1. Small, Tamara F. PhD, APRN, FNP-C

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Providing home healthcare services is essential for patients who do not require hospitalizations, or when hospitals reach capacity, or when patients are reluctant to receive healthcare services outside of their home because of the pandemic. Protecting the safety and health of home care workers during the pandemic is central to protecting the patients they serve.


Licensed employees provide skilled nursing care, rehabilitation therapy, and social assistance. Unlicensed employees aid with activities of daily living and assist with housekeeping chores and transportation to appointments. Home care clinicians also provide comfort and compassion to patients who may feel isolated, afraid, and anxious about the lockdowns, shelter-in-place orders, and the unknown effects the pandemic will have on their physical and mental health.


The home care work environment is unpredictable and unsupervised, and workers are at high risk for injury and illness, especially during a public health crisis. Additional challenges to the work environment due to the COVID-19 pandemic include lack of or inadequate personal protective equipment (PPE), as well as lack of pandemic training and education.


Home healthcare agencies are required to provide PPE, including alcohol-based hand sanitizer, gowns, respirators, and surgical masks (Centers for Medicare and Medicaid Services [CMS], 2020). However, if home healthcare agencies cannot obtain PPE, state and federal surveyors cannot issue citations (CMS). Without the necessary PPE to mitigate exposure and transmission of COVID-19, patient safety is jeopardized, and home care clinicians are left to fend for themselves. In a recent qualitative study conducted by Sterling et al. (2020), some home care agencies did not provide PPE to workers, or the amount supplied was insufficient. In response, home care workers purchased their own PPE or relied on friends and family members for PPE. To protect both home care clinicians and patients, PPE should always be provided. In the absence of PPE, home visits should be rescheduled until an adequate supply is available.


COVID-19 pandemic training and education are vital for keeping workers safe and healthy. According to Baron et al. (2009), pandemic training and education should be specific to the roles and duties of the worker and cover how and when to care for patients while protecting oneself from disease exposure. Sterling et al. (2020) found that some home care agencies did not provide COVID-19 pandemic training and education, and home care clinicians relied on the news, social media, government briefings, and worker unions to self-educate about the COVID-19 pandemic. When home care clinicians rely on sources outside the agency for information, there is risk for misinformation or disinformation. Since the beginning of the COVID-19 pandemic, news and social media as well as the federal government have misinformed the public about the seriousness of the pandemic and strategies to safely protect oneself from exposure and transmission.


Agencies must provide workers with truthful, unbiased, and timely information. During a pandemic, home care workers face additional challenges, and the risk of disease exposure and transmission threatens safe patient care. The provision of PPE, COVID-19 pandemic training, and education can ensure the safety and health of home care clinicians and the patients they serve.




Baron S., McPhaul K., Phillips S., Gershon R., Lipscomb J. (2009). Protecting home health care workers: A challenge to pandemic influenza preparedness planning. American Journal of Public Health, 99(Suppl. 2), S301-S307.[Context Link]


Centers for Medicare and Medicaid Services. (2020). Guidance for infection control and prevention concerning coronavirus disease 2019 (COVID-19) in home health agencies and religious nonmedical healthcare institutions. Accessed January 15, 2020. [Context Link]


Sterling M. R., Tseng E., Poon A., Cho J., Avgar A. C., Kern L. M., Ankuda C. K., Dell N. (2020). Experiences of home health care workers in New York city during the coronavirus disease 2019 pandemic: A qualitative analysis. JAMA Internal Medicine, 180(11), 1453-1459.[Context Link]