Older adults and individuals with disabilities prefer to receive Long Term Services and Supports (LTSS) in their home, which may be safer than congregate care settings during infectious disease pandemics. However, home-based care settings are far less regulated than institutional settings and not always guided by a clear chain of command. Further, private homes are part of a networks of care in which disease can be spread across connected households. Concerns over personal safety, coupled with other issues that have long-plagues the LTSS workforce such as low-wages and lack of benefits, further threaten an already strained workforce. We contend that structural, cultural, and individual factors provide challenges to providing quality LTSS care and implementing new safety practices in home-based settings during the pandemic, but that lessons can be learned from the adaptation experiences of consumers, workers, and agency providers. The long-term goals of this study are to improve the sustainability of the home care workforce. Safety of home care practices, and the health and well-being of consumers, informal caregivers, and direct service workers. To do that, we investigate the following research questions: 1. How did the system respond to meet the LTSS care needs of HCBS consumers during the pandemic? In particular, how were COVID-19 safety practices identified, negotiated, implemented, and managed across team members and consumer 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 consumers, family caregivers, workers and providers. The study population is Medicaid home-based LTSS consumers and their care teams in the state of Kansas. The study is guided by the System Engineering Initiative for Patient Safety (SEIPS) conceptual model. Which links the 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 workforce broadly, and the health and safety of direct service workers specifically, as well as strategies to address these threats. Increased understanding about the relationships between structural factors and worker and consumer attitudes, beliefs, and behaviors related to COVID-19 and care processes will inform the education and training needs of consumers, direct service workers, and caregivers.
Home and community based long term services and services (LTSS) are preferred over institutional settings and also may better protect against the spread of infectious disease; however, home-based settings are less regulated and there is a paucity of research on care quality and safety in home-based care. This mixed-methods study will collect interview and survey data from home-based LTSS consumers, family caregivers, direct support workers, and agency providers to investigate care and safety practices during the pandemic. In exploring the relationship between system factors and consumer, caregiver; worker attitudes, beliefs, and behaviors related to COVID-19; and care outcomes, the study will identify policies and practices that can improve the delivery of quality home care services and inform education and training to address the needs of consumers, caregivers, and workers.
