Abstract
BackgroundHome care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. Although the HC sector is growing rapidly in the USA, there is high job turnover among the HC aide workforce. HC provides an important alternative to facility-based care, yet it has often been overlooked within the larger health care system: most recently, in COVID-19 pandemic planning. The objective of the study was to characterize qualitatively the impact of the COVID-19 pandemic on three key HC stakeholders: clients, aides, and agency managers.MethodsThe study included 37 phone interviews conducted during April – November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). All interviews were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts followed the grounded theory approach. The interview transcriptions were coded line-by-line into hierarchical themes with NVivo 12 software which allowed weighting of themes based on the number of interviews where they were coded.ResultsFear of infection and transmission among HC clients and aides were strong themes. Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch – resulting from physical distancing practices – altered the expression of compassion in the HC aide-client care relationship.ConclusionsThe findings suggest that the pandemic has further increased psychosocial job demands of HC aides. Increased isolation of clients may be contributing to a wider public health problem of elder loneliness and depression. To support the HC stakeholders during the on-going COVID-19 pandemic, for future pandemic planning or other health emergencies, it is important to improve HC aide job retention. This action could also ease the serious care services shortage among the growing population of older adults.
Highlights
Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill
The term ‘home care’ (HC) refers to the full range of home-based services performed by HC aides to assist clients with activities of daily living, including personal care services and homemaking services [4]
A recent study followed COVID-19 survivors (n = 1409) after their inpatient hospital care and upon admission to health care (HHC) services; it found that about a month later, after receiving home-based care, 94% of COVID-19 patients had been discharged and most showed improvements in symptoms and functional status [8]
Summary
Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. The HC industry applied important lessons from earlier influenza outbreaks and a wide range of recommendations by key stakeholders were brought forward to inform pandemic preparedness planning in HHC and HC [9, 10]. These sectors were still overlooked nationwide at the beginning of the COVID-19 pandemic [5, 11,12,13,14] while challenged to function above capacity to provide home service visits [15]
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