An Outbreak Preparedness and Mitigation Approach in Home Health and Personal Home Care During the COVID-19 Pandemic

Abstract

The acute respiratory disease COVID-19, caused by the novel Coronavirus SARS-CoV-2, is a worldwide pandemic affecting millions of people. The methodology that organizations who provide home health and personal home care services are using to respond to this pandemic has not yet been characterized. In this report, we describe our approach to comprehensive outbreak suppression and report an initial case series of COVID-19 positive patients receiving home-based services. We implemented enhanced infection control procedures across our affiliates, and we communicated these protocols to our offices using multi-faceted methods. Using custom built software applications enabling us to track patient and employee cases and exposures, we leveraged current public health recommendations to identify cases and to suppress transmission. In the 100-day period between January 20, 2020 and April 30, 2020, our affiliates provided services to 67 COVID-19 positive patients (<0.3% of census). Twenty patients were referred to home health post hospitalization for COVID-19 related illness, whereas 47 were found to have COVID-19 while living in community settings. Of those who were found to have COVID-19 in the community, 17 (39%) required subsequent hospitalization. Hospitalized patients had an average age of 74.5 ± 18, and 53% were male. There were 13 deaths (76%) among those hospitalized from the community with COVID-19 related illness. A highly coordinated and frequently communicated approach to infection control, case identification and employee screening can be performed by home health and personal home care organizations. Studies that further assess risks and predictors of illness severity in home-based COVID-19 patients are needed.

COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

“…Since then, 21 additional studies were included, leading to a total of 54 study reports for 49 unique studies or outbreak reports (Figure 1). 7,10,11,12,19,20,21,22,23, 24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68…”

“…The same organisation providing services to people with intellectual and developmental disability also reported on their experience providing home health and personal care to older people. 61 Over 100 days, 67 people who contracted confirmed COVID-19 were detected (less than 0.3% of all clients). 47 of 67 were detected while living in the community.…”

Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the COVID-19 Pandemic

“…Our finding that HHAs were fearful of contracting COVID-19 and that they had a high risk of exposure and infection is consistent with other recent studies of HHAs in the United States. [13][14][15] There are several reasons why this may be. During COVID-19, HHAs had indoor, close, hands-on contact with patients and, in some cases, with other members of their households or support networks.…”

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

“…2,4 The findings in this survey are consistent with several recent studies. 4,12,13 A case series study also documented COVID-19 illness among clients in home care. 12 A qualitative study of home care worker experiences in New York City 4 and a national survey 13 also found similar challenges for HH&HC agencies responding to the pandemic including aides providing direct care for COVID-19 positive patients, a reduction in client visit requests related to fear of infection from aides, and HH&HC managers experiencing difficulty procuring PPE.…”