Melissa Gruber has been entering homes at a time when people have been shielding themselves indoors.

"In home care, our primary goal is to keep people in the home as safe as we can for as long as we can to prevent them from having to go to an assisted living facility or a skilled facility," said the registered nurse with Recover Health’s Winona office.

The goal can still spur concerns.

Gruber provides the first face-to-face assessment for Recover Health’s new patients, and she said that’s when she frequently hears questions about COVID-19 precautions.

"Once we get through those discussions, they seem more receptive to nursing services and other services coming into their home," she said.

Home-health providers throughout the region are adapting to care for patients in homes while working to reduce the chance of spreading the virus.

"Nursing staff, I believe, are the safest people to be entering a home, because they take all the precautions," said Matt Ebeling, an account executive at Interim HealthCare in Rochester.

In addition to regular hand-washing, sanitizing and wearing gowns and masks, the care providers said limiting the number of nurses and other staff who visit each patient helps reduce the chance of exposure.

"We have the same staff going to the same people," said Stephanie Eide, an account executive for Recover Health.

Paul Blanchard, clinical site manager for Regency Home Healthcare in Austin, said the precautions are what make him comfortable about going to homes amid the pandemic.

"My only concern is about bringing it home to my family," the registered nurse said. " I have a new baby, so I’m taking extra precautions."

Gruber, the mother of three, said she’s doing the same, even though her agency has yet to see a patient with COVID-19.

Eide said the staff is expecting to see that change.

"We anticipate a large volume of caring for those who are positive or can be assumed positive, and caring for them in their homes," she said, adding that caring for people in their homes can help alleviate pressure on hospitals needing space for the sickest patients.

As a result, the home-health agencies are preparing for increased activity.

It’s at a time when they are already reporting an uptick in calls for in-home nursing.

"We’ve had an increase of people wanting to step out of the nursing homes, step out of the hospitals, and do more care inside their personal homes," Ebeling said.

While some clients have opted to cancel or reduce visits due to concerns related to COVID-19, recent changes have made it easier for medical centers to refer patients to home care.

In the past, Medicare patients were required to be deemed homebound for health reasons, but that mandate was lifted with congressional action.

Now, anyone older than 65 needing skilled health care could qualify under Medicare guidelines.

It means clinic and hospital providers can send people home more often.

"We’ve been getting referrals from the hospital for folks they are trying to get out of the hospital who don’t need to be there," Blanchard said.

So far, the agencies report they are able to keep up with the added workload, even though the region has experienced a shortage of nursing staff in recent years.

Blanchard said he has seen some of his staff forced to choose between hours on home visits and keeping jobs at long-term care facilities that don’t want employees going in and out of homes.

"That’s been an issue with some of our staff," he said, acknowledging the concern.

At the same time, he said the Austin staff are able to continue meeting the needs of their patients.

Ebeling said the Rochester service has also been able to meet needs, as it also takes care to make sure staff has the time needed to care for patients and take precautions.

"We have to make sure we don’t overload ourselves," he said.

In Winona, Eide said Recover Health was growing prior to the pandemic, putting itself in a position to respond. She said the company is also reaching out to health care staff members who are not working due to reductions in voluntary procedures and other appointments.

"We can pick up those people to at least get them trained and ready before our surge hits," she said.