The great “essential services” debate

By Gloria Escalona |

I have an independent mobile business providing foot care nursing to at-risk elderly and other foot-care-challenged individuals in their home or facility. The question is now though, should I visit them? 

With the prolonged sheltering-in-place (SIP), people are calling who, prior to COVID-19, would never have called—like the dancer with painful pincher nails because she was unable to get an appointment with her podiatrist or nail salon. Among my colleagues, there is controversy as to whether mobile foot care nurses (FCNs) should be considered “essential.” My response has been that FCNs provide an essential service, but whether the visit should be immediate, routine, or deferred—well, that really depends. 

I’ve used the following criteria during the initial phone interview to determine if FCN service is essential. The more criteria met, the more urgent the call. 

1. Diabetes mellitus or potential for adverse outcome
2. Elderly or may affect patient safety or ability to function
3. Time sensitive
4. New onset pain

In the heart of the pandemic, I received a call from an 88-year-old with long-standing diabetes who lives in an assisted living facility. Unfortunately, during SIP, his primary care physician, podiatrist, AND nail technician refused to address his painfully long nails. I determined a visit was essential due to diabetes and a great potential for an adverse outcome. 

Although a 45-minute drive away, the facility was within my territory, and I knew he needed help immediately. I donned an N95 respirator, took my supply cart, assessment tools, bag of paperwork, and went in. A staff person took my temperature with a digital non-contact thermometer (I was 960F), and I completed and signed a form about my health and COVID-19 exposure. I laughed at the part that asked if you have been to a COVID-19 high exposure area within the last 14 days. I asked, “Does San Francisco count? Or living in California?” The person was not amused. I said, “Okay…” and checked no. 

A complete assessment found his long thin nails had curved and cut into the flesh of several toes on each foot. Each nail clipped relieved pressure and pain. When I finished, he ecstatically wiggled his toes and said, “It’s like having new feet!” 

People call an FCN because they are unable to safely care for their feet themselves, and prolonged periods of inattention put them at high risk for loss of mobility, function, or even a catastrophic event. When hospitals, emergency rooms, and urgent care facilities and personnel are overwhelmed, should I suggest the family bring their wheelchair or bedbound loved one to the emergency room or call an ambulance? My goal has always been to alleviate their problems—not add to them. Of course, with each home or facility visit, I am afraid I might expose them or myself to COVID-19, but their need did not suddenly end because of a SIP mandate. Taking that risk is my duty.  

 

Gloria Escalona, DNP, RN, PHN, WCC, CFCN, CFCS, is a Wound and Foot Care Nurse Specialist and operates Nightingale Senior Care, LLC aka The Foot Mobile in Daly City, California, USA. She is a member of Sigma’s Alpha Gamma Chapter at San Jose State University in San Jose, California, USA and Mu Nu Chapter at California State University-Fresno in Fresno, California, USA. 

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