COVID-19 exposures and infection control among home care agencies

Theresa A Rowe, Mallika Patel, Rachel O'Conor, Sheila McMackin, Vicki Hoak, Lee A Lindquist, Theresa A Rowe, Mallika Patel, Rachel O'Conor, Sheila McMackin, Vicki Hoak, Lee A Lindquist

Abstract

Background and objectives: Home care agencies (HCAs) provide caregivers, who perform an important role in maintaining the health and well-being of older adults. However, during the COVID-19 pandemic, paid caregivers had the potential to inadvertently spread COVID-19. We sought to characterize the effects of COVID-19 on HCAs and examine HCAs' infection prevention and control (IPC) policies.

Research design and methods: This was a qualitative analysis of data collected from a national survey of HCAs. Surveys were e-mailed to members of a national HCA association on March 18, 2020. Questions included queries on demographics, COVID-19 exposures, effects of COVID-19, and IPC protocols.

Results: 1204 HCAs responded with an average census of 96.2 (5-2800) patients daily. Across 36 states, 238 HCAs reported COVID-19 cases or exposures among caregivers. HCAs experienced challenges related to changing patient needs (e.g. decreased caregiver requests), staffing shortages (e.g., fear of COVID-19, inability to train caregivers), and management issues (e.g., inability to obtain supplies). ICP protocols varied in how HCAs followed recommended guidelines, responded to COVID-19 exposures, performed infection surveillance, and implemented precautions. Additionally, HCAs had varying policies for caregiver PTO.

Conclusions: HCAs experienced COVID-19 exposures and/or cases early in the pandemic. HCAs identified staffing and PPE shortages, and lack of IPC guidance as challenges. Although caregivers are providing essential care for millions of older adults, they have been largely absent from federal, state, and health system strategies for mitigating the spread of COVID-19. Future policies must include HCAs and their caregivers to optimize care for older adults.

Keywords: Caregivers; Infection prevention and control.

Conflict of interest statement

Declaration of Competing Interest All authors: No reported conflicts.

Copyright © 2020. Published by Elsevier B.V.

References

    1. Abrahamson K., Myers J., Arling G., et al. Capacity and readiness for quality improvement among home and community-based service providers. Home Health Care Services Quarterly. 2016;35(3-4):182–196.
    1. Behrens L.L., McGhan G., Abbott K.M., et al. Mapping core concepts of person-centered care in long-term services and supports. Journal of Gerontological Nursing. 2019;45(2):7–13.
    1. Buck J.I. In: Ed.), Handbook of home health care administration. 6th ed. Harris M., editor. Jones & Bartlett Learning.; Burlington, MA: 2017. The roles of and competency requirements for paraprofessionals.
    1. Bureau of Labor Statistics, U.S. Department of Labor . 2020. Occupational outlook handbook, home health aides and personal care aides. Available at . Accessed April 20, 2020.
    1. Butler S.S., Brennan-Ing M., Wardamasky S., Ashley A. Determinants of longer job tenure among home care aides: What makes some stay on the job while others leave? Journal of Applied Gerontology : the Official Journal of the Southern Gerontological Society. 2014;33(2):164–188.
    1. Creswell J., Plano Clark V.L. Sage; Newbury Park, CA: 1990. Basics of qualitative research: Grounded theory procedures and techniques.
    1. Ejaz F.K., Bukach A.M., Dawson N., Gitter R., Judge K.S. Examining direct service worker turnover in three long-term care industries in Ohio. Journal of Aging & Social Policy. 2015;27(2):139–155.
    1. Fernandez J., Reckrey J., Lindquist L.A. Aging in place: Selecting and supporting caregivers of the older adult. New Directions in Geriatric Medicine. 2016:115–126. doi: 10.1007/978-3-319-28137-7_8.
    1. Forman J., Damschroder L. Qualitative content analysis. Empirical Methods for Bioethics: A primer/Advances in Bioethics. 2008;11:39–62.
    1. Heinzerling A., Stuckey M.J., Scheuer T., et al. Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient - Solano County, California, February 2020. MMWR Morbidity and Mortality Weekly Report. 2020;69(15):472–476.
    1. Jump P., Floen C., Baruth K. Developing solutions to the direct care worker shortage. Caring. 2001;20(7):6–9.
    1. Kimball A., Hatfield K.M., Arons M., et al. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility - King County, Washington, March 2020. MMWR Morbidity and Mortality Weekly Report. 2020;69(13):377–381.
    1. Lindquist L.A., Cameron K.A., Messerges-Bernstein J., et al. Hiring and screening practices of agencies supplying paid caregivers to older adults. Journal of the American Geriatrics Society. 2012;60(7):1253–1259.
    1. Lindquist L.A., Jain N., Tam K., Martin G.J., Baker D.W. Inadequate health literacy among paid caregivers of seniors. Journal of General Internal Medicine. 2011;26(5):474–479.
    1. McMichael T.M., Clark S., Pogosjans S., et al. COVID-19 in a long-term care facility - King County, Washington, February 27-March 9, 2020. MMWR Morbidity and Mortality Weekly Report. 2020;69(12):339–342.
    1. Reckrey J.M., Geduldig E.T., Lindquist L.A., et al. Paid caregiver communication with homebound older adults, their families, and the health care team. Gerontologist. 2019
    1. Stear L.A. Developing a strong direct care workforce. Home Healthcare Now. 2017;35(10):554–560.
    1. True S., Neuman T., Cubanski J., Ochieng N., Koma W. 2020. Data note: Requirements for nursing homes and assited living facilites in response to COVID-19 vary across states. Accessed May 9, 2020.
    1. Wells H.B. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity. 2002;36:391–409.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren