Home health care during a lockdown

Even before the two-week lockdown, more and more Nepali families with elderly relatives hired nursing care at home. Several companies had started up as demand from the Nepali diaspora added to the need for home caregivers. The COVID-19 lockdown had accelerated this trend.  

Srijana Paudel (pictured above), 21, a certified nurse has been looking after a bed-ridden elderly woman in Lalitpur for more than six months. But on 23 March, when Prime Minister K P Oli went on television to announce a nationwide lockdown from 6 AM the next morning, she was in a fix.

While hospital workers and ambulances are allowed on the roads, many nurses taking care of elderly or sick family members could not commute to and from their own homes anymore. So, Paudel has been forced to stay over at her patient’s home for the past ten days, without being able to take care of her own family.

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“I feel bad not being able to return to my home and be with my family, but looking after someone more vulnerable is my duty as a nurse and I will make my best effort to protect them,” Poudel says. “It would make me feel more guilty if I stayed home. I have become close with my patient’s family, so that helps.” 

There are over 200 nurses and caregivers like Srijana Paudel from various home care services in Kathmandu working in private residences of elderly patients. Seniors and patients with pre-existing medical conditions such as asthma, diabetes, or heart disease are more vulnerable to becoming severely ill with the novel coronavirus, making the need for the home caregivers even more critical. 

Rupa Joshi of Bag Bazar has two elderly relatives to look after in her household: a 105-year-old grandmother-in-law and a mother-in-law who is 90. Both require special assistance. 

“We had been on self-quarantine even before the lockdown to protect elderly family-members and reduce the risk of contamination,” says Joshi who has asked her mother-in-law’s caregiver to stay with her own family until the lockdown is lifted to avoid contamination. Another caregiver has been asked to live-in so she does not catch the virus during her commute. 

“Our caregivers are like family members now, and in this difficult situation we have to help them, and accommodate their needs too,” Joshi adds.  

While some home care services had drawn up a contingency plan two weeks before the lockdown, other health providers have had to change their schedules overnight to cater to patients since the shutdown.  

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At Patan based health care service Medilink, Sushmita Khanal has been working non-stop from her home to cater to her clients and also address the needs of her caregivers who look after older patients. 

“We knew COVID-19 and the lockdown was inevitable, but I wish we had more time to buy equipment and medicines and plan effectively,” Khanal said over the phone. 

Home care had already become a trend in Nepal even before the pandemic scare as family members worked fulltime, and there was no one to take care of elderly relatives. The job has become even more challenging and necessary during the lockdown.  

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Bishal Dhakal was a resident surgeon in Pakistan, and returned to Kathmandu in 2009 to start a health service provider, Health at Home. Although his clients need services now more than ever, he says the economic downturn may affect the ability of families to hire services like his.  

“We have clients from all backgrounds, but since most of them work on monthly salaries we can foresee many clients cancelling their contracts in the next couple of months,” says Dhakal. 

Fearing a slump, Dhakal’s Health at Home, Sushmita Khanal’s Medilink have put off expansion plans in their businesses. However, their central focus continues to be in giving best possible service to existing patients during the lockdown, and communicating virtually with caregivers and nurses on preventing the virus from infecting the elderly. 

While most caregivers and nurses are trapped in the homes where they work, the service providers have managed to get limited transport permits to pick and drop some staff who have families to take care in their own homes. 

Like Rupa Rai, 22, a nurse at Medilink Health Care who finally got back to her own family after being trapped in her patient’s house for nine days. She says: “I didn’t bring spare clothes, but now I am more prepared mentally for an extended lockdown.”