Table 4 Most frequently coded themes and their subthemes from director/manager interviews (n = 12) on the impact of COVID-19 on HC agencies during phone interviews of Safe Home Care COVID-19 qualitative study
Themes | Subthemes | Frequency coded |
|---|---|---|
PPE sourcing for staff a high priority | • Initial PPE shortage, donations helped at the beginning • PPE availability sufficient now but requires continuous effort o PPE sourcing may be one person’s full-time job • Masks required for HC aides during care visits o Surgical disposable masks most commonly used o N95 respirators, envo® masks for direct COVID-19 care • Gloves required for HC aides during care visits • Face shield, goggles may be required during care visits o HC aides not allowed to wear cloth face coverings during care visits | *** |
Managing COVID-19 positive/ symptomatic HC clients and staff | • Tracking and monitoring HC staff, client health symptoms o Require HC staff, clients to self-monitor for COVID-19 symptoms and self-report • Change care model to isolate suspected and positive COVID-19 clients and reduce risk to HC aides while continuing to provide necessary care tasks o Create a reporting chain and alerting system for suspected and positive COVID-19 clients, HC staff • HHC agencies with skilled nursing care o Direct care of positive cases in the home o Anticipate post-acute care after hospital discharge • HC agencies contracted for hands-on personal care with aides o Higher visit rates paid to agencies for positive cases • Ensuring adequate PPE for staff caring for the positive cases • Situational awareness team at an elder service agency upon identifying a positive case o Communicates remotely, follows protocol for care decisions | *** |
Training and communication with HC staff | • Remote communication methods during the pandemic • In-service training for HC aides offered remotely online or through self-study assignments • Staff may be technologically challenged o Challenges in communicating information electronically to staff o No company email for staff – personal email only • Brief, scheduled visits allowed in the HC office o PPE, accumulated mail pick-ups o HC aides miss one-on-one interaction with colleagues | *** |
HC aide staffing/ retention challenges | • HC aide staffing, visit scheduling challenges o When caregivers quarantined o When clients first suspend and later resume services • Difficult to retain HC aides o Underfunded HC industry | ** |
Clients reaction/ behavior | • Initial fear o HC service visit cancelled, suspended, or referrals reduced o Meal services to clients increased • Mask wearing among clients varies | ** |