Many Hospitalized COVID Patients Will Need Longer-Term Care at Home
When COVID-19 patients go home from the hospital, their recovery is often far from over -- and many might benefit from home health care, a new study suggests.
At a time when U.S. COVID cases are surging and hospitals are running out of room, experts say home health care could serve a critical role by allowing some patients to have shorter hospital stays and be monitored at home.
But until now, little has been known about COVID patients' recovery during home health care.
The new study suggests that, at least in New York City, they do well.
Researchers looked at records from more than 1,400 COVID patients who were discharged from New York hospitals into care from the Visiting Nurse Service of New York -- a large nonprofit home health agency.
"When they entered home care, these patients were very sick," said lead researcher Kathryn Bowles, a professor at the University of Pennsylvania School of Nursing.
Overall, 84% still had trouble breathing with any exertion, while 42% had daily or constant pain. Half reported exhaustion, and just as many had anxiety symptoms. Most patients needed help with basics like bathing, dressing and moving around their home.
But by the time patients were discharged from home care, most were showing substantial improvements in those symptoms. And only 10% ended up in the hospital again.
Nearly all patients -- 94% -- were discharged, after an average of one month of home care. One percent of patients died, while others had to remain in home care for a longer term.
There was no comparison group of patients who did not receive home care. But on the whole, Bowles said, the findings "shine a light on the value of home health care."
In general, home care involves visits from nurses, physical therapists, occupational therapists and social workers, depending on the patient's needs.
For some, Bowles said, home care might allow a quicker hospital discharge. For others, it might be an alternative to being discharged to a skilled nursing facility or other institution.
But while the study patients mostly fared well in the end, the findings highlight a broader problem: COVID-19 can cause debilitating problems that require weeks to months of recovery.
"Death is not the only bad outcome of this disease," said Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth in Houston.
"In our clinic, we see young people with heart damage, lung damage and exacerbation of mental health conditions," said Ostrosky, who was not involved with the study.
The point that younger adults can suffer long-term consequences from COVID is an important one, according to Ostrosky.
Many of the patients in Bowles' study were older adults, but 43% were younger than 65.
Ostrosky agreed that home health care can be an important part of hospitalized COVID patients' recovery. At his hospital, he said, patients are considered candidates for home care based on two broad measures -- whether they are ready for it medically, and whether they and their families feel ready.
Ostrosky also agreed that home care can help free up needed hospital beds. But, he stressed, "no hospital will put patients in danger in order to discharge them sooner."
Bowles said it's important for patients and families to understand what home care is. "Sometimes patients say things like, 'I don't need it. My wife will take care of me,'" she said. "But this is skilled care from nurses and therapists."
A limitation of the study is that patients received care from a single home health agency. It's not clear whether the outcomes of COVID patients elsewhere would be the same.
Insurance coverage of home health care varies, too. Most patients in this study were on Medicare or Medicaid, which have their own rules about coverage, while around one-quarter had private insurance.
On the other hand, the study group was diverse; the majority of patients were Black or Hispanic -- two groups hard-hit by the pandemic.
At this point, Bowles said, it's not clear how often U.S. COVID patients are being discharged into home care. Government figures from June put the rate at only 11%.
That suggests home care is being underused, Bowles said.
The study was published online recently in Annals of Internal Medicine.
The Medicare Rights Center has more on home health care.
SOURCES: Kathryn Bowles, PhD, BSN, MSN, professor, van Ameringen chair in nursing excellence, University of Pennsylvania School of Nursing, Philadelphia; Luis Ostrosky, MD, professor, infectious diseases, McGovern Medical School at UTHealth, Houston, and fellow, Infectious Diseases Society of America, Arlington, Va.; Annals of Internal Medicine, Nov. 24, 2020, online
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