Home care agencies and their employees are performing critical services that help clients continue to live independently, work that has become even more challenging and dangerous in the coronavirus pandemic.

Kevin Smith is the chief executive of Best of Care, an agency headquartered in Quincy, Mass., that serves clients in greater Boston and many other areas of Massachusetts. Smith is also president of the Home Care Aide Council, Inc., a trade association of 70 agencies providing home care services in Massachusetts.

Gerontology Institute Director Len Fishman spoke with Smith on March 23 about home health agencies and their workers during the COVID-19 crisis. The following transcript was edited for length and clarity.

Len Fishman: Tell us briefly who your agency serves.



Kevin Smith: We are serving about 1,500 people. They are typically over age 60 and actually skew toward their 80s. It’s fair to say many depend on the care of our aides to remain independent and out of facility-based care.


LF: And your workforce?

KS: We are a non-medical agency, meaning we are not certified through Medicare. We deliver non-skilled services provided by home health aides, CNAs, homemakers and companions. On a given day we are deploying 330 to 400 staff. Our workforce is comprised predominantly of female homecare aides who are born outside of the United States, who speak English typically as a second language. Many of those aides are working parents. Many are single parents.

LF: What services does a typical client need from your aides?

KS: Most receive personal care assistance with the activities of daily living. That could be help getting up and out of bed in the morning, a reminder to take medication, assistance with bathing, grooming, dressing, brushing of teeth and oral care, meal preparation, toileting, and ambulating around the home. Essentially, supervising and assisting and promoting independence within the home so that an individual can continue to remain in their home.

LF: So your clients are among those most at risk for COVID-19 and yet the nature of the services your staff provide often require intimate contact between the client and the caregiver. What steps are you taking to protect your clients and your caregivers from this extremely infectious disease?

KS: All we can do is lean on the ever-changing guidance from the state and federal authorities who sit above our industry, the CDC and state agencies like the Department of Public Health, Health and Human Services, and Elder Affairs. We tell all our caregivers to perform daily self-screenings – take their temperatures, make sure that they are fever-free, that they are asymptomatic of COVID-19. If they have traveled somewhere or come into contact with areas that have been affected by COVID-19, they are directed to self-quarantine to ensure that they don’t develop any of the symptoms associated with coronavirus.

LF: What about protective gear?

KS: We’re trying to ration out the gloves and masks that we have. We have been able to purchase gloves. Masks, as you see in the news, there’s a shortage of Personal Protective Equipment. We are certainly amongst the people who are really feeling that. Beyond that, we’re telling all the aides to follow the appropriate CDC guidelines for proper handwashing techniques and utilization of their gloves.

LF: What kind of work-arounds are you using to make up for the lack of adequate masks?

KS: It seems you see a sort of tug-of-war on the mask topic every day, in terms of wearing one or not. We have seen some aides who have a mask encourage clients who are coughing to take it, that perhaps that might be the most appropriate move. But all you can do is to tell aides to keep as much distance as they can while working in the home, based on someone’s personal care needs. They also need to make sure they’re screening clients to make sure they’re symptom-free, and reporting that information back to us. People continue to encourage the most common sense, safe practices that they can in the face of these shortages.

LF: Obviously this is a time of great anxiety for your clients, their families, and for your professional caregivers. How are you helping to address these feelings among your aides?

KS: The first thing that we have done is ironed out some communication techniques. In every single phone call or email, I have requested that my coordinators, and even people who work in back-office functions, ask each aide each time they’re talking to them: “How are you today? How’s your family? How’s everything going at home? How are your clients?” Basically, “how are you today?” —  making sure they’re feeling heard and supported because they’re working in a vacuum.

Second, because many of our offices have transitioned to working from home now, we make sure that supplies — including gloves, masks, paperwork that aides might need —  can be brought to them where they live and work. Our coordinators are out there in their cars driving stuff to aides on the fly. We’re meeting the aides where they are to try to accommodate them so they can keep doing their jobs.

From my position, I have been emailing – not too frequently, because I want to make sure that the messaging is clear and gets heard when I do send something. I’m sending updated guidance and messages of support.

LF: I understand that Massachusetts Gov. Charlie Baker has designated these home health aides and these companions – your workforce – as essential workers. Is that correct?

KS: Yes, and it’s been a long time coming. During historic winter storms, natural disasters, things of that nature, our industry has fought hard to get that language included under the healthcare worker section, to just get our own bullet in that list. While it might sound simple, it really is a remarkable achievement for the industry – that people understand these are not just caregivers or babysitters. They are professional individuals who are helping their community from a public safety standpoint right now.

LF: Do you know whether any of the clients that you’re caring for have tested positive for COVID-19?

KS: We have not had a positive test to my knowledge. We have had a number of tests, though. And we have obviously had to keep those aides who had been working with those clients informed of the situation, which doesn’t necessarily help the standing level of anxiety that exists in the world right now.

LF: What guidance do you give aides when a client has been tested but you don’t know the results yet?

KS: They have been self-quarantining and self-screening while they await the results.

LF: Have any of your aides tested positive for COVID-19?

KS: They have not.

LF: How are your aides coping with their kids being out of school?

KS: When the schools closed, homecare was bracing for a total stoppage from the workforce. What we have found is that there is perhaps an invisible net of childcare within the aides’ families or network of friends. The prevalence of clients cancelling their service out of concern to exposure of coronavirus was far greater than the occurrence of aides who choose not to work.

LF: Many clients cancelled visits by aides?

KS: Not specifically the aides. They’re not letting anyone into their home right now. The concept of having someone come into the home right now is not something that they wanted to entertain.

LF: Are you concerned that if this pandemic continues for some length of time that it may become hard to replace aides who decide it’s too risky, or that they have to be with their kids, or who themselves become sick?

KS: Yes, but the number of people filing for unemployment right now is unprecedented. Joblessness is about to become pervasive. In times when unemployment goes up, the home care industry is typically able to embrace job seekers who would otherwise not have found or considered home care.

LF: How do you think COVID-19 will affect the demand for home health care over time?

KS: There will be more people than ever who need home health care as many recover from the virus and maybe experience long-lasting effects post-corona. There are going to be people who had been worrying about their parents for months prior to this pandemic who say, “That’s it. I am getting home care now.” The home care industry is going to come out of this pandemic with an enhanced reputation and significant visibility.