Barriers to providing internet-based home care services for urban older adults in China: a qualitative study of the service providers.

BACKGROUND: Due to the increasingly aging population in China and the changes in social and family structure, older adults' care problems are becoming more and more prominent. To meet the home care needs of urban older adults, the Chinese government has launched Internet-Based Home Care Services (IBHCS). Although this model innovation can significantly relieve care problems, more and more evidence shows that there are many barriers in the process of IBHCS supply. The current literature is mostly from the perspective of the service users, and there are very few studies on the experience of service providers. METHODS: In this study, we took a qualitative phenomenological approach and used semi-structured interviews to investigate service providers' daily experiences and the barriers they encounter. A total of 34 staff from 14 Home Care Service Centers (HCSCs) were included. Interviews were transcribed and analyzed using thematic analysis. RESULTS: We identified the barriers that service providers encounter in IBHCS supply: (1) bureaucratic repression: unreasonable policy plans, harsh assessment, excessive paperwork, different preferences of government leaders, and obstacles caused by COVID-19 control lead to a shift of focus in their work; (2) profitability crisis in the market: high service costs, dampened effective demand, government intervention in setting prices, and parent companies' excessively high sales targets hinder the service supply process; (3) client-related challenges: the crisis of confidence, the dilemma of popularizing new technology, and communication barriers lead to rejection by older adults; (4) job dissatisfaction: low and unstable salary, heavy tasks, poor social acceptance of occupations, and lack of professional value reduce work enthusiasm. CONCLUSION: We have investigated the barriers faced by service providers when providing IBHCS for urban older adults in China, providing empirical evidence in the Chinese context for the relevant literature. In order to provide IBHCS better, it is necessary to improve the institutional environment and market environment, strengthen publicity and communication, target customer needs, and adjust the working conditions of front-line workers.

Family caregiver involvement and role in hospital at home for adults: the patients' and family caregivers' perspective - a Norwegian qualitative study.

BACKGROUND: Hospital at home (HaH) provides acute healthcare services in patients' homes instead of traditional in-patient care. Research has reported positive outcomes for patients and reduced costs. Although HaH has developed into a global concept, we have little knowledge about the involvement and role of family caregivers (FCs) of adults. The aim of this study was to explore FC involvement and role during HaH treatment as perceived by patients and FCs in a Norwegian healthcare context. METHODS: A qualitative study was carried out among seven patients and nine FCs in Mid-Norway. The data was obtained through fifteen semi-structured interviews; fourteen were performed individually and one as duad interview. The age of the participants varied between 31 and 73 years, and mean age of 57 years. A hermeneutic phenomenological approach was used, and the analysis was performed according to Kvale and Brinkmann's description of interpretation. RESULTS: We identified three main categories and seven subcategories regarding FC involvement and role in HaH: (1) Preparing for something new and unfamiliar, including the subcategories `Lack of involvement in the decision process` and `Information overload affecting caregiver readiness`, (2) Adjusting to a new everyday life at home, including the subcategories `The critical first days at home`, `Coherent care and support in a novel situation`, and `Prior established family roles influencing the new everyday life at home`, (3) FCs` role gradually diminishes and looking back, including the subcategories `A smooth transition to life beyond hospital at home` and `Finding meaning and motivation in providing care`. CONCLUSIONS: FCs played an important role in HaH, although their tasks, involvement and effort varied across different phases during HaH treatment. The study findings contribute to a greater understanding of the dynamic nature of the caregiver experiences during HaH treatment, which can guide healthcare professionals on how they can provide timely and appropriate support to FCs in HaH over time. Such knowledge is important to decrease the risk of caregiver distress during HaH treatment. Further work, such as longitudinal studies, should be done to examine the course of caregiving in HaH over time to correct or support the phases described in this study.

[Management of COVID-19 pandemic in hospital at home in two regional Spanish hospitals. what it meant, who we cared for, who died and how assistance has evolved over time]. / Manejo de la pandemia de COVID-19 en hospitalización domiciliaria en dos hospitales comarcales españoles: qué significó, quiénes atendimos, quién falleció y como evolucionó la asistencia a lo largo del tiempo.

OBJECTIVE: Home Hospitalization (HH) is an alternative hospitalization modality that can be very useful in times of health stress such as the COVID-19 pandemic. This paper includes the management of patients admitted with COVID-19 in HH in two county spanish hospitals for two years. METHODS: A descriptive, observational and retrospective study of all patients admitted at HH with a diagnosis of COVID-19 disease was carried out. Subsequently, further analysis was carried out to characterize the patients who died in HH or 30 days after discharge and another to compare the management between the first phase of the study (2020) and the second one (2021 and part of 2022). RESULTS: A total of 167 patients were recruited. A 52.1% moved to watch that the recovery continued compared to 40.7% in which it was done to watch that they did not worsen. The patients who died in HAD were older (mean 87.5 years), more comorbid and more likely to have do-not resucitate orders (DNR) in case of cardiac arrest (85%). In the second phase of the study, older patients, more comorbid patients and with a greater degree of DNR orders were admitted than those admitted throughout 2020. CONCLUSIONS: HAD is a useful resource to increase the resilience of health systems in cases of stress such as the disease caused by COVID-19. The development and growth of existing units, as well as the creation of new ones where they do not exist, could be a basic tool for the medicine of the future.

Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services.

PURPOSE: This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic. DESIGN/METHODOLOGY/APPROACH: This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis. FINDINGS: The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students. ORIGINALITY/VALUE: The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.

Acceptability of contact management and care of simple cases of COVID-19 at home: a cross-sectional study in Senegal.

BACKGROUND: COVID-19 is a major public health problem. In mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The objective of the study was to determine the acceptability of contact and simple case management of COVID-19 at home and its associated factors in Senegal. METHODS: This was a descriptive and analytical cross-sectional study. We collected data from 11 June to 10 July 2020. We used a marginal quota sampling strategy. A total of 813 individuals took part in the survey. We collected data using a telephone interview. RESULTS: The care of simple cases of COVID-19 at home was well accepted (78.5%). The use of home contact management was less accepted (51.4%). Knowledge of the modes of transmission of the virus and confidence in institutional information were associated with the acceptability of home care for simple cases. Regularly searching for information on COVID-19 and confidence in the government's control of the epidemic were associated with the acceptability of managing contacts at home. CONCLUSIONS: Authorities should take these factors into account for better communication to improve the acceptability and confidence in home-based care for COVID-19 and future epidemics.

[Home-care services in the first two waves of the COVID-19 pandemic: challenges for staff and care recipients]. / Ambulante Pflege in den ersten beiden Wellen der COVID-19-Pandemie: Herausforderungen für Personal und Pflegebedürftige.

INTRODUCTION: During the COVID-19 pandemic, people in need of long-term care were among the most vulnerable population groups. Home-care services were under exceptional strain, especially at the beginning of the pandemic. The aim of this study is to examine the situation and problems of care services and the people in need of care during the first two waves of the pandemic in Germany. METHODS: Two cross-sectional studies were conducted during the first two COVID-19 waves (first survey 28 April to 12 May 2020, second survey 12 January to 7 February 2021). In total, data from N = 1029 outpatient care services were included in the analysis. Descriptive measures were used for the analysis. RESULTS: The clients of home-care services were severely burdened in the first two waves of the pandemic. This can be seen on the one hand in an increased risk of illness and increased mortality, and on the other in the loss of various care and support services. The latter also has negative effects on the psychosocial condition of those in need of care, for example. Care services were affected by high staff absenteeism and additional work due to protective measures. DISCUSSION: The COVID-19 pandemic led to immense burdens for people in need of care and home-care services and to a reduction in care services. The deterioration of care provision met with an already tense situation. It has become clear that the provision of care for those in need of care by outpatient care services is not crisis-proof, and that additional challenges such as a pandemic can have dramatic consequences. For the future, reliable structures and readily available emergency plans should be established with concrete instructions for action.

Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: A scoping review

Background: Although people receiving invasive home mechanical ventilation through a tracheostomy are facing both physical and mental health challenges, healthcare services often focus mainly on physical symptoms. To ensure well-functioning treatment and care for people receiving tracheostomy ventilation in a home setting, their mental health needs to be promoted and seen as an integral part of their health in general. Objective: This scoping review aimed to provide a summary of the current knowledge on the mental health of people receiving invasive home mechanical ventilation through a tracheostomy. Design: A scoping review of published and gray literature based on the framework developed by Arksey and O'Malley and refined by the JBI was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist was used for reporting the findings. Methods: A literature search was conducted by two researchers independently in the PubMed, CINAHL and PsycINFO databases. Additional searches for gray literature were conducted in Google, Google Scholar, websites of selected organisations, and the reference lists of included studies. The software system Covidence was used in the study selection process. For critical appraisal, the Mixed Methods Appraisal Tool was used. Results: Thirteen studies were included in this review, of which six used qualitative, six quantitative, and one mixed methods. The majority of studies were authored in Europe (n = 10), followed by the Americas (n = 2) and the Western Pacific (n = 1). Mental health was investigated both directly and indirectly (61.5% vs. 38.5%). Categorizing the reported mental health outcomes, we found that emotional well-being was reported widely across the studies (n = 13), while psychological well-being (n = 5) and social well-being (n = 4) were less widely reported. Conclusions: The mental health of people receiving home tracheostomy ventilation has received some scholarly attention. A heterogeneity of mental health outcomes was reported in the literature with emotional well-being being an important mental health area both in relation to the sub-components positive affect and quality of life appraisal. Mental health outcomes in relation to psychological well-being and social well-being were fragmented and only sparsely investigated. © 2022 The Author(s)

Challenges of Integrated Home-Based Palliative Care Services for Cancer Patients during the COVID-19 Pandemic: A Qualitative Content Analysis

Given the situation of cancer patients as vulnerable patients and the threat of COVID-19 in the society, integration of home-based palliative care services into the healthcare system is essential. The aim of this qualitative study was to explore the current barriers of integration of palliative care services from hospital to home for cancer patients during the COVID-19 Pandemic and to provide suggestions to resolve them. Semi-structured interviews were conducted with 25 stakeholders in the healthcare system, including health policy makers, healthcare providers, clinical home healthcare experts, home healthcare researchers, university faculty members, clergy, family caregivers, and cancer patients. Data were analyzed using directed content analysis method based on the World Health Organization Public Health Strategy for Palliative Care. Challenges were extracted in 4 main categories, containing education barriers (3 subcategories), implementation barriers (9 subcategories), policy barriers (5 subcategories), and drug availability barriers (2 subcategories). Based on the results, removing the barriers and establishing a strong infrastructure for home-based palliative care services is recommended in the healthcare system by concentrating on 4 essential factors, that is, utilizing a coordinating nurse during the process of patient’s hospital discharge, establishment of connecting outpatient palliative care clinics to home healthcare centers, access to palliative care tele-medicine and development of a comprehensive and flexible home-based palliative cancer care model in our context. [ FROM AUTHOR]

Good continence care: tips for nurses working in any setting: How to ask the right questions, assess symptoms and provide support before offering pads to patients with continence issues

The article offers tips for nurses on providing care for patients with continence issues. Topics discussed include the consequences of pressures on continence services, the lack of confidence among nurses in continence, tools used for initial assessment of bladder symptoms in adults, and the lack of services for younger patients with bladder and bowel issues in the Untied Kingdom.

COVID-19 in New South Wales children during 2021: severity and clinical spectrum.

OBJECTIVES: To describe the severity and clinical spectrum of coronavirus disease 2019 (COVID-19) in children during the 2021 New South Wales outbreak of the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). DESIGN, SETTING: Prospective cohort study in three metropolitan Sydney local health districts, 1 June - 31 October 2021. PARTICIPANTS: Children under 16 years of age with positive SARS-CoV-2 nucleic acid test results admitted to hospital or managed by the Sydney Children's Hospital Network (SCHN) virtual care team. MAIN OUTCOME MEASURES: Age-specific SARS-CoV-2 infection frequency, overall and separately for SCHN virtual and hospital patients; rates of medical and social reason admissions, intensive care admissions, and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 per 100 SARS-CoV-2 infections; demographic and clinical factors that influenced likelihood of hospital admission. RESULTS: A total of 17 474 SARS-CoV-2 infections in children under 16 were recorded in NSW, of whom 11 985 (68.6%) received SCHN-coordinated care, including 459 admitted to SCHN hospitals: 165 for medical reasons (1.38 [95% CI, 1.17-1.59] per 100 infections), including 15 admitted to intensive care, and 294 (under 18 years of age) for social reasons (2.45 [95% CI, 2.18-2.73] per 100 infections). In an analysis that included all children admitted to hospital and a random sample of those managed by the virtual team, having another medical condition (adjusted odds ratio [aOR], 7.42; 95% CI, 3.08-19.3) was associated with increased likelihood of medical admission; in univariate analyses, non-asthmatic chronic respiratory disease was associated with greater (OR, 9.21; 95% CI, 1.61-174) and asthma/viral induced wheeze with lower likelihood of admission (OR, 0.38; 95% CI, 0.18-0.78). The likelihood of admission for medical reasons declined from infancy to 5-11 years, but rose again for those aged 12-15 years. Sex and Indigenous status did not influence the likelihood of admission. CONCLUSION: Most SARS-CoV-2 infections (Delta variant) in children were asymptomatic or associated with mild disease. Hospitalisation was relatively infrequent, and most common for infants, adolescents, and children with other medical conditions. More children were hospitalised for social than for medical reasons.

Home admission in COVID times: challenge for the actions of the nursing professional

A very common method of care in the community is home admission, widely practiced during the COVID-19 pandemic, in which the family doctor and nurse were required to visit diagnosed patients daily at home. But, due to the increase in cases, it was not really possible to visit all the admissions. Given this fact, the nursing staff imposed a challenge on their professional performance, which included technical preparation, especially when performing the physical examination, emphasizing auscultation, since the respiratory system is the most affected in the patient sick from COVID. The objective of this article is to make considerations that express the author's point of view who considers home admissions to sick patients with COVID-19 a challenge in the performance of nursing staff.

Trends in home mechanical ventilation in the first year of the COVID-19 pandemic in Germany: a routine data analysis

Background: Routine data have shown a stark increase in home mechanical ventilation (HMV) in Germany in recent years. However, the development of HMV in the first year of the COVID-19 pandemic is unknown. Methods: Case numbers of initiations, control examinations, and terminations of invasive and non-invasive HMV in 2017-2020 were analysed. ICD-10 diagnoses of cases with an initiation of invasive HMV in 2017- 2020 were examined (data from the German Federal Statistical Office). Expenses of the statutory health insurances for ambulatory intensive care in 2017-2020 were analysed (data from the German Federal Ministry of Health). Results: Contrary to the trend in recent years, HMV initiations declined by 14.9 % in 2020, from n = 17,958 (2019) to n = 15,279 (2020). This development was due to a 15.9 % decline in initiations of non-invasive HMV. In contrast, initiations of invasive HMV remained stable in 2020, despite regional differences. For invasive and non-invasive HMV, control examinations (-28 % and -24 %, respectively) and ventilation terminations (-45.3 % and -15.1 %, respectively) dropped in 2020. Patients for whom invasive HMV was initiated had numerous comorbidities and care needs. Expenses of statutory health insurances for ambulatory intensive care increased from EUR 1.52 billion (2017) to EUR 2.16 billion (2020;+42.3 %). Conclusions: After an increase in control examinations and terminations of HMV in recent years, we observe a trend reversal in 2020. Additionally, initiations of non-invasive HMV decreased in 2020. Future studies need to explore the association between this development and the COVID-19 pandemic.

Home Delivery: Transfusion Services When and Where They Are Needed.

Home blood product transfusion has been utilized around the world in various forms over the past few decades. There is current interest in decentralizing hospital care to improve patient independence and convenience, minimize cost to the health service, and to prevent nosocomial infection, especially with the recent COVID-19 pandemic. The transition to "hospital in the home" is occurring across the healthcare sector driven by aims to improve patient outcomes and patient satisfaction, capacity pressures in the acute care sector, and most recently due to concerns regarding infectious disease transmission in hospital settings. This review explores the published literature on home red cell and platelet transfusions, and where the literature is limited, also considered data from subcutaneous immunoglobulin studies. Current published experience on red cell and platelet transfusion at home has identified benefits to the patient and health service, with further studies needed to quantify improvement in quality of life and health-related outcomes. Safety concerns may be a perceived barrier to implementation of home transfusion, however current published data suggests serious adverse reactions are rare. Cost-effectiveness data for home transfusion are very limited and a key area for future research. Home transfusion has the potential to benefit from newer technologies, such as portable/remote monitoring and electronic patient identifiers.

Effective Factors on Implementation of Pediatric Home Care Program Amid COVID 19 Pandemic: Facilitators and Barriers.

Background: Home care service is considered as comprehensive care for children with chronic disease or COVID-19. This study aimed to investigate the factors affecting the implementation of a home care nursing program for such children in 2019-2020. Materials and Methods: A descriptive-analytical study was conducted with 198 nurses working in pediatric wards of selective hospitals of Isfahan University of Medical Sciences. The data were collected through an author-administered questionnaire with 44 questions. The questionnaire was designed in two parts. Part one involved gathering the demographic data of the participants. Facilitating and barrier factors of the implementation of the care were prioritized and examined in part two by using the Likert scale in both the individual and the organizational domains. The data were analyzed using the mean frequency and paired t test. Results: The mean (SD) score of individual and organizational facilitating factors were 65.65 (16.24) and 65.98 (11.29), respectively, and the mean (SD) score of the organizational barriers was 82.04 (14.36), which was significantly higher than the mean score (SD) of the individual barriers of 57.94 (14.82) (t 197 = 21.32, p < 0.05). The most important individual facilitating factor (53.82%) was "respectful communication with the family," and the most important organizational facilitator (80.40%) was "Physicians' support of the nurses." Conclusions: Organizational factors were the most significant barriers. Therefore, the findings of this study will help policymakers in the program implementation.

Which factors are associated with COVID-19 infection incidence in care services for older people in Nordic countries? A cross-sectional survey.

AIMS: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units' and frontline managers' background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units. METHODS: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable. RESULTS: The proportions of residential/home units with client COVID-19 cases, mid-March-April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden's mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p ⩽ .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p ⩽ .05. CONCLUSIONS: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.

Barriers and facilitators to family caregiver training during home health care: A multisite qualitative analysis.

BACKGROUND: During Medicare home health care (HHC), family caregiver assistance is often integral to implementing the care plan and avoiding readmission. Family caregiver training delivered by HHC clinicians (nurses and physical therapists [PTs]) helps ensure caregivers' ability to safely assist when HHC staff are not present. Yet, family caregiver training needs often go unmet during HHC, increasing the risk of adverse patient outcomes. There is a critical knowledge gap regarding challenges HHC clinicians face in providing necessary family caregiver training. METHODS: Multisite qualitative study using semi-structured, in-depth key informant interviews with Registered Nurses (n = 11) and PTs (n = 8) employed by four HHC agencies. Participating agencies were diverse in rurality, scale, ownership, and geographic region. Key informant interviews were audio-recorded, transcribed, and analyzed using directed content analysis to identify existing facilitators and barriers to family caregiver training during HHC. RESULTS: Clinicians had an average of 9.3 years (range = 1.5-23 years) experience in HHC, an average age of 45.1 years (range = 28-63 years), and 95% were female. Clinicians identified facilitators and barriers to providing family caregiver training at the individual, interpersonal, and structural levels. The most salient factors included clinician-caregiver communication and rapport, accuracy of hospital discharge information, and access to resources such as additional visits and social work consultation. Clinicians noted the COVID-19 pandemic introduced additional challenges to providing family caregiver training, including caregivers' reduced access to hospital staff prior to discharge. CONCLUSIONS: HHC clinicians identified a range of barriers and facilitators to delivering family caregiver training during HHC; particularly highlighting the role of clinician-caregiver communication. To support caregiver training in this setting, there is a need for updated reimbursement structures supporting greater visit flexibility, improved discharge communication between hospital and HHC, and structured communication aids to facilitate caregiver engagement and assessment.

Effect of using disposable polyethylene bag as a probe cover or finger cover in pulse oximetry.

Background: Consumer-grade pulse oximeters are used to monitor blood oxygen levels (SpO2) at home. Sharing a pulse oximeter with family members in isolation centers or home isolation due to COVID-19 may increase the chances of cross-infection. Aim: We aimed to find if using commonly available disposable polyethylene covers either on the finger and/or on the pulse oximeter provides the same reading of SpO2 or not. Methods: Two operators measured SpO2 on 10 healthy subjects with three randomly selected pulse oximeters. Six types of commonly available polythene bags (transparent, translucent, and opaque) were used to cover the fingers and/or device. After measuring the baseline SpO2 (i.e., without using covers), the measurements were taken with a covered finger, and/or covered oximeter probe. Results: The mean age of the research participants (five male, five female) was 23.9 ± 5.11 years. Perfusion index was 9.12 ± 1.63 (males 9.6 ± 1.42, females 8.64 ± 1.85, P = 0.38). Black opaque polyethylene bag as finger or probe cover did not detect any signal. There was no difference in SpO2 reading when a pulse oximeter probe is covered, and/or a finger is covered. There was excellent inter-observer and inter-device agreement. Conclusion: Commonly available transparent and translucent polyethylene plastic bags may be used as finger or pulse oximeter cover without compromising the SpO2 reading. However, an opaque black plastic bag is not suitable for finger or probe cover. These easily available and cheap pulse oximeter covers may be used by multiple patients or family members in an emergency like the COVID-19 pandemic with the potential to prevent cross-infection.

In the Eye of the Storm: A Quantitative and Qualitative Account of the Impact of the COVID-19 Pandemic on Dutch Home Healthcare.

The COVID-19 pandemic has severely affected healthcare delivery across the world. However, little is known about COVID-19's impact on home healthcare (HHC) services. Our study aimed to: (1) describe the changes in volume and intensity of HHC services and the crisis management policies implemented; (2) understand the responses and the experiences of HHC staff and clients. We conducted an explanatory sequential mixed methods study. First, retrospective client data (N = 43,495) from four Dutch HHC organizations was analyzed. Second, four focus group interviews were conducted for the strategic, tactical, operational, and client levels of the four HHC organizations. Our results showed that both the supply of and demand for Dutch HHC decreased considerably, especially during the first wave (March-June 2020). This was due to factors such as fear of infection, anticipation of a high demand for COVID-19-related care from the hospital sector, and lack of personal protective equipment. The top-down management style initially applied made way for a more bottom-up approach in the second wave (July 2020-January 2021). Experiences vary between levels and waves. HHC organizations need more responsive protocols to prevent such radical scaling-back of HHC in future crises, and interventions to help HHC professionals cope with crisis situations.