Care and Safety Practices during the COVID-19 Pandemic in Home-Based Long term Services and Supports

项目摘要 老年人和残疾人士更喜欢接受长期服务和支持(LTSS) 在他们的家中，这可能比传染病大流行期间聚集的护理环境更安全。 然而，与机构环境相比，家庭护理环境的监管要少得多，而且并不总是由 清晰的指挥链。此外，私人家庭是疾病可能发生的护理网络的一部分 分布在互联家庭中。对人身安全的担忧，加上其他有 长期困扰LTSS劳动力的低工资和缺乏福利，进一步威胁到本已紧张的 劳动力。我们认为，结构、文化和个人因素对提供高质量提出了挑战 在大流行期间，LTSS在家庭环境中照顾和实施新的安全做法，但 可以从消费者、工人和代理提供商的适应经验中吸取教训。 这项研究的长期目标是提高家庭护理劳动力的可持续性。安全问题 家庭护理实践，以及消费者、非正式照顾者和直接服务的健康和福祉 工人们。为此，我们调查了以下研究问题： 1.在大流行期间，该系统如何应对以满足六氯联苯消费者的长期护理需求？ 特别是，如何识别、协商、实施和管理新冠肺炎安全实践 在私人家庭环境中跨团队成员和消费者？ 2.外部和结构性因素以及员工和消费者的态度、信念和行为如何 与新冠肺炎和CARE流程相关？ 3.对新冠肺炎的适应如何影响消费者关怀需求的满足程度；关怀 满意度、消费者、照顾者和员工的幸福感？ 这些问题的答案将采用访谈和调查设计相结合的方法来收集数据 来自消费者、家庭照顾者、工人和提供者。研究人群是以医疗补助家庭为基础的 堪萨斯州的LTSS消费者和他们的护理团队。本研究以系统工程为指导 患者安全倡议(SEIPS)概念模型。它将外部和结构因素与 护理过程和护理结果，强调在以下情况下发生的适应和变通的作用 这个系统失去了平衡。这一研究项目的预期成果包括确定对 广泛的家庭护理劳动力，特别是直接服务人员的健康和安全，以及 应对这些威胁的战略。加深对结构性因素之间关系的理解 与新冠肺炎和护理流程相关的员工和消费者的态度、信念和行为将提供信息 消费者、直接服务人员和照顾者的教育和培训需求。

Project Abstract Older adults and individuals with disabilities prefer to receive Long Term Services and Supports (LTSS) in their home, which may be safer than congregate care settings during infectious disease pandemics. However, home-based care settings are far less regulated than institutional settings and not always guided by a clear chain of command. Further, private homes are part of a networks of care in which disease can be spread across connected households. Concerns over personal safety, coupled with other issues that have long-plagues the LTSS workforce such as low-wages and lack of benefits, further threaten an already strained workforce. We contend that structural, cultural, and individual factors provide challenges to providing quality LTSS care and implementing new safety practices in home-based settings during the pandemic, but that lessons can be learned from the adaptation experiences of consumers, workers, and agency providers. The long-term goals of this study are to improve the sustainability of the home care workforce. Safety of home care practices, and the health and well-being of consumers, informal caregivers, and direct service workers. To do that, we investigate the following research questions: 1. How did the system respond to meet the LTSS care needs of HCBS consumers during the pandemic? In particular, how were COVID-19 safety practices identified, negotiated, implemented, and managed across team members and consumer in private home settings? 2. How are external and structural factors and worker and consumer attitudes, beliefs, and behaviors related to COVID-19 and care processes? 3. How did adaptations to COVID-19 impact the degree to which consumer care needs were met; care satisfaction, and consumer, caregiver, and worker well-being? These questions will be answered using a mixed methods interview and survey design to collect data from consumers, family caregivers, workers and providers. The study population is Medicaid home-based LTSS consumers and their care teams in the state of Kansas. The study is guided by the System Engineering Initiative for Patient Safety (SEIPS) conceptual model. Which links the external and structural factors to the process of care and care outcomes, highlighting the role of the adaptations and workarounds that occur when the system is out of balance. Expected outcomes of this research project include the identification of threats to the home care workforce broadly, and the health and safety of direct service workers specifically, as well as strategies to address these threats. Increased understanding about the relationships between structural factors and worker and consumer attitudes, beliefs, and behaviors related to COVID-19 and care processes will inform the education and training needs of consumers, direct service workers, and caregivers.