Care & Safety Practices During COVID-19 in Home Based Care

About This Project

Older adults and individuals with disabilities prefer to receive long term services and supports (LTSS) in their homes and communities, and demand is expected to increase as a result of COVID-19 due to perceptions that home settings are safer alternatives to congregate care. LTSS consumers are often at increased risk of COVID-19 complications due to age and pre-existing health conditions. LTSS involves hands-on care that typically cannot be postponed or replaced by tele-health, and while home-based care may be safer than institutional care settings during an infectious disease pandemic, it is also less regulated and not always guided by a clear chain of responsibility. The flexibility and freedom in providing care in home-based settings supports individualized care practices, but may also make it challenging to identify, implement, and enforce best practices; including safety practices to reduce the spread of COVID-19, where guidance is changing rapidly and surrounded by many myths and unknowns. Further, private homes are not isolated settings -- these are still networks of care in which disease can be spread across connected households. Concerns over personal safety, coupled with other issues that have long-plagued the LTSS workforce such as low-wages and lack of benefits, further threaten an already strained workforce. The capacity for delivering quality care in home-based LTSS settings is experiencing new challenges, and while consumer and worker safety and wellbeing are more important than ever, new safety practices may be difficult to implement and sustain.

The end goal if this project to identify policy needs and care strategies that can improve the sustainability of the home care workforce; safety of home care practices; and ultimately, the health and well-being of consumers, informal caregivers, and direct service workers (DSW). To do that, we investigate the following research questions:

1. How did the system respond to meet the LTSS care needs of home-based consumers during the pandemic? In particular, how were COVID-19 safety practices identified, negotiated, implemented, and managed across care team members and consumers in private home settings?

2. How are external and structural factors and worker and consumer attitudes, beliefs, and behaviors related to COVID-19 and care processes?

3. How did adaptations to COVID-19 impact the degree to which consumer care needs were met; care satisfaction; and consumer, caregiver, and worker well-being?

These questions will be answered using a mixed methods interview and survey design to collect data

from Medicaid funded home care consumers, family caregivers, workers and providers in Kansas. The study is guided by the System Engineering Initiative for Patient Safety (SEIPS) conceptual model, which links external and structural factors to the process of care and care outcomes, highlighting the role of the adaptations and workarounds that occur when the system is out of balance. Expected outcomes of this research project include the identification of threats to the home care LTSS system, including the health and safety of LTSS consumers and direct service workers, as well as policies and other strategies to address these threats. Increased understanding of the relationships between structural factors and attitudes, beliefs, and behaviors related to COVID-19 and care processes can also inform the support and training needs of consumers, direct service workers, and caregivers.

Interested in Joining the Study?

Individuals who receive or provide KanCare/Medicaid Home and Community Based Services (HCBS) in Kansas are invited to join this study by participating in either an interview or survey.  Caregivers who support HCBS recipients can also join the study. HCBS is also known as the waiver program. 

Interviews and surveys have not started yet, but will begin soon!  If you are potentially interested in joining the study, please complete this form and we will follow-up with you:

You are not obligated to join the study if you complete the form.  We will provide you with additional information and answer any questions you may have, and then you can decide if you want to join the study.  Your name and contact information will be kept confidential by the research team and not shared with others.  This includes that your name is not shared with Advisory Board members or the funder.