Many Older Adults Abandon Home Health to Avoid COVID

Many homebound older adults cancel medically necessary home-based health care services for fear of getting COVID-19, research has found.

This avoidance led to new or worsening medical conditions for many patients, and home-based health care providers felt they had little power to counsel patients through the process of deciding whether or not to continue with care. Lack of adequate information and training.

“A representative from a home health care agency said that patients canceling services resulted in a 38% decrease in their agency’s patient numbers,” first author Jennifer Inlows, a student doctor of nursing practice at the University of Michigan School of Nursing he said. “It really highlights the level of fear among patients receiving home-based health care services early in the pandemic.”

Both family members and patients canceled services, and the large number of cancellations stunned Inlow.

“I understand why patients may put off in-person visits or elective surgeries because there are so many potential points of infection associated with office- or hospital-based care,” she says. “I was not prepared to hear about so many patients who are declining home-based health care services, because home-based health care is a lot more controlled interaction with fewer potential points of infection.”

Disease management continues to shift toward a home health care model, but there is not much literature on how public health emergencies affect the continuity of home health care. To learn more, researchers interviewed 27 Medicare-certified home health providers in eight US counties to better understand older adults’ decisions about home-based care service during COVID-19.

The findings emphasize the large role emotions play in medical decision-making, and challenge the assumption that given enough accurate educational information, patients make rational decisions in their best interests. Inloes says their research highlights the importance of carefully weighing the well-known benefits of home-based health care services with the potential negative consequences of canceling services.

“For example, home-based health care providers are trained in infection control precautions, so the risk of becoming infected with COVID-19 from a provider visiting the home is quite low,” she says. “However, a patient experiencing a preventable denial-related complication requiring emergency department treatment may now unwittingly have an increased risk of COVID-19 risk due to the greater number of providers, patients, and family members in the emergency department versus the home setting.” The risk has increased.

It is unknown whether more older adults survive infection by isolation than harmed by the negative health consequences of refusing care — and the answer to that question is not black and white, Inlow says. In addition to new or worsening conditions, previous research has found that pandemic-induced isolation has also negatively affected older adults, an important consideration.

“For some, but certainly not all patients, a home-based health care provider may be their only regular visitor, so we need to consider that aspect when determining the risks and benefits of an individual’s decision to cancel care.” need to be considered,” she says.

The question is not of right or wrong.

“Palliative care, which is a specialty I wish more health care providers had training in, discourages patient decision-making in terms of right or wrong,” she says. “As health care providers, our job is to help our patients live as closely as possible to their personal values, belief systems, and goals. I know I have helped a person make the ‘right’ decision if they are clear Can clearly articulate how the choice they’ve made, whether to continue or cancel care, aligns with those three things.

appears in the study Gerontological Nursing Journal, Sue Anne Bell, assistant professor in the School of Nursing, is the principal investigator.

Source: University of Michigan

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