Barriers and facilitators to providing home-based care in a pandemic: policy and practice implications

OBJECTIVE: The purpose of this study is to describe the experiences of home-based care providers (HBCP) in providing care to older adults during the pandemic in order to inform future disaster planning, including during pandemics. DESIGN: Qualitative inquiry using an abductive analytic approach. SETTING AND PARTICIPANTS: Home-based care providers in COVID-19 hotspots. METHODS: Telephone interviews were conducted with 27 participants (administrators, registered nurses and other members of the allied healthcare team), who provided in-home care during the pandemic in Medicare-certified home health agencies. Interviews focused on eliciting experiences from HBCP on challenges and successes in providing home-based care to older adults, including barriers to care and strategies employed to keep patients, and providers, safe in their homes during the pandemic. RESULTS: Data was distilled into four major themes that have potential policy and practice impact. These included disrupted aging-in-place resources, preparedness actions contributing to readiness for the pandemic, limited adaptability in administrative needs during the pandemic and challenges with unclear messaging from public health officials. CONCLUSIONS: Home-based care plays an essential role in maintaining the health of older adults in disaster contexts, including pandemics. Innovative solutions, informed by policy that generate evidence-based best practices to support HBCP are needed to reduce barriers and increase protective factors, in order to maintain continuity of care for this vulnerable population during disruptive events.