Informal Home Care Providers: The Forgotten Health-Care Workers During The COVID-19 Pandemic

According to a study published in The Lancet, nearly 25% of the general population in Hong Kong took up informal home care responsibilities during he early phase of COVID-19.

Findings from a cross-sectional population-based survey in an urban setting suggests that many informal home care providers bear a double burden of working and being the primary care provider. During the pandemic, a proportion of these informal home care providers reported having inadequate knowledge about the health-care duties required and increased psychological stress.

The study has identified several research priorities relevant to informal home care providers. Some of these are:

Care Service Provision

Updating clinical home care guidelines related to health risks, disease, and clinical management of COVID-19 to support formal and informal home care providers

  • Special challenges associated with various home care settings, including informal settlements, in adhering to guidelines
  • Disease management for home care models
  • Strategies for formal home care providers to best support informal care providers during COVID-19 while protecting the safety of staff and organisational integrity
Health Monitoring And Clinical Outcomes of Home Care Models
  • Health outcome comparison studies of home care models
  • Home care-related clinical and health outcome monitoring and evaluation studies
  • Evidence-based disease-specific home care advice for people with chronic conditions with and without COVID-19 in the home context
Impacts On And Support For Home Care
  • Sociopsychological research linked with clinical and public health issues to address the vulnerable urban population
  • Situation of informal care providers of vulnerable groups: burden, physical and mental wellbeing, support, and burnout
  • Coping strategies of vulnerable people living alone and the related impact on their physical and mental health
  • Impact and support for people with mental disorders and their care providers during home confinement, and access to telehealth services
  • Application and limitation of telemedicine and telehealth in supporting vulnerable groups and their formal and informal care providers
  • Prioritise support for individuals at risk of domestic violence during home care
  • Contribution and problems of online learning to home care for children during school closure
  • Role of private sector in supporting home care during a pandemic

For home care to better support health needs during extreme events, urgent research related to social and economic impacts of home care is needed to update policies and improve health support programmes.

The latest WHO home care guidelines were updated in March, 2020, and mostly emphasise methods of infection risk control and clinical management of COVID-19, particularly for those placed under home quarantine.

Disease-specific and contextualised—eg, constraints of high-density living arrangements—home care advice for people with chronic conditions with and without COVID-19 in the home context will need to be updated and tailored to support informal home care providers in related clinical guidance and technical reports.

Culturally and gender9 sensitive guidance related to home care for severely ill patients who are unable to access health facilities, including for the provision of home-based palliative care, is also required, says the study.

Other priorities for ensuring the effectiveness of informal home health care for vulnerable populations are to identify a suitable support model for people living alone—eg, a buddy system—and to identify care providers with a disproportionate care burden, such as those with multiple care recipients. Additionally, research is required to examine how the closure of elderly residential care facilities and schools has placed additional burdens on informal care providers.

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