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Health care workers who provide their services at people's homes know they are treating patients who are most at-risk of lethal complications associated with the coronavirus.
But they also know for many of their patients to stay healthy and out of a hospital, they have to receive regular services from providers.
And the patients know the risks as well. With the COVID-19 pandemic forcing nationwide social distancing orders and stay-at-home orders, some are reticent to allow people - even their own nurses and caregivers - to come into their homes.
Where possible, home health companies across the country are experimenting with providing telehealth visits to their patients to avoid transmitting the virus to them. Others struggle to obtain all the protective equipment they need for in-home visits.
It's a balancing act, Jefferson City home health providers say.
The industry provides essential services, according to Brandi Crane, public relations manager for Phoenix Home Care and Hospice, which has an office at 500 Broadway St. in Jefferson City.
The pandemic has changed routines for the company's staff and clients.
"It has created disruption in our normal flow of business," Crane said. "We are trying to educate our clients and patients on the safety of staying at home and keeping their services. We're trying to keep our critical care patients covered."
Many have called and said they are concerned about letting caregivers in their homes, she said.
"We have told them the importance of us continuing their care," Crane said. "They could end up in a hospital (without continuing care). If they allowed one of us into their homes, they can remain healthier."
Home health care providers may offer a range of services, although home health care most often refers to home care that involves skilled medical assistance.
Services may include helping older adults with activities like bathing, dressing and eating. Services may include occupational and physical therapy, speech therapy and skilled nursing.
Data about the virus indicate it is more likely to cause severe illnesses or death in older people or people with underlying health conditions - both of which are common clients for home health care providers.
Companywide - in four states, Colorado, Illinois, Kansas and Missouri - Phoenix Home Care and Hospice has 3,500 employees and 5,600 patients.
It is mandatory within the company for employees to complete online COVID-19 training to continue providing services to clients.
"Education has been provided on the proper personal protection equipment, sanitation and all protocols to keep themselves and our clients safe," according to the organization's website, phoenixhomehc.com.
"As a home care provider, we are part of this plan to help people remain safely in their homes and reduce the risk of exposure during this time," company owner and President Phil Melugin wrote to patients. "With our caregivers and clinical staff continuing to serve our clients, we are able to decrease the need for people to leave their home to complete errands, such as grocery shopping and picking up medications."
Staff members talk every morning about the evolving changes that come with the pandemic, Crane said.
"Our entire leadership team works out of their local office. We have 15 local offices," she said. "If staff needs anything, we ask them to give us a call, and we meet them outside. As long as our client is comfortable and we can give them peace of mind, we'll give them comfort."
Elara Caring Home Health serves hundreds of patients in and surrounding Jefferson City, according to Chris Hardman, senior vice president of communications. Elara is one of the nation's largest home health care providers.
The pandemic represents a challenging time for the home health industry, whose patients need them more than ever, Hardman said. The safety of health care teams and their patients is a priority.
"We follow all (Centers for Disease Control and Prevention) guidelines, and our caregivers go through daily checklists regarding their own health before they go into patients' homes," he continued in an emailed response to the News Tribune. "For now, we have a sufficient supply of (personal protective equipment) for our caregivers, and they currently have the necessary tools to continue to provide quality care to our patients here and across the nation."
Elara launched a telehealth service early last week, allowing it to provide services using virtual technology, Hardman said.
Home health care providers aren't limited to serving elderly patients. ResCare Homecare in Jefferson City serves clients with intellectual disabilities. Its clients are higher functioning, according to Madelyn Mike, VERIFY program manager.
The company provides services for four clients in their 20s and 30s.
"They don't have family who come to see them," Mike said. "They are used to getting out into the community."
One volunteers at Capital Region Medical Center. He's not able to do that right now, she said.
"They are very bored. Two have accepted that they can't just go into stores right now," Mike said. "They are confused."
Staff members at ResCare provide games for their clients to play and take them for walks in the yard - sometimes venturing out into the neighborhood. They try to avoid contact with other people on walks.
That only lasts a brief time before the clients want to move on to something else.
"I have three homes here (in Jefferson City) that I have to buy a lot of food for," Mike said. "Toilet tissue is a big issue right now. I'm having trouble getting it right now."
Anyone who can donate toilet tissue or hand sanitizer to ResCare in Jefferson City is asked to call the office at 573-635-5085.