the Ministry and said ‘Whose responsibility is it?’ and the Ministry said it’s the DHB. 

“We’re running into a brick wall.”

Marshall says the company and the care workers are getting so desperate they’ve started trying to source their own equipment.

“We are contacting medical suppliers, OfficeMax, we’ve got seamstresses sewing us cotton masks, we’ve got employees picking up gloves when they go to Pak N Save,” she says.

On Tuesday night Marshall posted a Facebook message asking anyone with spare material (t-shirt fabric or pillowcases, for example) and rudimentary sewing skills to help make masks for Manawanui clients.

"We are an essential service, so you make 'em, I'll arrange to collect them from your doorstep and get them to someone who really needs them. You will be making someone's life much easier. Arohanui."

By the following morning offers of help were already coming in, but she needs more.

“I don’t think the DHBs understand the situation these people are in. We don’t have time to dick around. We need these things now.”

A big risk for spreading the virus

Jenny, a care worker from Canterbury, says she has supplies of disposable gloves and surgical masks. But she’s only been given six gowns, and she knows plenty of people that don’t even have masks.

Meanwhile, there’s no talk of being issued the thicker P2 masks which provide a much more certain protection against Covid-19 than surgical masks do, particularly when someone is infected.

And although Jenny has been advised to use hand sanitiser, she has to provide her own.

"I’ve gone to the local pharmacy and they are ordering some for me. I’m at the top of the list.” 

She hasn’t considered stopping work, but she’s nervous,” she says. “We are meant to call out when we arrive at someone’s house and say: ‘Is there anyone here that’s sick?’ But we aren’t notified if anyone’s in self-isolation in the house. I don’t even know if our providers know that. 

“We might be going into a situation where we should take extra precautions, or shouldn’t even be going at all. But we don’t know.”

Kirsty McCully is home support coordinator for E tū, the union for homecare workers. She says masks must be a minimum requirement for workers, who have no choice but to be in close contact with other people.

“Workers are feeling confused and alarmed and worried about their clients. They might see eight people a day and could inadvertently be walking the virus around the community. 

“It’s a big risk in terms of spreading the virus.”

She understands staff at the Ministry of Health and DHBs are extremely busy, but she has been trying to get information for some days and this should be a priority.

“If we are serious about preventing community spread and protecting our health workforce we need to provide them with the protective equipment they need to keep them safe. If we don’t have what we need, we need to make it. 

“We have factories and engineers that could be working on providing this equipment.”

She says care workers are under-appreciated.

“I could see a lot of support workers saying: ‘This is the last straw,. I don't know what I’m walking into when I turn up at work and I'm not being protected.'"

Do we have enough PPE? We don’t know

So why aren’t care workers being issued with protective clothing and masks? The answer is we don’t know, because the government hasn’t released figures about what stocks of PPE it holds. 

See our Newsroom story: Uncertain PPE stocks could leave medics unprotected.

“After three weeks inquiry, it’s not clear who is responsible for PPE in homecare,” says another frustrated homecare supplier who didn’t want to be named, but we’ll call Peter. “The MOH/DHB line is that they might supply PPE as needed but won’t say how much they have. One can only suspect they don’t know or do know but don’t want to say.”

Peter says he’s worried DHBs are keeping PPE equipment for their own staff and leaving homecare workers (who contract directly with the clients they work for, not the DHB) to go without. 

“They should publish the stocks and the policy so everyone else can get on with their decisions. 

“This is about informing decisions by people like middle managers in homecare providers, about how to ration healthy care workers and PPE to keep them and their clients safe and out of hospital.” 

Even if you take a brutally pragmatic view, preventing these vulnerable people catching Covid-19 from their caregivers makes sense, Peter says. 

Each homecare worker who gets sick takes one person out of an already stretched workforce. Meanwhile, many of these disabled or frail people are seriously at risk if they get coronavirus. They are the ones that will end up dying or spending weeks on ventilators. 

When the Government asks the over-70s and vulnerable people to stay at home, one reason is to keep intensive care beds free for other people.

In which case, not supplying PPE to their carers is crazy.

“These are people who are more likely to clog up the hospitals. We are using a lot of PPE for GPs testing healthy people that might or might not have the virus. We should also be focusing on these people.

The Government responds

Newsroom sent an email to the Ministry of Health asking about the provision of PPE equipment to homecare workers.

A spokesperson sent a statement.

"There is currently unprecedented demand for PPE. Covid-19 is likely to be with us for some months and it is important that we ensure the availability of supplies for the coming stages. 

"The Ministry is working to ensure the sustainability of PPE so it is available to those who need it now and in the future. We are currently establishing how much is available and setting up a process to centrally manage requests for PPE." 

Meanwhile Newsroom’s Sam Sachdeva asked Prime Minister Jacinda Ardern about it at her press conference yesterday. She said she wasn't aware of the problem but it was something "she would take away immediately”.

“PPE is something we have supplies of,” she said. “Just today we’ve been discussing getting provision of that through to our banking services.

“Today I watched a video of surgical masks rolling off a production line here in New Zealand and providing PPE is an essential service. We will keep rolling out those products and I’ll follow up on that today."

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