Home and Community Based Care (H&CBC) program developed two programs to meet Veterans' needs during the COVID 19 pandemic. The two programs developed are Home Care/Home Telehealth COVID 19 and Convalescence programs. COVID 19 program provides monitoring for Veterans with COVID 19 test or Person Under Investigation. There are two types of monitoring that fall within the COVID program. Veterans discharged from the hospital or immunocompromised were placed in a high acuity program and monitored by a nurse for 20 days. The other Veterans were placed in a low acuity program requiring phone calls by a nurse twice a day. We admitted our first Veteran and successfully discharged him. He was discharged to our Convalescence Program. Convalescence Program monitors Veterans with residuals from positive COVID-19. There are physicians from all specialties, Social Work support, Registered Nurses, Chaplain, and others. As a team Home and Community Based Care worked together to provide support and save lives.
The COVID program provided monitoring seven days of the week including holidays. There were times during two surges when the census was as high as 270. We discussed a plan to continue a plan to decrease BID phone calls to daily. This plan was never put in place due to support from not only staff within H&CBC but also devoted nursing staff from other areas within South Texas.
The COVID program received 5,000 encounters from March 2020 until March 2021, actively monitored over 3,000 Veterans and humanitarians, over 300 sent to ED for emergent care, 80% hospitalization avoidance, and less than 5% mortality rate. This was all due to Nurses conducting monitoring phone calls 7 days of the week. A spreadsheet was maintained to track a fast-moving program, assignments made daily, and emailed to staff. We developed COVID kits consisting of incentive spirometer, pulse oximeter, thermometer, blood pressure machines (as needed), and teaching material. COVID kits were stored in the Emergency Department, inpatient COVID unit, NOD office, and GEC office. Veterans visiting these areas were given kits. When a Veteran was admitted to the program from other areas, we delivered kits to their residence. There were times when two drivers delivered kits for a full day.
Several good catches came from the COVID program. Many lives were saved by nurses in the program. When conducting phone calls nurses discovered Veterans with low oxygen saturation and symptomatic. They were advised to report to the Emergency Department or have 911 called. Some of the Veterans upon arrival to the hospital were immediately placed on ventilators or we were told they came to the hospital just in time. Sharing a couple of good catch stories and patient satisfaction there are multiple stories. We found multiple Veterans requesting to hold their discharge. Veterans requested a couple of additional days for daily phone calls from nursing staff because calls provided comfort during a scary time in their lives.

***

Examples of good catches:

When the nurse contacted a Veteran his oxygen saturation at rest was 78%, so they instructed his spouse emergency care was required. The Veteran was taken to the nearest hospital. In the Emergency Department, oxygen saturation was 50% on room air, he was placed on BiPAP. The Veteran was able to obtain crucial care to save his life.

A Veteran contacted a nurse and requested to be left alone, however, the nurse was persistent, requested vital signs and symptoms, and then asked to speak with family members. They were not at home, so the nurse contacted them via cell phones and expressed concern about the Veteran's condition. The Veteran's spouse went home and took her to Emergency Department where she was admitted.

For two days a Nurse was unable to contact a Veteran. On day number three a Nurse made contact and found the Veteran febrile, with low oxygen saturation, and symptomatic. The Veteran was advised and reported to the Emergency Department. The Veteran was placed on five liters of oxygen. This took teamwork because the nurse had to notify ED, NOD, and a physician.

A Nurse contacted a Veteran for monitoring. He did not want to provide symptoms or pulse oximeter results because no one could help him, and he was not going to leave his mother. The Nurse continued to talk with the Veteran and could tell he was short of breath. They obtained oxygen saturation results which were low. She assisted with getting the Veteran and his COVID positive mother going to the Emergency Department.

***

An example of patient satisfaction:
A 100% service-connected Veteran expressed from the bottom of his heart thanks to the Nurses. The equipment provided and telephone calls to check his temperature and how he was feeling touched his heart. He wanted to express his feelings, thoughts, and with all his heart thank us. He put his wife on the phone, and she said “ditto “to all her husband said. Her husband was touched by all of us and the program.

***

COVID monitoring was extended to Veterans admitted to a nursing home COVID bed under Veteran Care Agreement. They were monitored through fax reports from nursing homes or electronic medical record reviews. We also monitored Veterans in Medical Foster Home, Community Adult Day Health Care, and State Veterans Home. During a period from January 20, 2021, to February 22, 2021, the COVID program monitored 68 Veterans in State Veterans Home. The COVID program Nurses conducted reviews of the Veteran's electronic medical records daily and reported abnormal results. Several Veterans were admitted to the inpatient unit for treatment and then discharged back to State Veterans Home, residence, or community nursing home. The mortality rate was kept low at 11.76%.
The COVID program developed a process to have lab work drawn and COVID testing in the home. Lab results were extremely beneficial to show some of the Veterans were sick and required hospitalization.
The COVID program planned and held two drive-thru lab draws and administered flu vaccines for Veterans recovering from COVID 19. Over 1000 Veterans were contacted and approximately 300 came to have lab work drawn to show their immunity level. The Research Department participated in the drive-thru. They were conducting research to show how a person's immunity level will predict if they will catch COVID and if they do, the level of illness.
The COVID program is participating with Bamlanivimab and Casirivimab COVID infusions held at Audie L. Murphy parking lot C-Fort. We participated in meetings to develop the infusion process. When reviewing referrals for the COVID program Veterans eligible to receive the infusion are identified. They are contacted by a physician to explain the infusion process and if they give consent, a FAQ and flyer are emailed. From December 29, 2020, to March 2, 2021, a total of 66 Veterans received infusion.
Convalescence Program has enrolled 588, 755 that have an upcoming appointment, and the remaining Veterans will be contacted to offer the program. Veterans receiving testing such as PFTs and lab work as appropriate.
During the COVID 19 pandemic South Texas went over and above to provide support and medical care to our Veterans, their family members, and humanitarians. We were innovative with our ideas and worked together as a team. The COVID program census has decreased significantly, however, we continue to provide monitoring support.
H&CBC is providing COVID Vaccines for homebound and rural Veterans. Veterans in rural areas with difficulty obtaining vaccines were vaccinated by H&CBC staff. We have provided vaccines for Veterans bedbound, on ventilators, with severe Dementia, and others unable to leave their residence or it would be a taxing effort to leave their residence.

***

Team Members honored with this DAISY TEAM Award:

Laura Medlin
Sherraine Gilman
Corina Escamilla
Rogelio Perez
Jennifer Gomez
Cindy Montez
Carolina Calderon
Michelle Rangel
Yvette Martinez
Kimberly Oakman
David Esquivel
Sally Grassmuck
Claudio Solorzano