HOME HEALTHCARE AGENCIES OPERATIONS CHANGE AFTER THE INITIAL COVID-19 PANDEMIC SURGE

Background: Since early 2020, the entire world has been enveloped within the COVID-19 pandemic. As research surrounding healthcare processes during the pandemic has surged, little has been studied regarding the pandemic’s impact on home-healthcare agencies (HHA). Previous research during the 2009 H1N1 pandemic found varied pandemic preparedness among HHAs. Therefore, this study aims to understand the presence of pandemic preparedness plans among HHAs in Colorado and any changes made as a result of the COVID-19 pandemic.

Methods: To address our study aims, a 51 question survey was developed to assess the presence of pandemic preparedness plans within HHAs in Colorado. We also queried any changes made to the HHAs’ patient populations and personal protective equipment protocols. This survey was pretested by study personnel, built into the REDCap database, and disseminated via assistance of Home Care and Hospice Association of Colorado. As this survey contained no personally identifiable information, it was determined to be “Non-Human Subjects Research”. Three electronic survey invitations were sent to all recipients of the Home Care and Hospice Association of Colorado’s mailing list between March 2021 and September 2021. Descriptive data are presented below.

Results: The survey had 34 unique respondents (estimated 56% response rate). The respondent agencies served multiple regions within Colorado (88% Front Range, 35% Central Mountains, 24% Eastern Plans, 15% Western Slope). The average patient census for these agencies was: < 200 patients-49%, 201-400 patient-24%, 401-600 patients-12%, >600 patients-15%. Fifty-three percent of agencies cared for persons positive for COVID-19, and 47% cared for persons under investigation for COVID-19. Nearly all (97%) of HHAs reported a change in type of PPE used as a result of the COVID-19 pandemic with 85% reporting a change in the instruction of PPE usage. Forty-four percent reported transition to tele-health services with 15% limiting the services the agencies provided. Only 44% of HHAs reported having a pandemic preparedness plan in place prior to the COVID-19 pandemic. Only 26% of HHAs mandated N95 mask fit testing prior to the pandemic. Since the onset of the COVID-19 pandemic, more HHAs mandated N95 mask fit testing (50%) and also reported knowledge of a PPE stockpiling plan (74%). Eighty-two percent of HHAs reported changing a surgical mask for every patient or every day, which followed similar requirements for N95s, gowns, and gloves (73.9%, 100%, and 100% respectively). Only 8.8% of HHAs reported utilizing respirators.

Conclusions: HHAs are a vital component of patient care and have been under-examined during the course of COVID-19 pandemic literature. This survey demonstrates that across Colorado HHAs have been impacted by the COVID-19 pandemic including alterations in PPE usage and an increase in telehealth services. Although most HHAs in this study did not have a thorough pandemic preparedness plan prior to 2020, the SARS-CoV2 outbreak lead to increase pandemic planning including mask-fitting and increase in respiratory planning. Future work must be done to ensure adequate support is provided to these vital aspects of patient care including strong pandemic preparedness planning.