Discussion
This case study has highlighted a challenge that could arise in-home
care particularly when a caregiver is exposed to an infectious disease
like COVID-19. While a caregiver was isolated due to COVID-19 infection,
a patient was left unattended by other family members and the care
center as she was exposed to the infected person. The patient could have
faced a huge risk if we had not provided timely support.
Long-term care insurance in Japan is based on the premise of family
care. However, when an informal caregiver becomes infected with
SARS-CoV-2 or any other disease and is quarantined in a hospital or
other institution, there would be no one to care for the patient as in
this case. It is particularly difficult to find alternative caregivers
when the patient is exposed to COVID-19 infected person. Moreover,
staffs of day-care and home care facilities are not necessarily trained
in medical countermeasures against infectious diseases, making it
difficult for them to take care of those with close contact with a
COVID-19 patient.
In this case, the home nursing station staff visited the patient with
infection control measures in place. For example, protective clothing
was worn when entering the room, the nurse in charge of this case was
separated from the nurse in charge of normal duties, and an office was
set up exclusively for the nurse in charge of this case. Thus, in
countries with home care systems, including Japan, it may be necessary
to establish flexible rules for dealing with close contact with a
COVID-19 patient, such as allowing public services to intervene in home
care with infection control.
Luckily, in this case, the patient was not in a critical condition.
However, for terminally ill patients, who are usually in critical
condition, disruption of care could pose a high risk. Home care became a
necessity in Japan particularly during COVID-19 where there is a
constant rise in cases, difficult hospitalization, and shortage of
health workers and beds. 6 However, while emphasizing
the importance of home care, it is equally important to expand home care
measures particularly during COVID-19 pandemic, as underlined by this
case.