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.