Abstract
BackgroundDuring a disaster, home-based care fills the critical need for continuation of health care. Home-based care is intended to function using existing care delivery models, continuing to provide care for patients wherever they are located, including in shelters and hotels. Home-based care providers are often the closest in contact with their patients —seeing them in place, even throughout a disaster— through which they develop a unique insight into aging in place during a disaster. The purpose of this study was to identify individual and community-level support needs of older adults after a disaster through the lens of home-based care providers.MethodsUsing qualitative inquiry, five focus groups were conducted with home-based care providers (n = 25) who provided in-home care during Hurricane Irma and Hurricane Harvey. Participants were identified by contacting home health agencies listed in an open-source database of agencies participating in Centers for Medicare and Medicaid Services programs. Data were coded using an abductive analytic approach, and larger themes were generated in light of existing theory.ResultsThe results were distilled into eight themes that related to the importance of community and family, informal and formal supports throughout the disaster management cycle, maintaining autonomy during a disaster, and institutional and systemic barriers to obtaining assistance.ConclusionsIn this study, home-based care providers described the challenges aging adults face in the response and recovery period after a large-scale disaster including maintaining continuity of care, encouraging individual preparedness, and accessing complex governmental support. Listening to home-based care providers offers new and important insights for developing interventions to address social and health needs for older adults aging in place after a large-scale disaster.
Highlights
During a disaster, home-based care fills the critical need for continuation of health care
In 2017, Hurricanes Irma and Harvey critically damaged coastal communities in the Southeastern United States, with Harvey alone causing $125 billion in damages [1, 2]. Events such as these are becoming more common as the effects of climate change advance
The guide was refined through pilot testing with qualitative experts initially and with a small group of registered nurses
Summary
Home-based care fills the critical need for continuation of health care. The purpose of this study was to identify individual and community-level support needs of older adults after a disaster through the lens of home-based care providers. In 2017, Hurricanes Irma and Harvey critically damaged coastal communities in the Southeastern United States, with Harvey alone causing $125 billion in damages [1, 2]. Events such as these are becoming more common as the effects of climate change advance. While we know anecdotally that older adults are at greater risk for adverse consequences from disasters, limited research exists to provide evidence of this effect. Maintaining health and healthcare in a disrupted environment after a disaster can predispose chronically ill older adults, who have a need for access to regular and uninterrupted healthcare, to even greater morbidity [4]
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