In the face of the COVID-19 pandemic, hospitals and health systems are exploring ways to increase their capacity. One of these approaches involves offering home-based programs for people who qualify.  Mount Sinai Hospitalization at Home provides hospital-level care in the homes of patients who might otherwise need to be in the hospital. Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, answers questions about how Mount Sinai’s Hospitalization at Home program is adapting to COVID-19.

How does the Hospitalization at Home Program work?

A team of doctors, nurse practitioners, registered nurses, and other professionals treat and monitor your health at home for a condition that would have usually been treated in the hospital. We communicate regularly with you both in your home and by video chat. That way you don’t have to leave your home and compromise social distancing. We deliver and provide medication, routine lab tests, and durable medical equipment and IVs. Social workers are also available to coordinate care and provide access to social resources.

Our staff are available 24/7 to answer any questions or concerns you might have. Following discharge, we will follow up with you or your loved one as determined by your health plan.

Has COVID-19 changed any of the Program’s requirements? 

We have begun accepting COVID-19-positive patients into the program after spending a few days in the hospital first, when appropriate. In addition, since the pandemic began, we have been able to accept more patients across the Mount Sinai Health System and more insurances. At this point, we can accept almost all health insurance plans for COVID-19 care.

 How do I qualify for the Hospitalization at Home program?

Most patients enrolled in our Mount Sinai Hospitalization at Home program came to us through the emergency room or after a few days in the hospital. In general, patients eligible for this program still require hospital level care. You may also need to meet other medical, geographic, and social criteria to ensure that the program is safe and appropriate for you. In addition, we require that you live in a stable residence that meets your needs for safety, shelter, and basic utilities.

If you qualify for admission, your provider will meet with you and your family to review the program and obtain consent. Your provider will then write an admission note with orders for care and arrange transportation home, usually by ambulance.

COVID-19 is a concern for everyone. But the elderly may be at increased risk of contracting this virus–or developing a bad case of it. Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, shares information that the elderly and their caregivers can use during the time of COVID-19.

How can the elderly protect themselves from COVID-19?

The best plan is to avoid contracting the virus. To protect yourself, follow the guidelines from the Centers for Disease Control and Prevention. That means stay home as much as you can. Wear masks and gloves if you must go out in public. Make sure home health aides and any family wash their hands when they come into your home. And, keep in close communication with your doctors and health care team so that you can notify them immediately of any new symptoms.

Should older adults make plans for what to do if they get sick?

It’s always good to think ahead if you can. Now is a good time to talk about the “what ifs” and begin your advance care planning, if you have not done so already. The social workers at your hospital can help. You should also tell your loved ones what your wishes are.  

How can I avoid social isolation and depression?

This is always a concern for people living alone—and even more so now with widespread directives to practice social distancing. Fortunately, we’re in much better shape to address this potential for loneliness now than we were even ten years ago. Use Skype, FaceTime, Zoom, or other video chatting technology as much as you can to connect with loved ones.

It also helps to keep as close to a normal routine as possible. Make your bed every morning and don’t let dirty dishes sit in the sink. Get some exercise, either in your home or by taking a walk, while maintaining social distance. This is also the time to try activities that you don’t usually do: paint a picture, play an old-fashioned board game, piece together a 1000-piece puzzle, read that novel that’s been sitting on the shelf. Equally important, try to limit how much time you spend reading or listening to the news.  

Additionally, you might want to get to know your neighbors and talk with them about emergency planning. If your neighborhood has a website or social media channel, think about joining it for access to people and resources nearby.

While it is true that the available data shows that older adults—and those with serious illnesses—are at somewhat greater risk for severe outcomes if they contract COVID-19; it is important to remember that many older adults will not get the virus. And, among those who do, most will survive. Remember, this will pass. We will get through this together.

A leader in geriatric medicine, R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, shares information that older people and their loved ones need to know about physical distancing in the time of COVID-19.

Are there any special steps that older people should take?

Because COVID-19 is so contagious–carried in droplets in the air and lingering on surfaces–we should all practice physical distancing. This is the term the World Health Organization (WHO) now wants us to use instead of “social distancing.” The idea is that we want to maintain a physical distance of at least six from the nearest person, to avoid infection. But we also want to maintain social and emotional closeness with friends and family, because that is also crucial to our well-being.

Distancing means that older adults should limit the number of visitors who come into their home or apartment, and this can be particularly hard. It means that children, grandchildren, even young adults, should not be visiting.

And it means that older adults should go out only when they can be assured that they can practice physical distancing and, if at all possible, should avoid going to grocery stores, riding public transportation, or going out for meals or religious services.

What about the emotional toll of this kind of self-isolation?

One of the things that many people worry about, including me, is the risk of depression. What can we do to prevent that from happening? First of all, if an older friend or relative is self-isolating in their home, call them frequently, and don’t just talk about COVID-19, talk about normal things.

Have different people call, so it’s not always the same person. Use video calls whenever possible, so grandparents can see their grandchildren and talk to their grandchildren–hear what’s going on in their lives.

What can older adults do to protect their mental well-being?

Stream movies, and watch TV, but try not to focus on the news. When we are exposed to minute-by-minute coverage of COVID-19, it can really increase our anxiety. Check in a couple times a day as to what’s happening in the United States, your community, and the world, but then turn to something else. Nothing is going to happen that you’re going to need to respond to immediately and that won’t still be there when you turn the television on again in say six or eight hours.

Are there any signs of depression to watch out for?

It’s important to realize that depression presents differently in older adults. Older adults may not experience it as sadness. What they may experience is loss of appetite, weight loss, difficulty sleeping, tiredness and fatigue, and sometimes memory problems. These are the things that both adult children and their parents should be watching for and self-monitoring, and if any of these develop, that’s the time to call your doctor right away so an intervention can be made, and treatment can be started before things progress.

What can I do to boost my immunity to COVID-19?

Unfortunately there is no magic pill that can rapidly boost your immune system. However there are things that you can do: Make sure you’re getting enough rest and sleep. Eat well. Stay well-hydrated. Exercise. This becomes hard in a setting of physical distancing, but there are things you can do. Use a stationary bike or a treadmill if you have them in your home or apartment. Go out for long walks in the community, or out in the park, at a time when few people are around, and make sure you stay six feet away from the nearest person.

Finally do everything you can to minimize your stress and anxiety in this very worrisome time. Steps you can take are limiting your time on social media, particularly the time you’re focusing on COVID-19 on social media. There is a lot of misinformation out there, and there are a lot of very, very scary posts. Instead, keep up-to-date by looking at the data. Look at the websites of the Centers for Disease Control and Prevention, WHO, your state and local health departments, and Mount Sinai, and also your local newspaper and one of the reputable national newspapers or news television shows.

What kind of supplies should I have on hand?

I would recommend that older adults have a 30-day supply of food, medicine, and other essential items. That’s a 30-day supply, not a six-month supply, of toilet paper.

Any more thoughts on the COVID-19 crisis?

We as a community, we as a country, and we as the world have not gone through a global humanitarian crisis like this in our lifetime. But we will get through this. We know what to do to control COVID-19. If we wash our hands thoroughly and often, disinfect high-contact surfaces, and rigorously practice physical distancing, we will get through this, and we will get through this well.