Two recent studies on the impact of COVID-19 on Massachusetts home care and home health workers and the people they care for highlight a need to build capacities for the safe delivery of care in this essential sector during the current pandemic era and beyond.
The studies, by the state’s Betsy Lehman Center for Patient Safety and its partners at UMass Lowell’s Safe Home Care Project, are based upon surveys and focus groups with home care agency managers and frontline home care workers. They provide additional details about the experiences of this exceptionally large and diverse workforce during the pandemic and identify points of weakness and opportunities for improvement.
While COVID-19 infection risks at congregate living facilities such as nursing homes, assisted living, and other senior and disability housing facilities are clearly real and of continuing concern, we worry that for the many thousands of disabled and frail elderly clients who receive care in their own homes, not enough attention has been focused on COVID risks to them or their caregivers.
We suggest that our state’s hospitals, affected by both wanting to carry out effective patient care and community benefit missions, strongly consider taking on a more active role to support not only congregate living facilities for vulnerable populations, but the needs of home care clients and consumers and members of the home care workforce to mitigate COVID infection risks in a variety of ways that we detail a bit more below.
Clearly, state government has a role in protecting vulnerable people living at home and the workforce that helps to care for them. The state should help by providing a policy framework that will support good infection control practice, and support access to: adequate PPE supplies and training; free COVID testing; emergency child care, paid sick leave and “hazard pay”; and, as supplies become available, prioritized COVID-19 vaccination for both home-bound clients and their caregivers.
While many of these things are happening to at least some degree and with state effort, we realize that the challenges are so immense that of course the state alone will not be able to meet the needs of the home care sector during the pandemic. Fortunately, the nonprofit organizations that are connected to elders, the disabled, or the home care space, including the Commonwealth’s network of Aging Services Access Points and 1199SEIU, the union which represents many of these direct care workers, have stepped it to help with PPE supplies and training to the best of its ability.
However, local hospitals and health systems and their staffs are highly knowledgable in these areas, and offering to share some of their competence with community-based organizations who support caregivers who work at congregate living facilities or in peoples’ homes seems to make sense.
To that end, we think that a hospital’s patient care and community benefit efforts in its target communities, during this pandemic era, should include a range of specific outreach activities and allocation of hospital financial and staff resources to include:
Convening function: Hospitals should convene meetings to include representatives from facilities that house seniors and disabled at all levels of care, as well as appropriate people and organizations connected to home care and home health workers and the people they care for in order to learn about the various needs of these facilities, agencies, and front line caregivers in helping to reduce COVID spread.
Help with infection control training and access to PPE supplies: Expertise on infection control and prevention tends to be concentrated in hospitals. Accordingly, hospital infection control staff members are well-positioned to offer web based and/or in person training on infection prevention practices, proper use of PPE, and related topics to congregate living and home care workers in the hospital’s target communities. Further, hospitals should try to assist these community-based organizations and caregivers to obtain adequate PPE of all kinds and at the most affordable prices that can be secured.
Vaccination: As the state’s vaccination distribution plan is now moving forward to include senior and disabled congregate living residents and their staffs as well as home-based care workers and their clients, there may well be a need to help these affected people secure vaccination at both community sites as well as in peoples’ homes. In some communities and for some number of home-bound people, that could be a significant challenge. Accordingly, hospitals may help with such vaccination efforts at a community level by both helping to sponsor vaccination efforts at community sites as well as by sending vaccination teams into community residents’ homes.
Hospital staff training about the continuum of care: We are aware that there are current discussions within the state’s hospital leadership about the need for general hospital and medical staff education about the continuum of care which exists beyond hospitals and clinician’s offices. From our view, there clearly is a need for everyone on the acute care side to better understand the extent of post-acute and community-based resources that people use and depend on each day for their continuing health and well-being—really their daily existence. We think that all hospitals in the state should make sure that there is some sort of organized educational effort for their staff and affiliated clinicians to ensure safe care transitions by learning about the resources and functions of the post-acute and community providers that deliver long-term care services in the communities that they serve.
Finally, we appreciate that hospitals are all challenged to meet the basic care needs of patients coming to them during this current second COVID surge we are experiencing. But it seems to us that the activities outlined here will serve to both reduce the spread of COVID infection in the community, and reduce the demand for hospital care—something clearly worth doing as the impact of the COVID variants now in circulation on serious COVID illness and the demand for hospital care remains a risk worth worrying about.
Lisa Gurgone is executive director of Mass Home Care and Paul A. Hattis is a retired associated professor at Tufts University Medical School.