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

Abstract

Background Home 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. Methods The 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. Results Fear 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. Conclusions The 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.

In the Eye of the Storm: A Quantitative and Qualitative Account of the Impact of the COVID-19 Pandemic on Dutch Home Healthcare

“…However, based on our focus group interviews, one overarching factor clearly influenced all stakeholders (i.e., managers, nurses, and clients): fear. Similar to our findings, studies in other countries suggest that many clients—and/or their informal caregivers—were unwilling to allow HHC professionals into their homes during the first wave of the pandemic because they were so concerned about being infected [ 16 ]. At the same time, the fear of unprecedented demand for HHC from COVID-19 patients discharged from hospital led managers in Dutch HHC to drastically scale back service provision.…”

A Qualitative Study of Home Health Aides’ Perspectives towards COVID-19 Vaccination

“…During the COVID-19 pandemic, aides provided hands-on personal care and assistance, as well as emotional support ( Bandini et al, 2021 ; Sterling et al., 2020 ). Unlike many other healthcare workers who may have been able to work remotely, aides provided care to patients in their homes without being able to socially distance and often without adequate access to personal protective equipment (PPE) at the beginning of the pandemic ( Markkanen et al, 2021 ). Doing so placed them at high risk for infection, and also posed challenges to their own financial, physical, and emotional well-being, exacerbating existing vulnerabilities among a workforce comprised largely of middle-aged women of color who earn low wages and often lack paid time off ( Bandini et al, 2021 ; PHI, 2019 ; Pinto et al, 2022 ; Rowe et al, 2020 ; Scales, 2021 ; Sterling et al, 2020 ; Tyler et al, 2021 ; U.S. Bureau of Labor Statistics, 2021 ).…”

Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study

“…It is possible that such experience, together with institutional organizations, made them feel relieved from work-related distress, which emerged from our qualitative inquiries and was also evoked in existing literature [7]. We could also imagine that frontline HCWs could more easily handle the ambivalence between risk-taking and self-protection [38] once they stepped out of acute crises [35]. An adjusted risk perception could therefore be a key element to consider, helping finding a balance between the need to establish a secure environment and feelings of frustration about restrictions.…”