You may find yourself in a position where you are offering support to a loved one who has had COVID-19 and has recently returned home from hospital. This brief guide offers insight into the home care our CareAngels can offer after your loved one has been hospitalised due to COVID-19. Here, you will find information that will help you understand what to expect when your loved ones return home as well as some of the causes and consequences of their new health-related circumstances.

You will find that when anyone is discharged from hospital, a detailed assessment will be provided to help us create a personalised care and support plan for that individual. Community health and social care professionals, such as community and district nurses, and social workers, work together to perform this assessment. The resulting plan states agreed outcomes and recommendations for ongoing care and support for the person, including home care support. The assessment should explain any health or social care tasks that carers should prioritise. Guardian Angel Carers will use this information to develop clients’ individualised care plans, and we always arrange any necessary training so CareAngels can complete health care tasks with skill and confidence.

Sometimes, after being discharged from hospital, people may experience some significant health difficulties. These challenges include concerns like long-term damage to the heart and lungs, difficulty swallowing, muscle weakness, fatigue, skin damage, confusion, and other mental health problems or feelings of reduced wellbeing that affect a person’s ability to resume day-to-day activities quickly and confidently. A home care plan created with Guardian Angel Carers may include details regarding the physical, psychological and social impacts of COVID-19 that are specific and unique to each client, including any additional support from health professionals and specific instructions for CareAngels who will be providing support.

THE PHYSICAL IMPACT OF HOSPITALISATION

Most people will make a full recovery from COVID-19 at home, but the disease can make it harder for someone’s lungs to get enough oxygen into the blood. The impact of COVID-19 on an individual’s lungs can lead to long-term damage like breathing problems. You may observe that your loved one is breathing quickly or experiencing difficulty breathing and/or shortness of breath. This sign of reduced lung function is due to blood clots. Some people particularly ill in hospital with COVID-19 may need artificial support with their breathing from one of a range of machines.

Some people will have suffered damaged to their heart during their period of illness. This situation may require specialist supportive measures, and our team of CareAngels can assess and explain the measures if they need to be a part of your loved one’s care plan.

How we can help:

• CareAngels can assist with exercise routines set by a lung rehabilitation specialist to help your loved one’s lungs recover. The specialist may provide advice on how to help the person to do these exercises. These details will appear in the person’s care and support plan, and CareAngels can use this information and training to support someone who needs to carry out these exercises.
• CareAngels can support your loved ones as they take any necessary medication which can thin the blood. Blood-thinners can lead to a tendency to bruise easily, so CareAngels will take care to maintain the highest safety standards to prevent injury.
• If a CareAngel notices any unusual bleeding, they will seek medical attention immediately by contacting the person’s GP or by calling NHS 111, an ambulance, or a family member.

Some individuals returning home from hospital may also need oxygen therapy at home. Oxygen therapy will be provided by a specialist team of CareAngels who possess relevant experience and training. Some types of oxygen therapy require a different type of personal protective equipment (PPE) that may include gloves, an apron, a long-sleeved gown, and an FFP3 respirator. The medical team supplying oxygen will advise your CareAngel if this additional PPE is needed, and they can show the CareAngel how best to support someone with oxygen therapy.

How we can help:

• CareAngels can ensure that oxygen, a medical gas, is stored properly in your loved one’s home. Oxygen can pose a serious fire hazard, and it is important that anyone who works with the supplying team ensures that care plans identify and manage the risk of explosions and fire.
• CareAngels can help to create a clear care plan that explains who will be responsible for managing the oxygen, including any support from family members or other CareAngels.
• A CareAngel will also conduct a risk assessment and, with support from community health services, make sure that all CareAngels involved in your loved one’s care are confident in how to manage oxygen safely within the home. The risk assessment will consider any risks to the person for whom the oxygen has been prescribed, as well as any risks to care staff supporting that person.
• Because oxygen is a medical gas and should be treated as a medicine, Guardian Angel Carers will provide medication training if extra support is needed.

People with diabetes are at a higher risk of complications if they have had COVID-19. Severe viral infections can make the symptoms of diabetes more severe, which means that your loved one’s needs and their treatment may warrant a thorough review. It is possible that your loved one will need to start taking insulin injections during the recovery period, which will be included in the care plan.

Anyone who has been hospitalised can experience damage to the skin, which can take the form of sores on the body known as ‘pressure sores’, ‘pressure ulcers’, or ‘moisture lesions’. CareAngels are aware that these sores can occur at home if mobility is limited and continual pressure is exerted on a part of the body, such as the heels, buttocks, lower back, elbows, shoulders, back of the head, or even on the face, if an oxygen mask is being worn. Sores can be mild, taking the form of slight discolourations of the skin which go away when pressure is removed, to severe, in the case of deep wounds which can become infected and cause people to become very unwell. Pressure ulcers are largely preventable, and CareAngels know that these pressure ulcers can be very painful, so we will do everything we can to prevent them or minimise them if they are already present.

Muscle weakness can occur when a range of important muscle groups lose size and strength during a hospital admission for COVID-19. The longer the person stays in hospital, the more muscle is potentially lost. People who were frail when they were admitted to hospital are particularly vulnerable to problems caused by muscle loss. This frailty has been linked to an increased likelihood of falls, a sense of generalised weakness, pressure ulcers, and reduced ability to move and to carry out activities of daily living. Some people may also experience nerve damage that can cause numbness or pain in different parts of the body, thereby also increasing the risk of falls. Muscle strength recovery and mobility can take a long time. Good nutrition and support to regain the strength to carry out normal daily activities are important parts of recovery.

How we can help:

• CareAngels can review your loved one’s care plan after their return home and make any necessary adjustments to the care plan, including the use of insulin if your loved one is diabetic.
• CareAngels can minimise the presence of painful pressure sores by incorporating well-known and proven strategies into your loved one’s care plan.
• CareAngels can support your loved one’s recovery and help manage risks from muscle weakness at home. These details will available in the care plan and risk assessment.

Some Notes Regarding Tracheotomy Care

Your loved one may have had a tracheotomy in hospital, which is a small cut made in the neck to allow a tracheostomy tube to be inserted into the windpipe and attached to a ventilator to help with breathing.

Typically, a tracheostomy tube is removed before the person is discharged from hospital, so normal breathing should be able to take place. However, some people may have difficulty swallowing afterwards and the wound left in the neck could become infected. In rare cases, a person may be discharged from hospital with a tracheostomy tube still in place. In this instance, community health teams will provide support to deliver the appropriate care required. It may mean CareAngels also providing support might need to wear a different type of personal protective equipment (PPE) that includes gloves, an apron, a long-sleeved gown, and an FFP3 respirator. As well, people who return home with difficulty swallowing have a heightened risk of choking on food.

How we can help:

• Risks will be assessed by the community health team, and our CareAngels will note any changes as to how and what the person eats in the care plan.
• As well, CareAngels can offer support in the establishment of a new routine of looking after dental health as some people may have damage to the soft tissue of the mouth or throat from having a tube inserted to help breathing.

THE PSYCHOLOGICAL IMPACT OF HOSPITALISATION

Being hospitalised for any reason can have an impact on mental health as the experience is often very isolating. COVID-19 hospitalisations are especially isolating due to the nature of the virus, so CareAngels know to be prepared to look after your loved one’s psychological and emotional well-being as well as physical well-being.

Coping with recovery from COVID-19 can be stressful and challenging. It is very common for people to experience fear or anxiety if they have had a serious illness, or to feel low about the challenges of recovery. A CareAngel can provide your loved one with a kind and listening ear as well as practical and healthcare support, which can make a big difference when your loved one is trying to accept and overcome these difficult feelings.

Whilst recovering from COVID-19, some people may develop more persistent difficulties with their mental health, such as feelings of anxiety or depression, or symptoms related to post-traumatic stress disorder. Experiences with their illness, their experiences of treatment or the wider impact on their lives as well as existential questions can cause psychological and emotional distress. They may also experience a lack of confidence regarding their day-to-day routines following social distancing measures and isolation. The lack of access to family members, friends, and carers whilst in hospital may also contribute to a feeling of distress.

Reports of a form of psychosis in response to COVID-19 have also emerged. Psychosis is a severe mental disorder which sometimes cause people to experience reality in a different way to other people. A psychotic episode might involve paranoia, which is a belief that others may want to harm the person or even seeing or hearing things that other people cannot see or hear (hallucinations). Delusions may also be observed, which is a belief in things that are not actually true.

How we can help:

• CareAngels will be able to notice changes in the mental health of your loved one. If you are worried about any aspect of your loved one’s recovery, talk with your CareAngel and, together, you can discuss your concern with your loved one’s GP, as well as with family and a wider support network if appropriate.
• CareAngels will also work with the community health team or GP if symptoms of anxiety, depression, or post-traumatic stress disorder persist for more than one month after the immediate health crisis has been resolved.
• Anyone can self-refer for talking therapy with the NHS, and your CareAngel can facilitate this process. The local Improving Access to Psychological Therapies service is available as well as the NHS 111 first response services for people experiencing mental health crises.
• CareAngels can also involve the NHS Volunteers Service who provide a telephone ‘check in and chat’ for people who have mental health issues and are feeling isolated. Call 0808 196 3646 from 8am to 8pm or visit NHS Volunteers Service. For people who are shielding, both the NHS and local authority have support services in place.

Good communication is essential for everyone receiving care and support. Open lines of communication reassure people and contribute to positive relationships. CareAngels understand that some people may have difficulty speaking which can feel distressing. At times, there is no need to speak, and we encourage you to respond to basic requests through nodding, shaking the head, gestures, facial expressions, and through the use of pictures. We know that people with dementia may be less able to report symptoms because of communication difficulties, so we are extra-vigilant in these situations.

Communication problems can stem from acute confusion from delirium, which is common during hospital admissions. Episodes of confusion may continue for some weeks at home while a person is recovering from hospitalisation. Delirium can be described as a disturbed state of mind; some people become easily distracted and appear more confused than normal. Some people may also have lasting difficulties with their memory. People with dementia are much more prone to develop delirium if they have an infection.

How we can help:

• CareAngels can help develop plans to support people suffering from delirium whilst recovering from COVID-19. We will discuss and document the plans after coming to an agreement with your loved one or, where necessary, a representative.
• CareAngels will take into account the views and expertise of close family members and carers when considering their approach to working with your loved one.
• In the care plan, CareAngels will prioritise arrangements to keep your loved one safe from injury if they are confused.
• If needed, CareAngels will seek a GP’s advice if your loved one exhibits signs of acute confusion, such as: unclear thoughts and speech, confusion around where they are, memory issues, hallucinations, unusual restless or withdrawal.

With a CareAngel by your loved one’s side after a hospitalisation for COVID-19, you can enjoy some peace of mind and the knowledge that they are in good hands. Contact us directly for more information, and a member of our friendly staff will be happy to talk with you.