Project Abstract
Older adults and individuals with disabilities prefer to receive Long Term Services and Supports (LTSS)
in their home, which may be safer than congregate care settings during infectious disease pandemics.
However, home-based care settings are far less regulated than institutional settings and not always guided by
a clear chain of command. Further, private homes are part of a networks of care in which disease can be
spread across connected households. Concerns over personal safety, coupled with other issues that have
long-plagues the LTSS workforce such as low-wages and lack of benefits, further threaten an already strained
workforce. We contend that structural, cultural, and individual factors provide challenges to providing quality
LTSS care and implementing new safety practices in home-based settings during the pandemic, but that
lessons can be learned from the adaptation experiences of consumers, workers, and agency providers.
The long-term goals of this study are to improve the sustainability of the home care workforce. Safety of
home care practices, and the health and well-being of consumers, informal caregivers, and direct service
workers. To do that, we investigate the following research questions:
1. How did the system respond to meet the LTSS care needs of HCBS consumers during the pandemic?
In particular, how were COVID-19 safety practices identified, negotiated, implemented, and managed
across team members and consumer in private home settings?
2. How are external and structural factors and worker and consumer attitudes, beliefs, and behaviors
related to COVID-19 and care processes?
3. How did adaptations to COVID-19 impact the degree to which consumer care needs were met; care
satisfaction, and consumer, caregiver, and worker well-being?
These questions will be answered using a mixed methods interview and survey design to collect data
from consumers, family caregivers, workers and providers. The study population is Medicaid home-based
LTSS consumers and their care teams in the state of Kansas. The study is guided by the System Engineering
Initiative for Patient Safety (SEIPS) conceptual model. Which links the external and structural factors to the
process of care and care outcomes, highlighting the role of the adaptations and workarounds that occur when
the system is out of balance. Expected outcomes of this research project include the identification of threats to
the home care workforce broadly, and the health and safety of direct service workers specifically, as well as
strategies to address these threats. Increased understanding about the relationships between structural factors
and worker and consumer attitudes, beliefs, and behaviors related to COVID-19 and care processes will inform
the education and training needs of consumers, direct service workers, and caregivers.