Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia

Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries

STUDY DESIGN

Descriptive repeated-cross sectional retrospective longitudinal cohort study.

OBJECTIVE

To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI).

SETTING

Health administrative database in Ontario, Canada.

METHODS

A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models.

RESULTS

Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021.

CONCLUSION

The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.

Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project

BACKGROUND

Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals.

METHODS

We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models.

RESULTS

Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic.

CONCLUSIONS

Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.

Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study

BACKGROUND

Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors' Autonomy program (SAPA [Soutien à l'autonomie des personnes âgées]) project was initiated within this context, embracing an innovative research approach that combines action research and design science.

OBJECTIVE

This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context.

METHODS

This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project.

RESULTS

The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients' ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients' homes, and detailed results will be presented in future papers.

CONCLUSIONS

To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/52284.

Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic.

METHODS

We utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately.

RESULTS

The study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰.

CONCLUSIONS

This study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.

Why Did Home Care Personal Support Service Volumes Drop During the COVID-19 Pandemic? The Contributions of Client Choice and Personal Support Worker Availability

Home care personal support service delivery decreased during the COVID-19 pandemic, and qualitative studies have suggested many potential contributors to these reductions. This paper provides insight into the source (client or provider) of reductions in home care service volumes early in the pandemic through analysis of a retrospective administrative dataset from a large provider organization. The percentage of authorized services not delivered was 17.2% in Wave 1, 12.6% in Wave 2 and 10.5% in Wave 3, nearing the pre-pandemic baseline of 8.9%. The dominant contribution to reduced home care service volumes was client-initiated holds and cancellations, collectively accounting for 99.3% of the service volume; missed care visits by the provider accounted for 0.7%. Worker availability also declined due to long-term absences (which increased 5-fold early in Wave 1 and remained 4× above baseline in Waves 2 and 3); short-term absences rose sharply for 6 early-pandemic weeks, then dropped below the pre-pandemic baseline. These data reveal that service volume reductions were primarily driven by client-initiated holds and cancellations; despite unprecedented decreases in Personal Support Worker availability, missed care did not increase, indicating that the decrease in demand was more substantial and occurred earlier than the decrease in worker availability.

How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021

Background

Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services.

Methods

We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission.

Results

Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission.

Conclusion

The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.

Implementing the interRAI Check-Up Comprehensive Assessment: Facilitating Care Planning and Care Coordination during the Pandemic

Background

Long-stay home care patients are a large population of older adults with multi-morbidity and frailty. The COVID-19 pandemic posed challenges to executing care coordination and completing in-home assessments due to provincial mandates restricting in-person care. We evaluated the implementation of the interRAI Check-Up Self-Report instrument administered by phone and video.

Methods

We report on a mixed-methods study, which involved the collection and analysis of survey and focus group data. Care coordinators from two regions in Ontario who had implemented the Check-Up at least once between March 2020 to September 2021 were recruited via convenience sampling.

Results

A total of 48 survey respondents and 7 focus group participants consented to the study. Advantages of completing the Check-Up over the telephone or video call included: reduced travel time, reduced risk of disease transmission, familiarity with the assessment questions, and reduced time spent administering the assessment. Limitations most frequently reported were: the inability to see the living environment, hearing impairments, inability to observe non-verbal responses or cues, language barriers, difficulty building rapport, and difficulty understanding the patient.

Conclusions

The Check-Up was advantageous in providing sufficient information to create a care plan when administered over the phone and by video. Implementation of the Check-Up assessment was facilitated by familiarity and alignment with other interRAI assessments. Our results indicate that population characteristics need to be taken into consideration for administration of self-report style of assessments.

Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging

BACKGROUND

The COVID-19 pandemic affected access to health care services in Canada; however, limited research examines the influence of the social determinants of health on unmet health care needs during the first year of the pandemic. The objectives of this study were to describe unmet health care needs during the first year of the pandemic and to investigate the association of unmet needs with the social determinants of health.

METHODS

We conducted a prospective cohort study of 23 972 adults participating in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study (April-December 2020) to identify the social determinants of health associated with unmet health care needs during the pandemic. Using logistic regression, we assessed the association between several social determinants of health on the following 3 outcomes (separately): experiencing any challenges in accessing health care services, not going to a hospital or seeing a doctor when needed, and experiencing barriers to accessing testing for SARS-CoV-2 infection.

RESULTS

From September to December 2020, 25% of participants experienced challenges accessing health care services, 8% did not go to a hospital or see a doctor when needed and 4% faced barriers accessing testing for SARS-CoV-2 infection. The prevalence of all 3 unmet need outcomes was lower among older age groups. Differences were observed by sex, region, education, income and racial background. Immigrants (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.09-1.27) or people with chronic conditions (OR 1.35, 95% CI 1.27-1.43) had higher odds of experiencing challenges accessing health care services and had higher odds of not going to a hospital or seeing a doctor (immigrants OR 1.26, 95% CI 1.11-1.43; chronic conditions OR 1.45, 95% CI 1.31-1.61). Prepandemic unmet health care needs were strongly associated with all 3 outcomes.

INTERPRETATION

Substantial unmet health care needs were reported by Canadian adults during the first year of the pandemic. The results of this study have important implications for health equity.

The Use of Health Care and Community-Based Services by People Living With Dementia and Their Caregivers During the COVID-19 Pandemic

INTRODUCTION

People living with dementia have been particularly affected by the COVID-19 pandemic.

METHODS

A survey of dementia care professionals was conducted to assess the use of health care and community-based services by people living with dementia and their caregivers during the first year of the pandemic.

RESULTS

The survey indicated that most services were no longer being used or were being used less during the pandemic, with a few key exceptions.

DISCUSSION

Many barriers and few facilitators were identified to service use for people living with dementia and their caregivers. The results identify potential gaps in the dementia care service network and may inform efforts to improve dementia care during future large-scale public health emergencies in the state of Wisconsin and beyond.

Personal Support Work and Home Care in Ontario during the COVID-19 Pandemic

Background

Governments introduced emergency measures to address the shortage of homecare workers and unmet care needs in Canada during the COVID-19 pandemic.

Objective

This article aims to describe how policies impacted home care and identifies the potential risks for clientele and staff.

Method

Experts in home care (n = 15) were interviewed about policies that affect health and safety for homecare recipients.

Results

New recruitment strategies, condensed education and rapid hiring during the pandemic did not lead to the recruitment of sufficient workers, but increased the potential for recruitment of unsuitable workers or workers with little training.

Conclusion

It is important to consider the unintended effects of emergency policy measures and to manage the effects of such policies on homecare clients.

Towards defining quality in home care for persons living with dementia

Introduction

Accelerating rates of dementia worldwide coupled with older adults living longer in the community calls for greater focus on quality home care support services. Few frameworks for quality dementia home care exist though prior findings have found elements considered to be important for “good” home care for people living with dementia. This study aimed to identify core components of a quality home care experience for people with dementia and their caregivers.

Methods

As part of a larger research study, in-depth interviews were conducted with persons living with dementia and caregivers (n = 25) to explore hospital-to-home care transitions. The design used for this study was a qualitative description. We used deductive-inductive thematic analysis, which was informed by previous work in this area. Open codes were mapped to pre-determined themes, and for codes not accommodated by an a piori framework, new themes were developed.

Findings

Our findings resulted in 4 overarching themes. Two themes were identified deductively (Availability and Acceptability of Home Care Services) and two inductively (Adaptability and Affordability of Home Care Services). Findings highlight the roles of family—care provider partnerships and responsive support in receiving quality home care, and the cost associated with unmet needs.

Interpretation

With an aging population, an increase in home care client acuity, and post-COVID-19 concerns over long-term care, more attention is needed to improve the quality of home care. The demand for these services will continue to increase particularly for those living with dementia and their families. The findings of availability, acceptability, adaptability, and affordability as core to quality care can help lay the groundwork for a home care framework for persons living with dementia and their caregivers. Future research could benefit from comparative analyses to evaluate the applicability of the findings to non-dementia home care service users and caregivers.

Venerable vulnerability or remarkable resilience? A prospective study of the impact of the first wave of the COVID-19 pandemic and quarantine measures on loneliness in Swedish older adults with home care

OBJECTIVES

To examine the early impact of the pandemic and of quarantine measures targeting older adults introduced in March 2020 on loneliness among older adults in Sweden.Design Prospective pretest-posttest and controlled interrupted time series designs.

SETTING

The population of older adults receiving home care before and during the emergence of the first COVID-19 pandemic wave in Sweden in Spring 2020.

PARTICIPANTS

Respondents (n=45 123, mean age 85.6 years, 67.6% women) came from two waves of a total population survey targeting all community-dwelling older adults receiving home care for older adults in Sweden in Spring 2019 and 2020.

OUTCOME

Self-reported loneliness.

RESULTS

Results estimated 14% (95% CI: 10 to 19) higher loneliness in Spring 2020 compared with 2019, taking covariates into account. No impact of the quarantine measure was found (1% increase, 95% CI: -1 to 4).

CONCLUSIONS

The results illustrate the broader public health consequences of the COVID-19 pandemic for older adults, but also suggest a relative resilience among older adults in home care to quarantine measures, at least during the first months of the pandemic. Future studies should examine the long-term effects of sustained pandemic and social distancing measures on loneliness among older adults.

Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada

OBJECTIVE

The objective was to compare home care episode, standardised assessment, and service patterns in Ontario's publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference.

STUDY DESIGN AND SETTING

We plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient's most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models.

RESULTS

The March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind.

CONCLUSION

The first wave of the COVID-19 pandemic was associated with substantial changes in Ontario's publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.

In the Eye of the Storm: A Quantitative and Qualitative Account of the Impact of the COVID-19 Pandemic on Dutch Home Healthcare

The COVID-19 pandemic has severely affected healthcare delivery across the world. However, little is known about COVID-19’s impact on home healthcare (HHC) services. Our study aimed to: (1) describe the changes in volume and intensity of HHC services and the crisis management policies implemented; (2) understand the responses and the experiences of HHC staff and clients. We conducted an explanatory sequential mixed methods study. First, retrospective client data (N = 43,495) from four Dutch HHC organizations was analyzed. Second, four focus group interviews were conducted for the strategic, tactical, operational, and client levels of the four HHC organizations. Our results showed that both the supply of and demand for Dutch HHC decreased considerably, especially during the first wave (March–June 2020). This was due to factors such as fear of infection, anticipation of a high demand for COVID-19-related care from the hospital sector, and lack of personal protective equipment. The top-down management style initially applied made way for a more bottom-up approach in the second wave (July 2020–January 2021). Experiences vary between levels and waves. HHC organizations need more responsive protocols to prevent such radical scaling-back of HHC in future crises, and interventions to help HHC professionals cope with crisis situations.

The Impact of COVID-19 from the Perspectives of Dutch District Nurses: A Mixed-Methods Study

Little is known about how COVID-19 affects older patients living at home or how it affects district nursing teams providing care to these patients. This study aims to (1) explore, from the perspectives of Dutch district nurses, COVID-19's impact on patients receiving district nursing care, district nursing teams, and their organisations during the first outbreak in March 2020 as well as one year later; and (2) identify the needs of district nurses regarding future outbreaks. A mixed-methods, two-phase, sequential exploratory design was followed. In total, 36 district nurses were interviewed during the first outbreak (March 2020), of which 18 participated in the follow-up questionnaire in April 2021. Thirteen themes emerged, which showed that the COVID pandemic has substantially impacted patient care and district nursing teams. During the first outbreak, nurses played a crucial role in organising care differently and worked under high pressure, leading to exhaustion, tiredness, and psychosocial problems, including fear of infection. A year later, nurses were better prepared to provide COVID care, but problems regarding work pressure and mental complaints remained. The identified needs focus on a sustainable implementation of leadership roles for district nurses. At the organisational and national levels, more support and appreciation are needed in terms of trust and appropriate policies.