Q. My grandfather lives alone and is housebound. He has a housekeeper and a caregiver who do everything for him. His housekeeper just discovered (and a pest control company confirmed) that he has bed bugs. How can that be? He never goes out anywhere so how could he pick up bed bugs?

A. With bed bugs, it’s a two-way street. Your grandfather doesn’t have to go out to get bed bugs. They can come to him…in more than one way. Anyone who comes into your grandfather’s home is a potential bed bug carrier because bed bugs are notorious hitchhikers. That’s one way that bed bugs spread. They will crawl into or lay eggs on suitcases, purses, tote bags, briefcases, furniture, clothing, equipment, etc. and are then carried to new locations.

That doesn’t necessarily mean that your grandfather’s caregivers are responsible or that they have bed bugs in their own homes. They could have picked up bed bugs at the home of a previous client and unknowingly carried them on their clothing, personal belongings, or service equipment to the home of their next client.

Visitors to your grandfather’s home, delivery people, contractors, repairmen, medical personnel, maids—anyone could have brought in bed bugs. Anyone who performs regular client in-home services that require spending time in sleeping or living areas is susceptible to bed bug infestation. Service people that visit several residences in a single day are at greatest risk for picking up bed bugs in their customers’ or clients’ homes. And it’s not just people that are implicated. Although less common, goods and furniture that are delivered can be harboring bed bugs as well. Bed bugs have even been found in library books.

There’s another possibility, too. You don’t say whether your grandfather lives in a detached home or in an apartment or condo. If he’s in multi-family housing, bed bugs can also come from neighboring units or the units above or below. In fact, this would be the most likely way for bed bugs to end up in his home. Bed bugs can move easily from one apartment to another through pipe or wiring runs, or through wall and ceiling voids, or by simply walking down the hallway, in much the same way as cockroaches move throughout a building. We know that bed bugs can move surprisingly fast: nymphs up to 11 inches per minute and adults up to 50 inches, or more than 4 feet per minute. Overcrowding, lack of a host to feed on, or any kind of disturbance could cause bed bugs to migrate to new locations.

Your grandfather has probably had the bed bugs for some time if the population has grown large enough to be easily noticed. Once the bugs are introduced into a home, their secretive and cryptic lifestyle may allow them to remain undetected for several months, and longer in many cases. Decreased awareness of bites and poor eyesight in the elderly contributes as well. So it’s impossible, at this point, to say how the bed bugs got there or who might have brought them in. What’s important now is to have a reputable pest control company eliminate the infestation both for your grandfather’s sake and so that his caregivers don’t transport bed bugs to other accounts.