Many older adults refused medical care at dwelling for worry of COVID, leading to new or worsening medical circumstances

Newswise – COVID-19 disrupted or delayed medical care for many people who chose to delay elective surgeries or were unable to see a specialist.

However, new research from the University of Michigan shows a different demographic was affected: Many homebound older adults are quitting medically necessary home health services for fear of catching COVID-19. This led to new or worsening health conditions in a number of patients, and GPs reported feeling they lacked sufficient information and training to advise patients on whether or not to continue treatment.

“A representative of an ambulatory health agency said their agency’s patient burden decreased by 38% because patients canceled services,” said study lead author Jennifer Inloes, a graduate student in nursing practice at the UM School of Nursing. “It really highlighted the level of anxiety among patients receiving home healthcare services at the start of the pandemic.”

Both family members and patients canceled services, and the large number of cancellations surprised Inloes.

“I understood why patients might cancel in-person visits or elective surgeries because there are so many potential points of infection related to in-office or hospital care,” she said. “I was unprepared to hear from so many patients refusing home health care as home health care is a much more controlled interaction with fewer potential points of infection.”

Disease management continues to shift toward a home health care model, but there is not much literature on how public health emergencies affect home health care continuity. To learn more, researchers surveyed 27 Medicare-certified healthcare providers in eight US states to better understand older adults’ decision-making regarding home care services during COVID-19.

The results emphasize the large role that emotions play in medical decision-making and challenge the assumption that given sufficiently accurate educational information, patients make rational decisions in their best interest. Inloes said her research shows the importance of carefully weighing the known benefits of home healthcare against the potential negative consequences of canceling services.

“For example, home healthcare providers are trained in infection control precautions, so the risk of contracting COVID-19 from an in-home provider is pretty low,” she said. “However, a patient who experiences a preventable complication associated with denial that requires treatment in the emergency department is now inadvertently faced with their risk of COVID-19 exposure due to the larger number of providers, patients and family members in the emergency department of the home environment increased. “

It’s not known if more older adults avoided infection through isolation than were harmed by negative health consequences from being denied care — and the answer to that question isn’t black-and-white, Inloes said. In addition to new or worsening conditions, previous research has found that pandemic-related isolation is also negatively affecting older adults, which is an important consideration.

“For some, but certainly not all, patients, a home healthcare provider may be the only regular visitor, so we need to consider this aspect when determining the risks and benefits of an individual’s decision to discontinue treatment,” she said.

The question is not right or wrong.

“Palliative care, a specialty in which I wish more healthcare providers would be trained, discourages categorizing patient decisions in terms of right and wrong,” she said. “As a healthcare provider, our mission is to help our patients live as fully as possible in alignment with their individual values, belief systems, and goals. I know I’ve helped a person make the ‘right’ decision when they can articulate clearly how the decision they’ve made about continuing or discontinuing care aligns with those three things.”

The study was published in the Journal of Gerontological Nursing. Sue Anne Bell, an assistant professor at the School of Nursing, is the lead investigator.

Study: Perspectives of Home Care Providers on Denial of Care Services During the COVID-19 Pandemic