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Medical home visit programs during COVID-19 state of emergency
Donna Seminara, Anita Szerszen, John R Maese
1Division of Geriatrics, Northwell Staten Island University Hospital, 420 Lyndale Ave, Staten Island, NY 10312.
Insights
The COVID-19 pandemic created significant challenges for elderly, homebound patients, impacting healthcare access and finances. Telehealth and policy changes are crucial for maintaining essential home healthcare services.
Area of Science:
- Gerontology
- Public Health
- Infectious Diseases
Background:
- Elderly, homebound individuals are a vulnerable population disproportionately affected by the COVID-19 pandemic.
- Fear of infection has deterred patients from seeking necessary healthcare, worsening treatable conditions.
- Reduced access to diagnostic services like at-home phlebotomy and radiology has impacted patient evaluation.
Purpose of the Study:
- To examine the multifaceted challenges faced by homebound elderly patients during the COVID-19 pandemic.
- To highlight the impact of the pandemic on healthcare access, diagnostic support, and home health services.
- To explore the role of technology and policy changes in adapting healthcare delivery.
Main Methods:
- Qualitative analysis of challenges faced by homebound patients and healthcare providers.
- Review of impacts on healthcare access, diagnostic support, and home health aide services.
- Examination of the role of telehealth and policy adaptations (e.g., CMS changes) in healthcare delivery.
Main Results:
- The pandemic led to decreased diagnostic support and limited home visits by healthcare agencies due to PPE shortages.
- Financial and health impacts on home health aides affected patient care, including those with Down syndrome and dementia.
- Increased pressure on end-of-life decisions, with a rise in palliative and hospice care utilization to avoid separation.
Conclusions:
- The pandemic has severely disrupted healthcare for homebound elderly individuals, necessitating adaptive strategies.
- Telehealth and policy modifications have been vital in maintaining care continuity and mitigating negative impacts.
- Continued flexibility and innovation are essential to ensure timely and effective care for this vulnerable population.
Abstract:
Elderly, homebound individuals comprise a vulnerable segment of society who have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic through a myriad of unique challenges. There is a significant amount of fear of acquiring COVID-19 by seeking health care services, which has adversely affected patients by worsening fixable situations. Another challenge is the decrease in diagnostic support for evaluating patients compared with a pre-COVID-19 world. Agencies providing at-home phlebotomy, portable radiology, and support services have had to limit their home visits due to an inability to access personal protective equipment. This loss of diagnostic and therapeutic support has had an emotional toll on patients and their caregivers. COVID-19 has had a tremendous impact on the health and finances of home health aides and their patients. Loss of long-term home health aides has adversely affected younger patients with ailments like Down syndrome as well as older patients with dementia. COVID-19 has also increased pressure on end-of-life decision making. Patients and their families are increasingly opting for palliative care and hospice programming to avoid separation. Families are being forced to consider advance directives under an increased emotional strain as patients become "persons under investigation" for COVID-19. Technology has allowed for the provision of services through telehealth, and changes to policy by CMS have aided widespread implementation of telemedicine. We anticipate continuing to be nimble in the face of challenge and to provide timely and meaningful care for those who depend on our efforts.
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