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Lum HD, Fischer S, Ytell K, Scherer L, O’Leary ST, Elk R, Hurley S, Washington KT, DeCamp M. Elevating Home Health Aide Input in Co-Creation of COVID-19 Vaccine Messaging. Am J Hosp Palliat Care 2024; 41:1094-1103. [PMID: 37991051 PMCID: PMC11109014 DOI: 10.1177/10499091231218455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Home health aides (HHAs) care for patients highly vulnerable to COVID-19 and are disproportionately women from minority communities that have been adversely impacted by COVID-19. Yet, direct care workers are less likely to be vaccinated against COVID-19 compared to others. As the pandemic evolves, interest in vaccination may decrease suggesting the need for relevant vaccine messaging to HHAs. Objectives: (1) to describe HHAs and administrators' perspectives related to COVID-19 vaccination messaging, and (2) to co-design a Communication Toolkit to create COVID-19 vaccine messages. Methods: HHAs and administrators from 4 geographically diverse Palliative Care Research Cooperative (PCRC) hospice agencies were recruited for a multi-method process involving qualitative interviews (17 HHAs and 5 administrators), community engagement (CE) studios, and development of a Communication Toolkit. Interviews were guided by the PEN-3 conceptual framework to explore barriers and facilitators to vaccination. Data were analyzed using qualitative content analysis. Results: Despite power differences, HHAs and administrators share a commitment to protecting patients affected by serious illness. HHAs desire vaccine messaging that includes personal narratives, good news about the vaccine, and facts about benefits and risks of the vaccine. Preferred message formats include the agency intranet, daily briefings, or "little seeds" (ie, short, high-impact information). Through the studios, HHAs provided input on a Toolkit prototype with messages tailored to the context of home care. Conclusions: Grounded in the commitment of HHAs and administrators to protecting vulnerable patients, we co-created an adaptable Communication Toolkit to address COVID-19 vaccination misinformation and mistrust among direct care workers.
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Affiliation(s)
- Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stacy Fischer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kate Ytell
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura Scherer
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Divisions of Infectious Diseases/Epidemiology and General Academic Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ronit Elk
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Karla T. Washington
- Division of Palliative Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew DeCamp
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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2
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LaPierre TA, Wendel CL, Babitzke J, Sullivan DL, Swartzendruber L, Olds DM. Experiences with care coordination and backup plans in home and community based services during the COVID-19 pandemic in Kansas. Disabil Health J 2024:101677. [PMID: 39095293 DOI: 10.1016/j.dhjo.2024.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 06/14/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The COVID-19 pandemic was an emergency event during which backup plans became widely relevant. Although backup plans are required for Medicaid-funded Home and Community Based Services (HCBS) as a key risk management strategy, we know little about their effectiveness. OBJECTIVE The purpose of this study was to explore whether backup plans and care coordination met the needs of HCBS consumers during the COVID-19 pandemic in Kansas. METHODS An interactive, convergent mixed-methods design within a community-based participatory research framework was used. Data came from 70 in-depth interviews with HCBS consumers, caregivers, workers, and providers, as well as 100 surveys from consumers, asking about experiences receiving or providing care during the COVID-19 pandemic in Kansas. Inductive coding was used to identify major themes for the qualitative data. Descriptive and bivariate analysis were used for quantitative data. RESULTS One-third of survey respondents reported not having a backup plan and 39% went without formal homecare services for at least 2 consecutive weeks. The pandemic exacerbated and exposed deficiencies in care coordination and backup plans in a managed care environment. Interview participants expressed great need for backup workers during the pandemic but struggled to find these supports. Although family, friends, and providers stepped in to help fill gaps, there remained many unmet care needs. CONCLUSIONS Findings indicate that improvements are needed in care coordination to support the development and maintenance of backup plans that can be successfully drawn on to avoid interruptions to care.
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Affiliation(s)
- Tracey A LaPierre
- University of Kansas Department of Sociology, 1415 Jayhawk Blvd, Fraser Hall #716, Lawrence, KS, 66045, USA; Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, 4401 Wornall Rd., Kansas City, MO, 64111, USA.
| | - Carrie L Wendel
- University of Kansas School of Social Welfare, 1545 Lilac Lane, Twente Hall, Lawrence, KS, 66045, USA.
| | - Jennifer Babitzke
- University of Kansas Department of Sociology, 1415 Jayhawk Blvd, Fraser Hall #716, Lawrence, KS, 66045, USA.
| | - Darcy L Sullivan
- University of Kansas Department of Sociology, 1415 Jayhawk Blvd, Fraser Hall #716, Lawrence, KS, 66045, USA.
| | - Lora Swartzendruber
- University of Kansas School of Social Welfare, 1545 Lilac Lane, Twente Hall, Lawrence, KS, 66045, USA.
| | - Danielle M Olds
- Healthcare Institute for Innovations in Quality, University of Missouri - Kansas City, 4401 Wornall Rd., Kansas City, MO, 64111, USA; Saint Luke's Hospital, 4401 Wornall Rd., Kansas City, MO, 64111, USA; University of Kansas School of Nursing, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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3
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Sama SR, Quinn MM, Gore RJ, Galligan CJ, Kriebel D, Markkanen PK, Lindberg JE, Fallon PJ. The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation. J Appl Gerontol 2024:7334648241246472. [PMID: 38652665 DOI: 10.1177/07334648241246472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.
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Affiliation(s)
- Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Rebecca J Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - David Kriebel
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pamela J Fallon
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
- Employee Health and Wellness, Southern New Hampshire Health, Nashua, NH, USA
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4
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Bayram A, Chiappinotto S, Palese A. Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review. BMC Health Serv Res 2024; 24:352. [PMID: 38504283 PMCID: PMC10949800 DOI: 10.1186/s12913-024-10708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Unfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic. METHODS Systematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing. RESULTS Twenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care. CONCLUSIONS Two continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.
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Affiliation(s)
- Aysun Bayram
- Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | | | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy
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5
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Markkanen PK, Gore RJ, Sama SR, Lindberg JE, Galligan CJ, Quinn MM. Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:360. [PMID: 38541359 PMCID: PMC10970455 DOI: 10.3390/ijerph21030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.
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Affiliation(s)
- Pia K. Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Rebecca J. Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA
| | - Susan R. Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - John E. Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Catherine J. Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Margaret M. Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
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6
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Tsui EK, LaMonica M, Boerner K, Baron S. "A Major Issue": The Impact of the COVID-19 Pandemic on How Home Care Leaders Perceive and Promote Aides' Mental Health and Well-Being. J Appl Gerontol 2024:7334648241236245. [PMID: 38414156 DOI: 10.1177/07334648241236245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Home care aides play a critical role in the care of older adults, but they do this under difficult working conditions. The COVID-19 pandemic exacerbated aides' stress and worsened their mental health, raising the question of how agencies can better support aides. We explore how home care industry leaders in New York perceived and addressed home care aides' mental health and well-being prior to and during the pandemic through in-depth interviews conducted in 2019 (n = 8 agencies) and 2022 (n = 14 agencies). We found that these topics became more central in leaders' thinking, reflected in a range of new internally and externally funded agency actions, albeit limited by ongoing financial constraints. Maintaining a skilled and reliable aide workforce is critical to societal health but will remain challenging without continued investment in aide support of the kind described in the Surgeon General's Framework for Workplace Mental Health and Well-Being.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Kathrin Boerner
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY, USA
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7
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McCabe CA, Venkatram C, Yarakala S, Korin M, Boulos A, Oliver K. Assessing COVID-19 Vaccine Hesitancy and Trust in Home Health Workers in New York City: A Pilot Study. J Occup Environ Med 2024; 66:166-173. [PMID: 38037263 DOI: 10.1097/jom.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE This study aimed to identify characteristics surrounding COVID-19 vaccine hesitancy and trust in home health workers (HHWs) in New York City. METHODS Data were collected from HHWs through focus group sessions conducted via Zoom. We developed a facilitator guide using the 5C Scale, a validated psychometric tool for assessing vaccine hesitancy. We performed qualitative thematic analysis using a combined inductive and deductive approach. RESULTS Major themes that emerged included the following: conflicting information decreased vaccine confidence; individualized outreach is valued when information gathering; mandates and financial incentives may increase skepticism; low health literacy and conflict in personal relationships are barriers to acceptance; and experiencing a severe infection and fear of exposure at work increase acceptance. CONCLUSIONS Based on our study, personalized yet consistent messaging may be key to reaching hesitant HHWs.
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Agerholm J, Burström B, Schön P, Liljas A. How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers' experiences in Region Stockholm. BMC Health Serv Res 2023; 23:1173. [PMID: 37891523 PMCID: PMC10612274 DOI: 10.1186/s12913-023-10173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff. METHOD A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis. RESULTS Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions. CONCLUSION Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.
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Affiliation(s)
- Janne Agerholm
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pär Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Ann Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Cannings-John R, Schoenbuchner S, Jones H, Lugg-Widger FV, Akbari A, Brookes-Howell L, Hood K, John A, Thomas DR, Prout H, Robling M. Impact of the COVID-19 pandemic on domiciliary care workers in Wales, UK: a data linkage cohort study using the SAIL Databank. BMJ Open 2023; 13:e070637. [PMID: 37263685 DOI: 10.1136/bmjopen-2022-070637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To quantify population health risks for domiciliary care workers (DCWs) in Wales, UK, working during the COVID-19 pandemic. DESIGN A population-level retrospective study linking occupational registration data to anonymised electronic health records maintained by the Secure Anonymised Information Linkage Databank in a privacy-protecting trusted research environment. SETTING Registered DCW population in Wales. PARTICIPANTS Records for all linked DCWs from 1 March 2020 to 30 November 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was confirmed COVID-19 infection; secondary outcomes included contacts for suspected COVID-19, mental health including self-harm, fit notes, respiratory infections not necessarily recorded as COVID-19, deaths involving COVID-19 and all-cause mortality. RESULTS Confirmed and suspected COVID-19 infection rates increased over the study period to 24% by 30 November 2021. Confirmed COVID-19 varied by sex (males: 19% vs females: 24%) and age (>55 years: 19% vs <35 years: 26%) and were higher for care workers employed by local authority social services departments compared with the private sector (27% and 23%, respectively). 34% of DCWs required support for a mental health condition, with mental health-related prescribing increasing in frequency when compared with the prepandemic period. Events for self-harm increased from 0.2% to 0.4% over the study period as did the issuing of fit notes. There was no evidence to suggest a miscoding of COVID-19 infection with non-COVID-19 respiratory conditions. COVID-19-related and all-cause mortality were no greater than for the general population aged 15-64 years in Wales (0.1% and 0.034%, respectively). A comparable DCW workforce in Scotland and England would result in a comparable rate of COVID-19 infection, while the younger workforce in Northern Ireland may result in a greater infection rate. CONCLUSIONS While initial concerns about excess mortality are alleviated, the substantial pre-existing and increased mental health burden for DCWs will require investment to provide long-term support to the sector's workforce.
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Affiliation(s)
| | | | - Hywel Jones
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Ashley Akbari
- Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ann John
- Health Data Research UK | Administrative Data Research Wales, Swansea University, Swansea, UK
- DECIPHer-Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Daniel Rh Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
- Cardiff Metropolitan University, Cardiff, UK
| | - Hayley Prout
- Centre for Trials Research, Cardiff University, Cardiff, UK
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10
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Brouillette NM, Markkanen PK, Quinn MM, Galligan CJ, Sama SR, Lindberg JE, Karlsson ND. Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders. J Appl Gerontol 2023; 42:571-580. [PMID: 36565062 PMCID: PMC9996781 DOI: 10.1177/07334648221146769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
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Affiliation(s)
- Natalie M Brouillette
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole D Karlsson
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
- Environmental Public Health Tracking Program, Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
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11
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Russell D, Onorato N, Stern A, Vergez S, Oberlink M, Luebke M, Feldman PH, McDonald MV, Sterling MR. A Qualitative Study of Home Health Aides' Perspectives towards COVID-19 Vaccination. J Appl Gerontol 2023; 42:660-669. [PMID: 36210760 PMCID: PMC9548484 DOI: 10.1177/07334648221130677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Home health aides provide care to homebound older adults and those with chronic conditions. Aides were less likely to receive COVID-19 vaccines when they became available. We examined aides' perspectives towards COVID-19 vaccination. Qualitative interviews were conducted with 56 home health aides at a large not-for-profit home care agency in New York City. Results suggested that aides' vaccination decisions were shaped by (1) information sources, beliefs, their health, and experiences providing care during COVID-19; (2) perceived susceptibility and severity of COVID-19; (3) perceived benefits of vaccination including protection from COVID-19, respect from colleagues and patients, and fulfillment of work-related requirements; (4) perceived barriers to vaccination including concerns about safety, efficacy, and side effects; and (5) cues to action including access to vaccination sites/appointments, vaccination mandates, question and answer sessions from trusted sources, and testimonials. Providing tailored information with support to address vaccination barriers could lead to improved vaccine uptake.
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Affiliation(s)
- David Russell
- Department of Sociology, 1801Appalachian State University, Boone, NC, USA
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Nicole Onorato
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Alexis Stern
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | - Mia Oberlink
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | | | - Penny H Feldman
- Center for Home Care Policy & Research, 44198VNS Health, New York, NY, USA
| | | | - Madeline R Sterling
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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Wendel CL, LaPierre TA, Sullivan DL, Babitzke J, Swartzendruber L, Barta T, Olds DM. "Anything that Benefits the Workers Should Benefit the Client": Opportunities and Constraints in Self-Directed Care During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:524-535. [PMID: 36471575 PMCID: PMC9729716 DOI: 10.1177/07334648221143604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Self-directed care (SDC) models allow Home and Community Based Services (HCBS) consumers to direct their own care, thus supporting flexible, person-centered care. There are many benefits to the SDC model but access to resources is essential to successful outcomes. Considering the autonomy and flexibility associated with SDC, it is important to understand how SDC responded to the COVID-19 pandemic and the resources available to help manage this situation. We conducted 54 in-depth interviews with HCBS consumers, direct support workers, family caregivers, and providers to examine the impact of COVID-19 on HCBS services in Kansas. Findings illuminate how self-directed consumers carried a lot of employer responsibility, with limited resources and systemic barriers constraining self-determination and contributing to unmet care needs, stress, and burden. Policy flexibilities expanding the hiring of family members were beneficial but insufficient to address under-resourced working conditions and labor shortages that were exacerbated by the pandemic.
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Affiliation(s)
- Carrie L Wendel
- School of Social Welfare, 370371University of Kansas, Lawrence, KS, USA
| | | | - Darcy L Sullivan
- Department of Sociology, University of Kansas, Lawrence, KS, USA
| | | | | | - Tobi Barta
- School of Social Welfare, 370371University of Kansas, Lawrence, KS, USA
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13
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Consequences of the Early Phase of the COVID-19 Pandemic for Home-Healthcare Recipients in Norway: A Nursing Perspective. Healthcare (Basel) 2023; 11:healthcare11030346. [PMID: 36766920 PMCID: PMC9914130 DOI: 10.3390/healthcare11030346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies.
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14
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Franzosa E, Wyte-Lake T, Tsui EK, Reckrey JM, Sterling MR. Essential but Excluded: Building Disaster Preparedness Capacity for Home Health Care Workers and Home Care Agencies. J Am Med Dir Assoc 2022; 23:1990-1996. [PMID: 36343702 PMCID: PMC9634621 DOI: 10.1016/j.jamda.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has demonstrated the essential role of home care services in supporting community-dwelling older and disabled individuals through a public health emergency. As the pandemic overwhelmed hospitals and nursing homes, home care helped individuals remain in the community and recover from COVID-19 at home. Yet unlike many institutional providers, home care agencies were often disconnected from broader public health disaster planning efforts and struggled to access basic resources, jeopardizing the workers who provide this care and the medically complex and often marginalized patients they support. The exclusion of home care from the broader COVID-19 emergency response underscores how the home care industry operates apart from the traditional health care infrastructure, even as its workers provide essential long-term care services. This special article (1) describes the experiences of home health care workers and their agencies during COVID-19 by summarizing existing empiric research; (2) reflects on how these experiences were shaped and exacerbated by longstanding challenges in the home care industry; and (3) identifies implications for future disaster preparedness policies and practice to better serve this workforce, the home care industry, and those for whom they care.
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Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA,Address correspondence to Emily Franzosa DrPH, Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Emma K. Tsui
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Jennifer M. Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Home care nurses’ perception of the challenges they faced during the COVID-19 pandemic: a qualitative study. BMC Nurs 2022; 21:314. [PMID: 36380297 PMCID: PMC9666995 DOI: 10.1186/s12912-022-01082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite the significant role they play in the whole health care system, home care nurses are not paid the attention they deserve. Besides highlighting their significant role in the health care system, the COVID-19 pandemic also posed several challenges for home care nurses. Objective The purpose of this study is to explain the nurses’ perception of the challenges of home care during the Covid-19 pandemic. Methods The present study was a qualitative study with a conventional content analysis approach conducted from November 2020 to September 2021. Participants included 16 home care nurses who were purposefully selected based on the eligibility criteria. After obtaining ethical authorization, the data were collected through semi-structured interviews. MAXQDA Version 10 software was used for data mangement. Data analysis was performed using the Granheim and Lundman five-step method. Guba and Lincoln criteria were utilized for trustworthiness. Findings The seven main categories obtained in this study included “the onset of a new chapter: from avoidance to relapse”, “burnout”, “vortex of moral distress”, “social stigma”, “difficulty in breaking the transmission chain”, “care inhibitors related to the patient and family” and “support deficiency: the crisis of home care nursing agencies during the crisis”. Conclusion The results showed that nurses working in home care during the Covid-19 pandemic experienced several challenges in various fields. This study captured the nurses’ perception of the challenges of home care during the Covid-19 pandemic, a period of unprecedented change and difficulty. These challenges included lack of support, psychological problems, and dealing with new experiences. Identifying these challenges can help improve the quality of home care nursing and planning in this area. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01082-y.
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16
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Hopwood P, MacEachen E, McAIney C, Tong C. Personal Support Work and Home Care in Ontario during the COVID-19 Pandemic. Healthc Policy 2022; 18:61-75. [PMID: 36495535 PMCID: PMC9764448 DOI: 10.12927/hcpol.2022.26970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Governments introduced emergency measures to address the shortage of homecare workers and unmet care needs in Canada during the COVID-19 pandemic. Objective This article aims to describe how policies impacted home care and identifies the potential risks for clientele and staff. Method Experts in home care (n = 15) were interviewed about policies that affect health and safety for homecare recipients. Results New recruitment strategies, condensed education and rapid hiring during the pandemic did not lead to the recruitment of sufficient workers, but increased the potential for recruitment of unsuitable workers or workers with little training. Conclusion It is important to consider the unintended effects of emergency policy measures and to manage the effects of such policies on homecare clients.
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Affiliation(s)
- Pamela Hopwood
- School of Public Health Sciences, University of Waterloo, Waterloo, ON
| | - Ellen MacEachen
- Professor, School of Public Health Sciences, University of Waterloo, Waterloo, ON
| | - Carrie McAIney
- Associate Professor, School of Public Health Sciences, University of Waterloo, Schlegel Research Chair in Dementia, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
| | - Catherine Tong
- Adjunct Professor, Research Scientist, School of Public Health Sciences, University of Waterloo, Waterloo, ON
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Chapman SA, Greiman L, Bates T, Wagner LM, Lissau A, Toivanen-Atilla K, Sage R. Personal Care Aides: Assessing Self-Care Needs And Worker Shortages In Rural Areas. Health Aff (Millwood) 2022; 41:1403-1412. [DOI: 10.1377/hlthaff.2022.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Susan A. Chapman
- Susan A. Chapman , University of California San Francisco, San Francisco, California
| | - Lillie Greiman
- Lillie Greiman, University of Montana, Missoula, Montana
| | - Timothy Bates
- Timothy Bates, University of California San Francisco
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18
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Grazioli VS, Tzartzas K, Blaser J, Graells M, Schmutz E, Petitgenet I, Favrat B, Zozaya JS, Kokkinakis I, Marion-Veyron R, Bodenmann P. Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study. Int J Public Health 2022; 67:1604517. [PMID: 36119446 PMCID: PMC9478025 DOI: 10.3389/ijph.2022.1604517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs. Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses. Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions. Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.
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Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program. Geriatrics (Basel) 2022; 7:geriatrics7030066. [PMID: 35735771 PMCID: PMC9223204 DOI: 10.3390/geriatrics7030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/17/2022] Open
Abstract
The onset of the COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such medically complex veterans residing in the private homes of non-VA caregivers rather than institutional care settings like nursing homes. In this qualitative descriptive study, we assessed adaptations to delivering safe and effective health care during the early stages of the pandemic for veterans living in rural MFHs. From December 2020 to February 2021, we interviewed 37 VA MFH care providers by phone at 16 rural MFH programs across the US, including caregivers, program coordinators, and VA health care providers. Using both inductive and deductive approaches to thematic analysis, we identified themes reflecting adaptations to caring for rural MFH veterans, including care providers rapidly increased communication and education to MFH caregivers while prioritizing veteran safety. Telehealth visits also increased, MFH veterans were prioritized for in-home COVID-19 vaccinations, and strategies were applied to mitigate the social isolation of veterans and caregivers. The study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high-quality care for vulnerable, homebound populations during crises like the COVID-19 pandemic.
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The Second Side of the Coin-Resilience, Meaningfulness and Joyful Moments in Home Health Care Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073836. [PMID: 35409520 PMCID: PMC8997992 DOI: 10.3390/ijerph19073836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022]
Abstract
Nursing literature predominantly focuses on job demands but is scarce for resources related to nurses' work. In the face of the COVID-19 pandemic, resources that can buffer the health-impairing effects of increased demands gain importance. The aim of this study is to explore resilience, meaning of work and joyful moments in home health care workers in South Germany during the pandemic. Resilience and meaning of work were measured quantitatively; moments of joy were investigated qualitatively by audio diaries and analyzed with qualitative content analysis. In all, 115 home health care workers (mean age = 47.83 ± 11.72; 81.75% female) filled in the questionnaires and 237 diary entries were made by 23 persons (mean age = 46.70 ± 10.40; 91.30% female). The mean scores of resilience (5.52 ± 1.04; 1-7) and meaning of work (4.10 ± 0.92; 1-5) showed high levels, with significantly higher values in females. Home care workers experienced joyful moments 334 times in 60 different types in the categories of social relationships, work content, work organization, work environment and self-care. A deeper understanding of resilience, meaning of work and joyful moments provides a basis for the development of worksite health promotion programs that address both demands and resources in home health care workers.
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21
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van den Bulck AOE, de Korte MH, Metzelthin SF, Elissen AMJ, Everink IHJ, Ruwaard D, Mikkers MC. In the Eye of the Storm: A Quantitative and Qualitative Account of the Impact of the COVID-19 Pandemic on Dutch Home Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042252. [PMID: 35206437 PMCID: PMC8872342 DOI: 10.3390/ijerph19042252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
The COVID-19 pandemic has severely affected healthcare delivery across the world. However, little is known about COVID-19’s impact on home healthcare (HHC) services. Our study aimed to: (1) describe the changes in volume and intensity of HHC services and the crisis management policies implemented; (2) understand the responses and the experiences of HHC staff and clients. We conducted an explanatory sequential mixed methods study. First, retrospective client data (N = 43,495) from four Dutch HHC organizations was analyzed. Second, four focus group interviews were conducted for the strategic, tactical, operational, and client levels of the four HHC organizations. Our results showed that both the supply of and demand for Dutch HHC decreased considerably, especially during the first wave (March–June 2020). This was due to factors such as fear of infection, anticipation of a high demand for COVID-19-related care from the hospital sector, and lack of personal protective equipment. The top-down management style initially applied made way for a more bottom-up approach in the second wave (July 2020–January 2021). Experiences vary between levels and waves. HHC organizations need more responsive protocols to prevent such radical scaling-back of HHC in future crises, and interventions to help HHC professionals cope with crisis situations.
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Affiliation(s)
- Anne O. E. van den Bulck
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.F.M.); (A.M.J.E.); (I.H.J.E.); (D.R.)
- Correspondence:
| | - Maud H. de Korte
- Department of Economics, Tilburg University, 5037 AB Tilburg, The Netherlands; (M.H.d.K.); (M.C.M.)
- Dutch Healthcare Authority (NZa), 3502 GA Utrecht, The Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.F.M.); (A.M.J.E.); (I.H.J.E.); (D.R.)
| | - Arianne M. J. Elissen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.F.M.); (A.M.J.E.); (I.H.J.E.); (D.R.)
| | - Irma H. J. Everink
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.F.M.); (A.M.J.E.); (I.H.J.E.); (D.R.)
| | - Dirk Ruwaard
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.F.M.); (A.M.J.E.); (I.H.J.E.); (D.R.)
| | - Misja C. Mikkers
- Department of Economics, Tilburg University, 5037 AB Tilburg, The Netherlands; (M.H.d.K.); (M.C.M.)
- Dutch Healthcare Authority (NZa), 3502 GA Utrecht, The Netherlands
- Tilburg Law and Economics Center (TILEC), Tilburg University, 5000 LE Tilburg, The Netherlands
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