Alternative Care Sites During the COVID-19 Pandemic: Policy Implications for Pandemic Surge Planning.

Alternative care sites (ACS) across the United States were widely underutilized during the coronavirus disease (COVID-19) outbreak, while the volume and severity of COVID-19 cases overwhelmed health systems across the United States. The challenges presented by the pandemic have shown the need to design surge capacity principles with consideration for demand that strains multiple response capabilities. We reviewed current policy and previous literature from past ACS as well as highlighted challenges from the COVID-19 pandemic, to make recommendations that can inform future surge capacity planning. Our recommendations include: (1) Preparedness actions need to be continuous and flexible; (2) staffing needs must be met as they arise with solutions that are specific to the pandemic; 3) health equity must be a focus of ACS establishment and planning; and (4) ACS should be designed to function without compromising safe and effective care. A critical opportunity exists to identify improvements for future use of ACS in pandemics.

Barriers and facilitators to providing home-based care in a pandemic: policy and practice implications.

OBJECTIVE: The purpose of this study is to describe the experiences of home-based care providers (HBCP)  in providing care to older adults during the pandemic in order to inform future disaster planning, including during pandemics. DESIGN: Qualitative inquiry using an abductive analytic approach. SETTING AND PARTICIPANTS: Home-based care providers in COVID-19 hotspots. METHODS: Telephone interviews were conducted with 27 participants (administrators, registered nurses and other members of the allied healthcare team), who provided in-home care during the pandemic in Medicare-certified home health agencies. Interviews focused on eliciting experiences from HBCP on challenges and successes in providing home-based care to older adults, including barriers to care and strategies employed to keep patients, and providers, safe in their homes during the pandemic. RESULTS: Data was distilled into four major themes that have potential policy and practice impact. These included disrupted aging-in-place resources, preparedness actions contributing to readiness for the pandemic, limited adaptability in administrative needs during the pandemic and challenges with unclear messaging from public health officials. CONCLUSIONS: Home-based care plays an essential role in maintaining the health of older adults in disaster contexts, including pandemics. Innovative solutions, informed by policy that generate evidence-based best practices to support HBCP are needed to reduce barriers and increase protective factors, in order to maintain continuity of care for this vulnerable population during disruptive events.