Home care in Germany during the COVID-19 pandemic: A neglected population?

Abstract

Older persons and those with pre-existing conditions are at the biggest risk for severe illness and death from COVID-19. In Germany, more than 3.3 million people out of this population receive care in their own homes. User representatives and nurses have criticized health policy during the COVID-19 pandemic as inappropriate for the home care setting. This policy analysis, therefore, aims to answer the question, which policy changes should be made following Bardach's framework. Home care in Germany is mainly funded through the statutory long-term care and statutory health insurance funds. It focuses on compensation of physical functioning, selected therapy-related tasks prescribed by a physician and is not well integrated with acute and primary care. The pandemic highlighted the following challenges: nurses are excluded from policy decisions; epidemiological data from the home care setting is lacking; nurses do not have prescribing authority for vaccines; user and family education is not made available; home care-specific guidance on infection control and prevention is absent and the home care setting is underprepared to care for acutely ill patients. Nurses need to be included in policy decision and authorized to adopt more responsibility in home care than currently possible. Home care-specific policies and guidance are needed and integration with primary care should be sought. Changes to current policy in the identified areas could make the health system more resilient to future crisis. Older persons and those with pre-existing conditions are at the highest risk for severe illness and death from COVID-19 and most of them receive care in their own homes in Germany. Improving health policy governing home care, improving the availability of valid data and evidence, and improving the delivery of home care during the pandemic will contribute to better outcomes.