Iran Journal of Nursing

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Keyvanloo Shahrestanaki S. “Letter to Editor” Challenges of Home Care during the COVID-19 Outbreak. IJN 2020; 33 (127) :1-6
URL: http://ijn.iums.ac.ir/article-1-3300-en.html

The emerging phenomenon of COVID-19 has affected all aspects of life across the world as the disease is spreading rapidly worldwide. The widespread COVID-19 pandemic and its consequences are of great concern to the human community⁾¹⁽. The pandemic has posed particular challenges to healthcare services⁽²⁾. Healthcare services in a community consist of various sectors, one of the most important of which is home care. It seems that during the COVID-19 outbreak, attention has mostly been paid to hospital care issues, and the challenges of home care services have been neglected^(3-5). The World Health Organization (WHO) has recently focused and published most of its guidelines on infection control and the clinical management of COVID-19 during home quarantine⁽⁶⁾.
Home care services may act as a supportive part of healthcare services and reduce the burden on the healthcare system^(3,7,8). Nevertheless, our knowledge of home care challenges during the COVID-19 pandemic is alarmingly limited⁽⁴⁾. Therefore, special attention should be paid to the challenges and issues associated with home care in order to improve such healthcare services, particularly during crises. In the current pandemic, the home care of the patients is divided into two general categories, including the care of COVID-19 patients and care of the patients without this disease⁽⁴⁾. Most of the individuals in the second group are vulnerable patients who are cared for at home due to other chronic diseases or complications caused by aging⁽⁹⁾. During the current pandemic, the second group has received less attention due to the increased attention to those who have contracted COVID-19^(3,4).
Prior to the disease outbreak, home care patients were often faced with numerous problems with the provision of medicines due to inadequate insurance coverage⁽¹⁰⁾. The prevalence of COVID-19 appears to have added to this burden, posing countless challenges to these patients⁽⁵⁾. Another problem among home care patients in both groups is the complications and challenges associated with the provision of medical supplies and equipment⁽¹¹⁾. Apparently, the supplied equipment has imposed a heavy burden on these patients and their families⁽¹²⁾. The lack or high costs of personal protective equipment (PPE) for home healthcare providers are among the other significant issues in this regard⁽¹³⁾. Furthermore, the lack of PPE has been reported among health care providers in various countries^(5,13). Early into the pandemic, PPE was mostly provided to hospitals, which led to the shortage of the equipment for home care centers, as well as a large number of the healthcare providers contracting COVID-19⁽¹⁴⁾. Given the issues and challenges caused by the shortage of medical supplies and equipment, a comprehensive plan seems crucial. On the other hand, extensive research is required regarding medicine and home care equipment during the COVID-19 pandemic in Iran.
Another challenge for healthcare providers has been to recognize the desires and demands of patients' families during home care provision. Due to the families’ desire to reduce home visits, longer shifts than before have been in place for home care providers. However, measures such as using PPE and proper clothing has become immensely difficult and exhausting⁽¹⁵⁾ as the care shifts of COVID-19 patients at home becomes longer. Meanwhile, less attention has been paid to the physical, mental, and social health of home care providers^(4,5), and some have been reported to feel neglected or that they are unsupported during the pandemic⁽⁵⁾.
Environmental challenges are another hurdle of the patients with COVID-19 at home. For instance, these patient have to be cared for in a separate, well-ventilated room⁽¹⁶⁾, while it may not be feasible for all patients to have such conditions due to limited space or the presence of a large number of family members at home⁽⁴⁾, which in turn leads to challenges in infection control for the patients and their families.
Due to limited hospital beds, some governments have implemented policies to care for COVID-19 patients at home⁽³⁾, while these policies are intertwined with the shortage of healthcare providers⁽¹⁷⁾. Among the main responsibilities of home healthcare center managers are effective crisis management and appropriate decision-making regarding the control of equipment and workforce⁽¹⁸⁾. Evidently, training the officials of nursing care centers on crisis management could resolve this issue⁽¹⁹⁾.
COVID-19 is yet to be investigated and explored, and the current data on this disease are changing every day⁽²⁰⁾. To protect themselves and the patient, healthcare providers must constantly receive sufficient and recent information. Inadequate training (especially for home care providers) is considered to be a significant challenge, which could lead to numerous problems in home care⁽⁵⁾. The proper and high-quality training of in-home care providers increases the quality of care⁽²¹⁾. Planning for adequate and updated training is indispensable and an urgent need in this regard. During the coronavirus pandemic, most educational processes have been adversely affected⁽²²⁾, and healthcare providers have been forced to retrieve credible evidence to update their knowledge of the current circumstances. Evidence-based practice has always been a major challenge for healthcare providers, including nurses⁽²³⁾. With this background, healthcare providers have been made to update their information. Due to the continuous spread and rising prevalence of COVID-19, great strides are required to educate in-home care providers and implement evidence-based practice successfully.
In conclusion, prioritizing research on the challenges of home health care during the COVID-19 pandemic could contribute to informing, planning, training, and management in order to control epidemic crisis in the future⁽²⁴⁾.