Compassionomics in Action: Professional and Ethical Issues in Home Health Physical Therapy During the COVID-19 Pandemic

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Home health physical therapy plays a crucial role in patient recovery and return to the home environment following hospitalization. Despite the significant presence of physical therapists and physical therapist assistants in home health, there has been limited research on the professional and ethical challenges they face. The COVID-19 pandemic exacerbated these challenges, including triaging patients, balancing patient rights with public safety, resource allocation, moral distress, lack of protective equipment, burnout, and organizational challenges. The purpose of this study was to explore the professional and ethical issues encountered by PTs and PTAs in home health care settings during the COVID-19 pandemic. This qualitative study employed virtual semi-structured interviews with 15 PTs (n = 12) and PTAs (n = 3) to explore these issues. Reflexive thematic analysis produced 4 major themes: the silo effect, caring for patients, pouring from an empty cup, and constant moral conflicts for individuals and organizations. Results demonstrated that the COVID-19 pandemic created new ethical and professional issues as well as magnifying pre-existing issues. This study revealed experiences similar to other physical therapy settings during the COVID-19 pandemic, as well as challenges unique to the home health setting such as the invisibility of the patient and those involved in their care. The study highlights the importance of context in shaping ethical issues and suggests the need for further research, education, and advocacy to address these challenges. Despite these challenges, the dedication and professional duty exhibited by physical therapists and physical therapist assistants during the pandemic were commendable.