Caregiving During the Covid-19 Pandemic Through Publicly-Funded Home- and Community-Based Services

TL;DR

During the pandemic, more people used home care services, but many still had unmet needs, especially for personal care.

Contribution

The study compares pandemic-era changes in home care service use and unmet needs with pre-pandemic data using a national survey.

Findings

Pandemic increased odds of personal care aide use and unmet needs compared to pre-pandemic.

Temporary pandemic policies for respite care reduced unmet needs for caregiver support.

Findings suggest need for further research on effective pandemic policies for home care services.

Abstract

Workforce shortages in home- and community-based services (HCBS) were exacerbated during the COVID-19 pandemic. We evaluated changes in HCBS use and consumer-reported unmet HCBS needs for (1) personal care aide (PCA) and (2) caregiver support/respite (CS/R) in 2021-2022 (during the pandemic) versus 2018-2019 (pre-pandemic), in the US National Core Indicators- Aging & Disability Adult Consumer Survey. We included 7143 community-dwelling HCBS consumers (age, ≥65 years, from 11 states). We calculated adjusted odds ratios (aOR) and 95% confidence interval (CI) for HCBS use and consumer-reported unmet HCBS needs for PCA and CS/R using logistic regression, adjusting for sociodemographic and health-related variables (fixed effects), with random intercept for state (to account for clustering by state). For PCA, compared to 2018-2019, during 2021-2022, there was a significant increase in the odds of both PCA use (aOR, 1.24; 95% CI, 1.09, 1.40) and unmet PCA needs (aOR, 1.23; 95% CI, 1.03, 1.46), suggesting that pandemic policy efforts to mitigate service disruptions were insufficient to decrease unmet PCA needs. For CS/R, during 2021-2022, there was a significant increase in the odds of CS/R use (aOR, 1.24; 95% CI, 1.09, 1.40) and a simultaneous significant decrease in the odds of unmet CS/R needs (aOR, 0.49; 95% CI, 0.35, 0.70), suggesting that temporary pandemic policies for CS/R may have successfully abated consumers-reported unmet CS/R service needs. These cross-sectional findings call for more rigorous investigation to identify which temporary pandemic-related CS/R policies were effective; to inform disaster preparedness efforts for mitigating HCBS disruptions during future public health emergencies.