Home Health Aides' Increased Role in Supporting Older Veterans and Primary Healthcare Teams During COVID-19: a Qualitative Analysis.

BACKGROUND: Home health aides are important but often overlooked members of care teams, providing functional and emotional support to patients. These services became increasingly important during the COVID-19 pandemic as older adults faced disruptions in in-person medical services and family caregiving. Understanding how aides supported healthcare teams is important for informing emergency planning and better integrating home health services with primary care. OBJECTIVE: To describe aides' roles in supporting veterans and working with primary care teams during COVID-19 and identify COVID-related changes in tasks. DESIGN: Semi-structured interviews. PARTICIPANTS: Eight home health aides, 6 home health agency administrators, and 9 primary care team members (3 RNs, 3 social workers, 3 MDs) serving veterans at a large, urban, Veterans Affairs medical center. APPROACH: Combined deductive and inductive analysis to identify a priori concepts (aide roles; changes in tasks and new tasks during COVID-19) and emergent ideas. Aide, administrator, and provider interviews were analyzed separately and compared and contrasted to highlight emergent themes and divergent perspectives. KEY RESULTS: Participants reported an increase in the volume and intensity of tasks that aides performed during the pandemic, as well as the shifting of some tasks from the medical care team and family caregivers to the aide. Four main themes emerged around aides' roles in the care team during COVID-19: (1) aides as physically present "boots on the ground" during medical and caregiving disruptions, (2) aides as care coordination support, (3) aides as mental health support, and (4) intensification of aides' work. CONCLUSIONS: Home health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. Integrating aides more formally into healthcare teams and expanding their scope of practice in times of crisis and beyond may improve care coordination for older veterans.

Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community.

The use of alerts from the Bronx RHIO, a health information exchange (HIE) to identify James J. Peters VAMC patients diagnosed with COVID-19 in the community was described to facilitate COVID-19 VA primary care follow-up. COVID-19 hospitalization and testing alerts were delivered on a Bronx RHIO facility report. VA COVID-19 follow-up care by telephone and video was guided by local COVID-19 clinical pathways, electronic health record (EHR) templates, and tracking through a database. VA received 180 RHIO alerts for 111 unique patients, and 88 had positive non-VA testing from March to June 2020. 41% of the 88 had non-VA admissions and 23% died. 63% received VA primary care follow-up of COVID-19 symptoms documented by custom EHR templates. The HIE identified 11% of the facility COVID-19 patients. HIE alerts can be used to identify facility COVID-19 patients diagnosed in the community and facilitate follow-up by their VA primary care teams.