RESUMEN
After hip fracture surgery, a patient is stabilized but is given only hours to choose a rehabilitation facility before discharge.
Asunto(s)
Hospitales , Alta del Paciente , HumanosRESUMEN
Policy Points Hospital-at-Home (HaH) is a home-based alternative for acute care that has expanded significantly under COVID-19 regulatory flexibilities. The post-pandemic policy agenda for HaH will require consideration of multistakeholder perspectives, including patient, caregiver, provider, clinical operations, technology, equity, legal, quality, and payer. Key policy challenges include reaching a consensus on program standards, clarifying caregivers' issues, creating sustainable reimbursement mechanisms, and mitigating potential equity concerns. Key policy prescriptions include creating a national surveillance system for quality and safety, clarifying legal standards for care in the home, and deploying payment reforms through value-based models.
Asunto(s)
COVID-19 , COVID-19/epidemiología , Cuidadores , Hospitales , Humanos , Mecanismo de ReembolsoAsunto(s)
Población Negra/estadística & datos numéricos , COVID-19/prevención & control , Hispánicos o Latinos/estadística & datos numéricos , Personas Imposibilitadas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/psicología , Femenino , Estado de Salud , Personas Imposibilitadas/psicología , Humanos , Vida Independiente , Masculino , Pandemias , Prevalencia , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
Homebound older adults are a highly vulnerable population, yet little is known about their experiences with healthcare during the COVID-19 pandemic. We interviewed patients in home-based primary care (HBPC) in New York City by telephone in May and June of 2020. Interviews covered social supports, household activities, self-care, and medical care, and asked participants to compare current with prepandemic experiences. Among 70 participants, 37% were Black and 32% were Hispanic. Disruptions in the home included greater difficulty accessing paid caregivers (13.9%) and food (35.3%) than before the pandemic, and unaddressed household chores (laundry, 81.4%; food preparation, 11.4%). Black study participants were more likely than White and Hispanic participants to report disruptions in accessing medical care (13 [50.0%] vs. 3 [14.3%] vs. 6 [27.3%], respectively, p = 0.02), as well as food preparation and medication taking. Black patients in HBPC are at risk of disparities in healthcare and social support during the COVID-19 pandemic.