The Homestead Model: Family physician says social distancing doesn’t have to be one size fits all

The experience of a pandemic is a new one to most of us in the United States, as is the concept of social distancing. As we head toward a second full month of quarantine, the experience of stress and isolation has mounted. Single parents and only children feel the burden. Parents now are supposed to somehow be able to home-school their children while working all day from home, if they’re among those who can. When my active, social, elderly mother had to stop visiting with us, her local family, we felt it an unfair punishment, especially over the Easter holiday, as she lives alone.

But there are variations when it comes to the definition of a household. As a family physician, I have had the opportunity to learn of different models in practice by my patients, and I have come to conclude that these can be safe options for individuals and families. One of my patients is divorced with three kids and lives with her boyfriend. Her ex-husband is remarried with another child. All eight of those people are considering themselves one homestead, although the children go back and forth between two households. One of the adults works outside the house, and they designate that person to do the shopping in a cautious manner. A young couple who both work remotely full time have two, school-aged children home all day and are at wit’s end. They are considering forming an alliance with another family in a similar situation. One of the adults will oversee and teach the children, while the other three work on an alternating schedule.

These are examples of the Homestead Model. The group dictates who the members are and then ensures that all of the members agree to the Centers for Disease Control and Prevention (CDC) mandates to prevent coronavirus infection in their group. The Homestead Model is our term at Atkinson Family Practice and is not endorsed by the CDC or any medical society. I am speaking as an individual, but many people are endorsing the process and, from what I can see to date, are doing so effectively. Another patient allows her son’s girlfriend to be part of their collective. Several of my families include their elderly parents, who live separately but do not go out at all. The cornerstone is a shared agreement with all of the adults. It cannot work without mutual trust in each other. I have included the Homestead recommendation, which Atkinson Family Practice is sharing with our community.

For some people, the members of a household extend beyond one residence, including, for example, elderly parents or divorced families with shared custody. It is a reasonable approach to make a concrete list of who you include as members of that homestead if and only if:

1) All members of the family agree to strict adherence to CDC guidelines.

2) All members stick to an organized plan outlining who will leave the homestead to shop or work, based on an assessment that those members are not at undue risk of contracting the virus. Only one person should be doing the errands, and extra caution should be maintained to protect children as well as other members who may be immunocompromised, elderly or pregnant.

3) Any new member of the homestead has adhered to strict quarantine for three weeks prior to the arrangement, and no members have any symptoms of illness during that time period.

4) All rules are followed. If any member cannot adhere to the guidelines, they should be asked to leave as they put other members at risk.

5) Good judgment is exercised. Remember that the more people involved in a homestead, the higher risk of contagion to all members, so try to keep the list short.

If this is a new concept, I recommend consulting with your own primary care provider and/or your family. Not everyone is comfortable with such an arrangement. But as the days of quarantine drag on, it is nice to know that one has options.