Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia

Abstract

Objective To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata. Design Population-based time series analysis Setting and Participants Community-dwelling adults with dementia in Ontario, Canada from January 2019 to September 2020 Methods We used health administrative databases (Ontario Registered Persons Database and Home Care Database) to measure home care services used by participants. Possion regression models were fit to compare weekly rates of home care services during the pandemic to historical trends with rate ratios (RR) and 95% confidence intervals (CI) stratified by service type (Nursing, personal care, therapy), sex, rurality, and neighbourhood income quintile. Results During the first wave of the pandemic, personal care fell by 16% compared to historical levels (RR 0.84, 95% CI (0.84,0.85)) and therapies fell by 50% (RR 0.50, 95% CI (0.48, 0.52)), while nursing did not significantly decline (RR 1.02, 95% CI (1.00, 1.04)). All rates had recovered by September 2020, with nursing and therapies higher than historical levels. Changes in services were largely consistent across sociodemographic strata, although the rural population experienced a larger decline in personal care and smaller rebound in nursing. Conclusions and Implications Personal care and therapies for individuals with dementia were interrupted during the early months of the pandemic, while nursing was only minimally impacted. Pandemic responses with the potential to disrupt home care for individuals living with dementia must balance the impacts on individuals with dementia, caregivers, and providers.

The Impact of COVID-19 from the Perspectives of Dutch District Nurses: A Mixed-Methods Study

“…On the other hand, care for patients at home was often downscaled due to fear of infection, delayed operations, or insufficient availability of nurses. This has been seen in other studies as well [26,27]. This shift in care delivery at home had a high impact on informal caregivers, sometimes leading to informal caregivers becoming stressed during the first outbreak as well as a year later.…”

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

“…There was an expectation that service levels might remain at a lower level after the reduction in HHC because of clients’ increased self-reliance; however, our findings suggest that has not happened. As in other studies [ 2 ], service provision was almost back to its original levels by the time of the second wave of the pandemic. It seems that informal caregivers took on most care activities during the first wave.…”

“…The COVID-19 pandemic has led to radical changes in healthcare delivery across the world since its onset in the beginning of 2020 [ 1 ]. Uncertainty about the course and consequences of the disease, the risks of transmission, uncertainty about the effectiveness of personal protective equipment (PPE), and the lack of PPE for healthcare professionals all resulted in drops in the volumes of regular, non-COVID-19-related care provided [ 2 ]. This has affected not only hospital settings, but also the home healthcare (HHC) sector.…”

Venerable vulnerability or remarkable resilience? A prospective study of the impact of the first wave of the COVID-19 pandemic and quarantine measures on loneliness in Swedish older adults with home care

“…First, while it is reasonable to assume that social isolation, that is objective lack of social contacts, 39 has worsened during the pandemic, interactions with home care staff and compensatory responses can potentially have shielded older adults in home care against severe social isolation. Even though the quality of the eldercare may have been negatively affected by pandemic-related restrictions, 40 the regular contacts the participants of this study had with home care staff could have protected this population against more extreme social isolation faced by older adults without the support from home care during the pandemic. At a more general level, the widespread public awareness of loneliness among older adults in Sweden during the pandemic may also have resulted in compensatory responses; for example adult children taking the initiative calling their parents more often or making extra efforts to meet under safe conditions, for example, outside and with physical distance, or by video calls.…”