Impacts of the COVID-19 Pandemic on Home Health and Home Care Agency Managers, Clients, and Aides: A Cross-Sectional Survey, March to June, 2020

Abstract

Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients’ concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers’ workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.

COVID-19′s impact on home health services, caregivers and patients: lessons from the French experience

“…In addition to these difficulties, other factors participated in a decline of visits by care providers to patients at home, especially during the first wave of the pandemic. Similar to findings observed in the United States [6] , the main reasons behind this reduction are the concerns from families or care providers about bringing or getting Covid-19 in the home, home aides needing to care for their own children due to school closures, or providers being forced to remain in quarantine because they were diagnosed positive to Covid-19. The reduction of home care services has imposed a substantial additional burden on informal caregivers.…”

All alone: A qualitative study of home health aides' experiences during the COVID-19 pandemic in New York

“…During the pandemic, HHC agency leaders, similar to other health care leaders, were confronted with staffing and resource shortages to meet agency needs. 12 Thus, Spanish-speaking HHAs may have been assigned to non-Spanish-speaking patients to ensure adequate patient coverage, exacerbating the need for interpreter services. HHAs in our study highlighted the need for enhanced access to medical interpreters as important to the provision of high-quality care.…”

“…11 This demographic profile represents a key segment of the HHC workforce which already experiences high levels of marginalization, and faced greater risk for COVID-19 given the disproportionate impact of the pandemic on Black and Hispanic communities. 12 , 13 , 14 Developing strategies to better support this diverse direct care workforce is critical to meeting the needs of an increasingly diverse aging population in the United States. 15 , 16 …”

“It changed everything”: The Safe Home Care qualitative study of the COVID-19 pandemic’s impact on home care aides, clients, and managers

“…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]. Yet, 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].…”

“…In summer 2020, the Project team conducted a survey of managers in Massachusetts HC agencies (n = 94) to assess the impacts of COVID-19 on agencies, clients, and aides early in the pandemic. Most agencies (60%) provided services to clients with COVID-19 and three quarters of agencies reported that they employed HC aides who had tested positive for the virus, had been symptomatic, and/or quarantined [14,20].…”