New research from VNSNY’s Center for Home Care Policy & Research on COVID-19 patients who received home health care after being discharged from the hospital shows that home care services play an important, positive role in these patients’ recovery and outcome. The findings are significant in that they are the first to highlight the fact that home health care is a valuable, underutilized resource that, if used more widely, could help relieve the burden faced by hospitals nationwide.
According to the Centers for Medicare and Medicaid Services, only 11 percent of discharged COVID-19 patients in the United States are receiving home care.
“The vast majority of studies about COVID-19 take place in the hospital setting,” says Dr. Kathy Bowles, Vice President & Director of the VNSNY Center for Home Care Policy & Research and van Ameringen Chair in Nursing Excellence at the University of Pennsylvania School of Nursing, and an author of the study. “We were curious to study what happens longer term to these patients who recover in their homes.”
Published in the Annals of Internal Medicine on November 24, 2020, with the title “Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients,” the study looked at 1,409 VNSNY home care patients who had been hospitalized with COVID-19 during the first few weeks of the pandemic—from April through mid-June. The patients were referred to VNSNY home care by 64 hospitals across the New York City area, and their outcomes were followed through mid-September.
“When these patients arrived in home health care, they were very sick and debilitated,” says Bowles. The average age of the patients was 67, and the majority had multiple underlying conditions, with the most common being hypertension, diabetes, and chronic pulmonary disease. Forty-two percent of patients reported daily or chronic pain; 84 percent reported trouble breathing with any exertion; and 50 percent reported symptoms of anxiety. On average, they entered home health care needing help with six out of the nine activities of daily living, such as dressing and bathing.
The COVID-19 patients’ health improved dramatically after receiving several weeks of in-home services. After an average of 32 days, 94 percent of patients were able to be discharged. At that time, most showed noticeable improvements in pain, ability to breathe, and anxiety levels; 88 percent (1,241 patients) were discharged without any adverse health events, such as re-hospitalization or death.
Furthermore, when the patients were discharged, they needed, on average, help with only one activity of daily living, as opposed to six upon admission.
In total, the 1,409 patients cared for received 13,926 home health visits. More than 75 percent of those visits were carried out in person, with 16 percent and 8 percent being conducted by telephone and video, respectively.
Registered nurses provided 52 percent of the visits, with physical therapists providing 37 percent of visits. The remainder were provided by social workers, occupational therapists, and speech-language pathologists.
The key takeaway from the study is that home health care provided to COVID-19 patients after hospital discharge benefits patient recovery. Transitioning patients from the hospital to home care can relieve the burden on hospitals so they can prioritize the sickest patients.
“Our study shows that home health care is an effective service to aid safe recovery from COVID-19,” says Bowles. “In addition, home health care can serve as a relief valve for overwhelmed acute care hospitals, giving them a place to safely discharge patients, or avoid admission altogether, by referring patients to the watchful eyes of skilled home health care.
“As we experience this current surge, we urge providers to better identify patients who can benefit from home health care, and to increase referrals to capitalize on this effective resource as a safe haven for COVID-19 recovery. This will enable us to aid in the recovery of many more COVID survivors.”