Table 2.
Measures of COVID-19 Home Health Preparedness by Location
| Total |
Location |
||
|---|---|---|---|
| Rural |
Urban |
||
| n (%) | n (%) | n (%) | |
| Emergency preparedness | |||
| Components in current preparedness plan | |||
| Infectious disease outbreaks | 92 (76.0) | 25 (75.8) | 67 (76.1) |
| Specific COVID-19 plan | 73 (60.3) | 16 (48.5) | 57 (64.8) |
| Other IPC components | 25 (20.7) | 4 (12.1) | 21 (23.9) |
| Has staff member responsible for outbreak/disaster preparedness∗ | 100 (84.0) | 27 (84.4) | 73 (83.9) |
| Outbreak simulations conducted in past 2 years | 62 (52.1) | 16 (50.0) | 46 (52.9) |
| Agency capacity | |||
| Ability to test patients for COVID-19 | 15 (12.4) | 7 (21.2) | 8 (9.1) |
| Access to laboratory for surveillance/detection | 67 (55.4) | 21 (63.6) | 46 (52.3) |
| Surge capacity | |||
| Agency could admit patients with COVID-19 requiring a lower level of care | 84 (69.4) | 26 (78.8) | 58 (65.9) |
| Agency could admit hospital patients without COVID-19 requiring a lower level of care | 82 (67.8) | 22 (66.7) | 60 (68.2) |
| Cares for patients in residential care settings | |||
| Nursing homes | 32 (26.4) | 8 (24.2) | 24 (27.3) |
| Assisted living facilities | 96 (79.3) | 25 (75.7) | 71 (80.7) |
| Changes due to COVID-19 pandemic | |||
| Has patients with COVID-19 | |||
| Suspected | 66 (54.5) | 17 (51.5) | 49 (55.7) |
| Confirmed | 33 (27.3) | 6 (18.2) | 27 (30.7) |
| Recovered | 23 (19.0) | 2 (6.1) | 21 (23.9) |
| Patient census | |||
| Increased | 10 (8.3) | 2 (6.1) | 8 (9.1) |
| Decreased | 84 (69.4) | 20 (60.6) | 64 (72.7) |
| No change | 24 (19.8) | 10 (30.3) | 14 (15.9) |
| Telehealth usage | |||
| Increased | 70 (57.8) | 19 (57.6) | 51 (57.9) |
| No change | 27 (22.3) | 9 (27.3) | 18 (20.4) |
| No telehealth usage at agency | 21 (17.4) | 5 (15.2) | 16 (18.2) |
| New procedures/protocols | |||
| Aerosol-generating procedure policies | 36 (29.7) | 9 (27.3) | 27 (30.7) |
| Barriers when in patient homes | 62 (51.2) | 16 (48.5) | 46 (52.3) |
| PPE donning and doffing in patient homes | 98 (81.0) | 28 (84.8) | 70 (79.5) |
| Not applicable | 10 (8.3) | 2 (6.1) | 8 (9.1) |
| COVID-19 staff training and education provided† | 114 (97.4) | 32 (100.0) | 82 (96.5) |
| Challenges due to COVID-19 pandemic | |||
| Supplies currently without | |||
| N95 respirators | 75 (62.0) | 17 (51.5) | 58 (65.9) |
| Masks (surgical) | 54 (44.6) | 15 (45.4) | 39 (44.3) |
| Gloves | 25 (20.7) | 5 (15.1) | 20 (22.7) |
| Eye protection | 55 (45.4) | 11 (33.3) | 44 (50.0) |
| Gowns | 67 (55.4) | 16 (48.5) | 51 (57.9) |
| Cleaning supplies/disinfectants | 62 (51.2) | 15 (45.4) | 47 (53.4) |
| Hand soap or alcohol-based hand sanitizer | 59 (48.8) | 14 (42.4) | 45 (51.1) |
| Supplies anticipated to be without in next 2 weeks | |||
| N95 respirators | 48 (39.7) | 13 (39.4) | 35 (39.8) |
| Masks (surgical) | 52 (43.0) | 15 (45.4) | 37 (42.1) |
| Gloves | 25 (20.7) | 6 (18.2) | 19 (21.6) |
| Eye protection | 38 (31.4) | 7 (21.2) | 31 (35.2) |
| Gowns | 56 (46.3) | 14 (42.4) | 42 (47.7) |
| Cleaning supplies/disinfectants | 49 (40.5) | 14 (42.4) | 35 (39.8) |
| Hand soap or alcohol-based hand sanitizer | 50 (41.3) | 14 (42.4) | 36 (40.9) |
| Currently experiencing staffing shortages∗ | 38 (31.9) | 6 (18.7) | 32 (36.8) |
| Primary reason for staffing shortage‡ | |||
| Staff at risk, or with family members at risk for COVID-19 | 12 (31.6) | 1 (16.7) | 11 (34.4) |
| Staff infected with/quarantined from COVID-19 exposure | 8 (21.0) | 0 (0.0) | 8 (25.0) |
| Child care issue due to school closings | 9 (23.7) | 0 (0.0) | 9 (28.1) |
| Other | 9 (23.7) | 5 (83.3) | 4 (12.5) |
| Anticipated staffing shortages during current pandemic§ | 19 (23.7) | 4 (15.4) | 15 (27.8) |
| Mitigating strategies for COVID-19 pandemic challenges | |||
| Addressing staffing shortages | |||
| Remaining staff volunteering to work extended hours | 23 (19.0) | 2 (6.1) | 21 (23.9) |
| Remaining staff mandated to work extended hours | 7 (5.8) | 2 (6.1) | 5 (5.7) |
| Contracted temporary staff | 13 (10.7) | 1 (3.0) | 12 (13.6) |
| Nonclinical staff filling different roles | 16 (13.2) | 3 (9.1) | 13 (14.8) |
| Accessing supplemental PPE | |||
| State or local resources | 77 (63.6) | 25 (75.8) | 52 (59.1) |
| Private/community donations | 63 (52.1) | 24 (72.7) | 39 (44.3) |
| Do-it-yourself efforts | 73 (60.3) | 25 (75.8) | 48 (54.5) |
| Not applicable | 2 (1.6) | 2 (6.1) | 0 (0.0) |
| Current PPE usage strategy | |||
| Use expired PPE supplies | 17 (14.0) | 8 (24.2) | 9 (10.2) |
| Extended use | 67 (55.4) | 23 (69.7) | 44 (50.0) |
| Limited reuse | 74 (61.2) | 19 (57.6) | 55 (62.5) |
| Rationing | 83 (68.6) | 25 (75.8) | 58 (65.9) |
| Not currently having to use a strategy | 13 (10.7) | 3 (9.1) | 10 (11.4) |
IPC, infection prevention and control.
Other IPC components included influenza, tuberculosis, multidrug-resistant Staphylococcus aureus. Other reasons for staffing shortages included employee fear and competition from other health care facilities. Totals varied due to missing data or skip patterns.
∗
n = 119.
†
n = 117.
‡
n = 38.
§
n = 80.