“At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID‐19

Abstract

Background/Objectives COVID‐19 required rapid innovation throughout the healthcare system. Home‐based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands‐on, model of care to accommodate restrictions on in‐person contact. Our aim was to determine strategies used by New York City (NYC)‐area HBPC practices to provide patient care during the first wave of the COVID‐19 pandemic with the goal of informing planning and preparation for home‐based practices nationwide. Design Cross‐sectional qualitative design using semi‐structured interviews. Setting HBPC practices in the NYC metro area during spring 2020. Participants HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC‐area practices. Measurements Semi‐structured interviews explored HBPC practices' COVID‐19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end‐of‐life care, telehealth, community‐based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach. Results Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID‐19, such as patient outreach and telehealth. HBPC‐specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in‐person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long‐standing patients. Conclusion NYC‐area HBPC providers adapted care delivery and operations rapidly during the height of the COVID‐19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.

Home palliative care professionals perception of challenges during the Covid-19 outbreak: A qualitative study

“…Obstacles in doctor-patient communication due to personal protective equipment and social distancing complicated the professionals' daily routine. 12,36 Some challenges were reported as well in healthcare procedures and operational functions, as reported by Franzosa et al 37 who highlighted that keeping patients "at home with care" during the pandemic included both patient-faced and practice-faced challenges. These dynamics created a high emotional burden in home palliative care professionals, according to the literature showing how continuous changes, overwork, and the fear of infection may negatively impact on the physical and psychological health of healthcare professionals, leading to anxiety, depression, burnout syndrome, and other mental health concerns.…”

“…6,37,43 The healthcare team represents another resource. As reported in a study on home care professionals, 37 our findings confirmed that team connections played an essential role for the home palliative care professionals, both in terms of the clinical management of patients and their emotional support. However, other findings on hospital staff reported a lack of communication between colleagues and challenging relationships within the staff during the pandemic.…”

“…Flexibility should be fostered in healthcare organizations and stimulating improvisation and innovation in organizational culture may be a strategy for preparing healthcare workers in an emergency crisis. 54 The healthcare team played an essential role for home palliative care professionals, 37 both in terms of the clinical management of patients as well as their emotional support. It seems a good strategy to promote meetings and debriefing sessions among healthcare workers during an emergency situation.…”

“…Lastly, the data collected suggests fostering community-based palliative care within healthcare planning during the Covid-19 pandemic and for post-emergency scenarios. 37,48 The relocation of healthcare services to patients’ homes should be considered as a safer and effective model of caring for frail people, even after the pandemic. 17…”

“…Previous studies highlighted the importance of the operational flexibility in home primary care and home care for advanced cancer patients during the pandemic. 6,37,43 The healthcare team represents another resource. As reported in a study on home care professionals, 37 our findings confirmed that team connections played an essential role for the home palliative care professionals, both in terms of the clinical management of patients and their emotional support.…”