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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

From: “It changed everything”: The Safe Home Care qualitative study of the COVID-19 pandemic’s impact on home care aides, clients, and managers

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
**
  1. Coding frequencies (n = 12): *** 7 or more participants; **5–6 participants.