Home care as a safe alternative in post-acute and long-term care during COVID-19 crisis

Dear Editor,

Advanced age and comorbidities are associated with increased mortality related to coronavirus disease 2019 (COVID-19). The high prevalence of this combination, associated with physical environments that provide inadequate barriers to infection control, place patients in long-term care facilities at great risk. There are several reports worldwide about the high mortality related to COVID-19 among residents of long-term care institutions, showing they account for 25% of deaths from COVID-19, in the United States. ( ¹ , ² ) Percentages are even higher in some US states and European countries. ( ³ )

In Brazil, much of post-acute care and long-term chronic patient care is provided at home. Our organization provided home care to 2,931 patients in the first 3 months of the pandemic and reported only 31 cases of COVID-19 (1%) and six deaths. The low incidence of COVID-19 in this population reinforces that home care protects patients and lessens the risk of infections. Patients naturally remain at home isolation and are treated by a team of professionals in a directed way. This, together with proper use of personal protective equipment (PPE) and implementation of innovations ( e.g. telemedicine), are key for safe care.

Shifting post-acute and chronic care to the household environment with the implementation of technology should be a recommended alternative.

REFERENCES

• ¹ McMichael TM, Currie DW, Clark S, Pojosjans S, Kay M, Schwartz NG, Lewis J, Baer A, Kawakami V, Lukoff MD, Ferro J, Brostrom-Smith C, Rea TD, Sayre MR, Riedo FX, Russell D, Hiatt B, Montgomery P, Rao AK, Chow EJ, Tobolowsky F, Hughes MJ, Bardossy AC, Oakley LP, Jacobs JR, Stone ND, Reddy SC, Jernigan JA, Honein MA, Clark TA, Duchin JS; Public Health-Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team. Epidemiology of Covid-19 in a long-term care facility in King Country, Washington. N Engl J Med. 2020;382(21):2005-11.
• ² Comas-Herrera A, Zalakaín J, Litwin C, Hsu AT, Lemmon E, Henderson D, et al. Mortality associated with COVID-19 outbreaks in care homes: early international evidence [Internet]. London (UK): International Long Term Care Policy Network; 2020 [cited 2020 Jun 16]. Available from: https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/
  » https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/
• ³ Grabowski DC, Mor V. Nursing home care in crisis in the wake of COVID-19. JAMA. 2020;324(1):23-4.

Publication Dates

• Publication in this collection
  23 Oct 2020
• Date of issue
  2020

History

• Received
  30 July 2020
• Accepted
  12 Aug 2020