There’s no dispute that the coronavirus pandemic has caused untold distress and death in nursing homes and assisted living facilities around the country. But the reality is that only a minority of older adults live in such facilities. The vast majority of those 65 and older live in the community. And while most of those adults are healthy and active, some 12 million of them depend on formal home care support each year, and some 7 million of those are considered frail, with 60% having at least two chronic conditions (such as heart disease or diabetes) that put their health and well being at risk. But with non-urgent health care visits curtailed, senior centers closed and family members socially-distanced, those seniors are perhaps even more imperiled during the pandemic, especially if their home care has been lessened or even eliminated due to the virus. And the professional home health providers and personal assistance workers who support these seniors are also at risk- from viral infection and lack of protective equipment. In essence, the entire home care system is in jeopardy and scrambling from the weight of the pandemic.

Anyone familiar with our nation’s home care “system” likely knows of its complexity and patch-work nature (Take a look at these agebuzz posts and resources to better understand this background). There are medical, highly-skilled services provided in the home that require physician, nursing, or therapist oversight and that are likely reimbursed by Medicare. Many older adults can live comfortably and safely at home provided they have these services in place. Then there are personal aides and assistants who provide help with such “non” skilled activities as bathing, cooking, toileting, and even companionship. These services are not usually paid for by Medicare but rather privately paid or paid for by Medicaid or some long term care insurance. Both types of services, however, have now been affected by the coronavirus.

The agencies that provide support to older adults at home report significant problems at this time. In an ironic way, with elective surgeries delayed and family members home to help, many agencies are experiencing less demand or conducting more services via telemedicine, which don’t reimburse at the same level as an in-home visit. And many home-care recipients are refusing in-home help right now for fear of being exposed to the virus. In fact, a recent article in Politico reports on a new survey of 1000 home health agencies in all 50 states that found more than half of the agencies have had to lay off staff, and almost every agency reported some care recipients who have refused to allow services in their home during the pandemic.

Reduced professional and supervised help for ill or fragile seniors in the community is likely a recipe for disaster. As a recent JAMA article notes, there are all sorts of risks for these seniors: concern about depression from isolation, deconditioning from lack of movement or exercise, cognitive decompensation from lack of stimulation, and decline due to lack of basic cleaning or hygiene supports. Telemedicine, which many seniors with hearing loss or cognitive impairment may not easily adapt to, doesn’t help with the essential in-person needs of many of these older adults.

Home care workers are also suffering. Many are losing their positions or may be confronting the care of coronavirus patients in the home setting as hospitals look to discharge patients to free up beds for the most severely ill. The 3.3 million people who work in the home setting also are at risk from lack of sufficient protective equipment and the inability to socially distance given the intimate care they often provide. Most of these workers are low-income minority women, many with younger children they need to support and find care for while they toil in the trenches.

So, from both sides of the equation in the home care setting, there is fear, frustration, and shortages that are making the work of providers, and the support of seniors, more difficult. Such problems also are affecting home hospice care at this point. It’s a dangerous situation that has the potential to affect us all in one way or another- and as one expert recently decried, “…without additional support, and additional support very soon, you’re going to start to see the system sort of fall apart in front of our eyes.”