Home nurses in demand

On a Sunday in Nairobi’s Karen, a nurse walks into a home with Covid-19 patients. She is given new gloves, two masks, protective gear (PPE suit and a face shield mask.)

Three of the family members have coronavirus with mild to severe symptoms and are isolating at home.

She then walks to each bedroom to check the patients’ temperatures, oxygen levels and sore throats. After ensuring that they are recuperating well, steaming daily, and taking Vitamin C and Zinc supplements, she leaves and comes after two days to the same routine.

This is a remarkably busy time for nurse aides and patient assistants who have had to pick extra shifts in people’s homes since the pandemic began.

The lack of hospital beds, fear of staying in lonely hospitals and the cost of hospital bills mean that those isolating are hiring nurses, some of whom work in Covid-19 units.

Naom Monari-Ajwang’ is one of those who has found success in home clinical care. In 2017, she started Bena Care, an agency assisting patients with life-limiting illnesses and the old, enabling them to live as independently as possible in their homes.

“When I started Bena Care, I had a difficult time explaining to people what I was doing,” Ms Monari says.

“They found the service unnecessary because hospitals were readily available. Then the Covid-19 pandemic became the bell ringer that has made people understand what it is we do.”

As a nursing student, Ms Monari encountered patients who had accrued huge bills due to extended hospital stays for non-urgent medical care since there was no expert to attend to them at home. This prompted her to start Bena Care, which is now serving Covid-19 patients and others with chronic diseases.

50 patients

Labib Hospital in Nairobi’s Eastleigh has also been providing home-based care for the past three years. It started slowly with the hospital sending out 10 nurses and nurse assistants per month for palliative care.

With Covid-19, demand has skyrocketed. By last week, Labib nurses and nurse assistants were taking care of more than 50 patients in different homes in Nairobi.

“There are no beds in hospitals. Even us we’re full at the moment. If you’re not critically ill, doctors send you home and we assign you a nurse and a patient attendant especially if you need oxygen monitoring,” says Ashiundu Khayumbi, Labib Hospital administrator.

A nurse always accompanies a patient attendant. Nurses are the eyes and the ears of the doctors as they are qualified to administer medication and injections, check oxygen levels and cannulation (insert tubes inside the body). Patient attendants, on the other hand, feed, bathe, turn the patient in bed, and change wound dressing.

“Hospital bed charges are expensive. If the patient is stable enough, they can be monitored at home,” he says.

For fear of contracting Covid-19 in hospitals, more people with underlying diseases such as high blood pressure and diabetes, are also seeking home care.

“The reality is one might come to a hospital with a minor disease and leave with Covid-19, a big, life-threatening problem. Who wants to take that risk except for health care professionals?” poses Mr Khayumbi.

New jobs

For years, several Kenyans in the US have been making a living as certified caregivers to the old and the terminally ill. The trend is gradually catching up in Kenya, albeit the lower pay. The patient assistants are hired to help the sick bathe, take walks, read a book, play puzzles and games.

Per hour, a certified nurse assistant earns about Sh1,200 to Sh3,800 and between Sh3.2 million to Sh4.2 million a year.

In Kenya, it was the affluent who paid a premium for a luxury pursuit like hiring a personal nurse. But now more families have been forced to as home-based care provides privacy, ease of flow of information between the doctor, patient and family.

“Not forgetting that healing is also psychological. You’re surrounded by family unlike in a hospital where a next-bed neighbour’s death makes you think you’re next,” Mr Khayumbi adds. Then there is the inconvenience of hospital visits, traffic jams and restricted visiting hours.

Ponea Health, a Dutch-based firm with offices in Nairobi is leveraging on technology to eliminate the need to go to the hospital for minor emergencies.

“We offer patient concierge services. Patients get access to healthcare services within minutes,” says Kui Kamau, the brand awareness lead.

Ponea Health has been in existence for six years but launched operations in Kenya in December 2020 seeking to capture concierge care. These patients pay for direct access to their doctors, to avoid sitting in hospital with strangers.

During the third wave, the firm started offering Covid-19 testing at home or hotels, post-Covid recovery care as well as doing medical check-ups on domestic staff and the old.

Customers are paying for Covid-19 home nursing and at-home doctor visits, Covid and post- Covid physiotherapy breathing services, and pulse-oximeter checks.

Others order for sanitisers, masks, and thermometers, in addition to home fumigation after the isolation period and drugs prescribed by doctors, all from the comfort of their beds or couches.

“So far, Ponea Health has served over 1,200 clients over the past four months since last December with at least 60 per cent customers being repeat clients,” Ms Kamau says.

Their clients are corporates, individuals or families who require either clinical nurses or patient attendees.

Bena Care, on the other had receives an average of 2,100 calls with more than 10 percent of them related to coronavirus. The most peculiar request was an Intensive Care Unit (ICU) to be set up in a patient’s home.

“People are not aware that an ICU works in a space that is sterile, has supporting equipment, and intensive care doctors. You may have the equipment but about the medical personnel?” Ms Monari says.

She shares another case of a client who called their office seeking a patient attendant. They had been duped into buying oxygen and other medical supplies under the guise that they could manage the patient at home by themselves.

“It was only later that they realised they needed a qualified nurse to assist in caring for the patient,” she says.

Now Ms Monari has five nurses on Covid-19 watch duty and has catered to 1,900 patients since she started the business, some staying for as long as two years with one client.

The high demand for home care has seen more nurses secure jobs and earn extra income.

Sh8,000

On average, a nurse earns Sh8,000 and a patient assistant earns Sh4,000 a day.

“Nurses are currently getting more business. For instance, Ponea Health has brought on board several nurses helping about five clients a week,” says Ms Kamau.

Besides the daily rate, the client provides food, buys medication, PPEs and other medical necessities used by the patient. Nurses and their attendants normally work in 12 hours shifts. If one is required full-time, the client must provide accommodation.

With the increase in chronic diseases, home care nursing can be the fastest-growing job category.

Weaknesses

But even then, there are weaknesses. There are many uncountable private hiring arrangements known as the gray market, there is no clear regulation and insurance companies do not pay for home-based care packages, yet they are cheaper in the long term.

Between June 2020 and January 2021, it is estimated that about 50 home-based agencies were registered.

“Demand is high. The government should train more patient attendants in rural areas to ease the burden on patients. We have patients who incur extra costs staying here in Nairobi for medical care that can be offered by a patient attendant back home,” says Mr Khayumbi.

To qualify to be a nurse or patient attendant, one must have a diploma or a university degree. Specialised nurses must hold post-graduate documents in fields such as cancer or diabetes.

“Besides a diploma or degree, add compassion and keenness to understand verbal and non-verbal communication from a patient. It is these non-educational qualities of patient attendants that separate the wheat from the chaff,” Mr Khayumbi says.