Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA, USA.
Department of Health and Human Services, New Hampshire (NH) Environmental Public Health Tracking Program, Division of Public Health Services, NH, Concord, NH, USA.
BMC Health Serv Res. 2021 Oct 5;21(1):1055. doi: 10.1186/s12913-021-07076-x.
Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. Although the HC sector is growing rapidly in the USA, there is high job turnover among the HC aide workforce. HC provides an important alternative to facility-based care, yet it has often been overlooked within the larger health care system: most recently, in COVID-19 pandemic planning. The objective of the study was to characterize qualitatively the impact of the COVID-19 pandemic on three key HC stakeholders: clients, aides, and agency managers.
The study included 37 phone interviews conducted during April - November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). All interviews were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts followed the grounded theory approach. The interview transcriptions were coded line-by-line into hierarchical themes with NVivo 12 software which allowed weighting of themes based on the number of interviews where they were coded.
Fear of infection and transmission among HC clients and aides were strong themes. Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch - resulting from physical distancing practices - altered the expression of compassion in the HC aide-client care relationship.
The findings suggest that the pandemic has further increased psychosocial job demands of HC aides. Increased isolation of clients may be contributing to a wider public health problem of elder loneliness and depression. To support the HC stakeholders during the on-going COVID-19 pandemic, for future pandemic planning or other health emergencies, it is important to improve HC aide job retention. This action could also ease the serious care services shortage among the growing population of older adults.
家庭护理（HC）服务对老年人、残疾人和慢性病患者的健康和社会福利至关重要。尽管美国家庭护理行业在美国迅速发展，但家庭护理助理人员的流失率很高。家庭护理为基于机构的护理提供了重要的替代方案，但在更大的医疗保健系统中往往被忽视：最近在 COVID-19 大流行规划中也是如此。本研究的目的是定性描述 COVID-19 大流行对三个关键家庭护理利益相关者（客户、护理人员和机构经理）的影响。
该研究包括在 2020 年 4 月至 11 月期间进行的 37 次电话访谈：HC 客户（n=9）、护理人员（n=16）和机构经理（n=12）。所有访谈均进行录音并逐字记录。使用扎根理论方法对转录本进行定性分析。访谈转录本逐行编码为层次主题，使用 NVivo 12 软件对主题进行加权，该软件允许根据编码的访谈次数对主题进行加权。
HC 客户和护理人员对感染和传播的恐惧是强烈的主题。感染预防和控制成为机构日常业务的首要任务；为员工采购足够的个人防护设备是最紧迫的任务。HC 护理人员对因大流行而隔离的客户表示担忧，因为他们出现抑郁迹象。由于实施了保持身体距离的措施，安慰性触摸的缺失改变了 HC 护理人员与客户护理关系中同情的表达。
研究结果表明，大流行进一步增加了 HC 护理人员的心理社会工作需求。客户隔离的增加可能导致更广泛的公共卫生问题，即老年人孤独和抑郁。为了在当前的 COVID-19 大流行期间支持家庭护理利益相关者，为未来的大流行规划或其他卫生紧急情况，重要的是要提高家庭护理助理人员的工作保留率。这一行动还可以缓解在不断增长的老年人口中严重的护理服务短缺问题。
