The Michigan Department of Health & Human Services (MDHHS) has issued guidance further tightening the protocols governing in-home caregivers for older adults to prevent the spread of COVID-19 among the vulnerable individuals they serve.  Although the recommended steps are not mandatory, the MDHSS “strongly urges” direct care workers to follow the guidance while providing support to their clients for non-emergency medical care, activities of daily living (ADLs), and instrumental ADLs.¹  For purposes of the guidance, “older adults” are persons age 60 or older, and “direct care workers” include, but are not limited to, personal care assistants (PCAs), certified nurse aides (CNAs), home health aides, private duty nurses (RNs), direct support professionals, and informal caregivers who do not reside at the client’s home.

The guidance provides that direct care workers should engage in face-to-face contact with clients only after taking these steps:

• The caregiver has contacted the client by phone and asked if they need “support to sustain life.”  If not, the caregiver should not visit the client’s home.  Unfortunately, the guidance does not define what constitutes “support to sustain life” or the other words or phrases italicized in this text.
• If the caregiver cannot reach the client, or does reach the client and they need such “help,” the caregiver should try and reach all known members of the client’s “informal caregiver network” and ask for an assurance that one of them will contact – or if necessary visit – the client “to sustain life,” provided that the friend or family member is healthy, not in a high-risk group, and has been practicing social distancing.
• The caregiver should visit the client’s home only if the caregiver and the caregiver network cannot reach the client or the network tells the caregiver the client has a need necessary “to sustain the client’s life” that the network cannot provide.

The guidance also contains recommendations on maintaining a one-to-one ratio between the direct care worker and client where visits are necessary and adhering to CDC guidance on precautions the worker should take during such visits.  These include the use of disposable facemasks and gloves, handwashing after removal of these items, and immediate disposal of gloves and masks if the client has or is suspected to have COVID-19.

It appears the intent of this guidance is to place the primary responsibility of home care for older adults during the pandemic on their family, friends, “or other contacts” while restricting in-home caregivers from providing these services.  The stated rationale for the guidance is that “a friend or family member can conduct caregiver visits to one individual with less risk of repeatedly transmitting COVID-19 than a direct care worker.”  The guidance also encourages direct care workers to work with their clients’ informal care network to establish a regular schedule of visits that can be conducted by the client’s network and not the care worker.  As with all things COVID-19, only time and data will prove whether the Department’s assumption that this is the most effective way to limit transmission of the virus among this population proves to be true.  In the meantime, the guidance states that the MDHHS will work with all managed care entities to ensure the guidance “is appropriately executed.”  Given the state’s aggressive response to the virus, these recommendations could quickly become mandatory through the issuance of an executive order if the governor and the state’s chief medical executive determine that is necessary.