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Home Care Staff in New York City During the Pandemic

The following article is about the experiences of home health workers during the pandemic. 

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Elizabeth
(877) 871-4062
ElizabethHogue@ElizabethHogue.net 
 
A recent article, "Experiences of Home Health Care Workers in New York City During the Coronavirus Disease 2019 Pandemic: A Qualitative Analysis" by Madeline R. Sterling, MD, MPH, MS et al, appeared in JAMA Internal Medicine online on August 4, 2020. The author describes a study conducted in partnership with the 1199SEIU Home Care Industry Education Fund. Participants included thirty-three home care workers employed by twenty-four different New York City agencies.
 
The study raised this question: "What are the experiences of home health care workers caring for older adults and for patients with chronic illnesses during the coronavirus disease 2019 (COVID-19) pandemic?" Home health and personal care aides and home attendants were interviewed. Participants reported that they were at greater risk for contracting and transmitting the coronavirus. Despite the fact that they provided integral care to vulnerable patients, home care staff involved in the study said that they felt inadequately supported and generally invisible.
 
Five major themes emerged:
  1. Workers were on the front lines of the pandemic, but felt invisible.
  2. Staff members reported an increased risk for virus transmission.
  3. Home care agencies provided various amounts of information, supplies, and training.
  4. Participants relied on non-agency alternatives for support, including information and supplies.
  5. Staff members were forced to make difficult trade-offs in their professional and personal lives.
Theme 1: On the Front Lines of COVID-19 Management, But Invisible
As essential workers, participants continued to work and care for their patients. Most patients had several chronic conditions that made them at high risk for contracting COVID-19. In addition to their usual tasks, workers monitored their patients for signs and symptoms of the coronavirus. Despite these important activities, many said that they felt invisible: "You hear people clapping, thanking doctors and nurses, even the hospital cleaning staff...I'm not doing this because I want praise; I love what I do. But it would be nice for people to show us gratitude."
 
Theme 2: Increased Risk for COVID-19 Transmission to Patients and Themselves
Participants worried about spreading the coronavirus to patients because workers routinely went to grocery stores and pharmacies on behalf of their patients. Those who usually took public transportation to work were also especially concerned about transmission of the virus to patients.
 
Theme 3: Varying Levels of Support from Agencies
Participants said they received varying levels of support from agencies they worked for when it came to: information about the coronavirus, availability of personal protective equipment (PPE), and training about how to care for COVID-19 patients.
 
Theme 4: Reliance on Alternative Sources for Support
When agencies did not provide the level of support that workers needed, they then turned to other sources, including the news media, social media, government briefings, the union, each other, and their faith.
 
Theme 5: Forced to Make Tough Trade-Offs Between Health and Finances
Workers had to decide whether to continue to care for coronavirus patients. Patients sometimes refused services, so workers then had to decide whether to take on new patients. Participants also had to decide whether to continue to see patients who they perceived as risky.
 
There is greater recognition that COVID-19 patients can, and perhaps should, receive care at home throughout the course of their illnesses.   In order to succeed, staff members will be an essential part of the team. The issues described above must be addressed! 
 
 
©2020 Elizabeth E. Hogue, Esq.  All rights reserved.

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