**2. What did home care do differently in Brazil?**

Home Care providers needed to take additional steps to keep patient care at home and to ensure a safe environment for patients and professionals. Each institution adopted targeted measures and Home Doctor, a private home care company, became a Brazilian reference on this topic. The main measures adopted were as follows:

#### **2.1 Environment measures**

With regard to the COVID-19 pandemic, patients in home care have an advantage. As they are naturally in isolation at home, it is possible for them to strictly follow the recommendations of keeping distance from other people, especially those with any suspicious symptoms while staying in a ventilated and clean environment with rigorous hand hygiene and the use of individualized materials (**Figure 2**).

**Figure 2.**

*Main environmental benefits: A - ventilated environment; B - environment cleaned with 70% alcohol; C - strict hand hygiene; D - individualized kitchenware; E - individualized hygiene utensils; F - face mask; G - privative room; and H - social distancing.*

Physically, the home environment is the best place to reduce the circulation and spread of the virus and patients in home care take advantage of this evident benefit.

#### **2.2 Professionals and training**

Patients under home care are treated by a team of skilled professionals in a directed way in order to receive exactly the assistance needed by a qualified team trained in the use of personal protective equipment (PPE) with rational optimization of the number of home visits depending on the patient's clinical condition.

These professionals receive training on topics related to the pandemic so as to inform professionals regarding the recommended protocols, as well as to provide the emotional and psychological support necessary for caring in this critical scenario (**Figure 3**).

#### **2.3 Personal protective equipment (PPE)**

The professionals who work at home care services undergo periodical training about how to use PPE, regarding the criteria of indication, and in the techniques for putting on and taking off the PPE (**Figure 4**).

#### **2.4 Telemedicine**

Telemedicine was regulated in Brazil on an emergency basis at the beginning of the pandemic. In this way, home care companies that were not structured for virtual care had to quickly prepare themselves, acquire secure telemedicine platforms, train their employees, guide patients and family members, and implement this resource in practice.

Virtual consultations have become routine for many professionals in order to reduce the flow of professionals in patient homes and the circulation of these professionals (**Figure 5**).

Telemedicine played an important role in home care during the pandemic in Brazil because it made it possible to replace regularly scheduled visits and to minimize the circulation of professionals in the patient homes. It also showed itself to be a valuable resource for more rigorous and close follow-up of patients with more complex clinical conditions and patients infected with COVID-19. The monitoring done by the physician using telemedicine enabled a faster decision-making process at the first sign of clinical decompensation, optimizing treatment, reaching a rational use of scarce ambulance resources, and ultimately providing a better care of the patient at home with reduced levels of hospitalization.

**Figure 3.** *Two training spheres.* *Home Care as a Safe Alternative during COVID-19 Crisis DOI: http://dx.doi.org/10.5772/intechopen.98529*


#### **Figure 4.**

*Definition of PPE use and training protocol regarding putting on and taking off PPE.*

#### **Figure 5.** *Teleconsultation.*


#### **Figure 6.**

*A COVID-19 patient remote monitoring (blood pressure, heart rate, temperature, glycemia, oxygen saturation).*

#### **2.5 Remote devices for monitoring**

Vital signs such as blood pressure, heart rate, temperature, and pulse oximetry can be measured by the patient using Bluetooth wireless devices, which are transmitted in real time to a monitoring center (**Figure 6**).

Additionally, patients using mechanical ventilation may have their ventilation monitored remotely through equipment with this real-time transmission feature. This resource, which had already been utilized on a smaller scale for home care in Brazil, began to be used more widely during the pandemic. It allows real-time visualization of patient ventilation monitoring so that decompensations are quickly identified, allowing adjustments to be made in an agile manner, and consequently improving patient care and optimizing the deployment of resources to the home (**Figure 7**).
