During this incredible time, the world has unified around one element of best practice: protect older adults who are most vulnerable to this disease. Vigilance is taken in long-term care facilities, while friends and family are stepping in to grocery shop for those living at home. As this social distancing time period increases, however, we are seeing other issues that need to be considered for the elderly population still living at home.
At The Helper Bees, we have unique insight into how the pandemic is changing behaviors. We support caregivers in the home while partnering with some of the world’s largest insurance carriers to ensure quality, effective support for older adults across the nation. We are always looking for ways to improve care and transform aging-in-place for a new generation of adults. To that end, we analyzed our digital home-based visit notes (with all information anonymized) to answer the questions of how older adults and their critical helpers are dealing with the crisis at home.
The result is unique insight into how our most vulnerable population is shifting their behavior and hints at potential negative effects post-pandemic.
The best news from The Helper Bees in-home data is that older adults are indeed reducing their exposure to the virus by leaving their homes less. We can tell by tracking all the percentage of visits where a helper has transported their client to essentially anywhere. We can see starting March 8th that older adults across the US stayed at home more often than they did early in the year.
The Helper Bees’ data further suggests (see graph below) that the in-home helpers is the one leaving the care-recipients home at a higher rate than they did early in the year. For those of you who want to dive deep into our calculations, we isolated home care visits that required leaving the home of the care-recipient and displayed this as a function of both number of care-recipients and total number of visits. We then compared this to a baseline of January 19th. This means that positive percentages represent an increase over the typical number of visits at the start of the year when life was normal where a helper went outside the home on behalf of a care-recipient.
Taken together, we see a significant deviation in the behavior of older adults and how they are utilizing their in-home caregiver during the early days of the pandemic. Older adults are not leaving their homes and instead are relying upon their helpers to go outside the home for the reasons that they presumably would have gone along for.
This leads to an obvious question: where are the helpers going?
Our data allows us to identify the reasons that a helper is leaving their care-recipient’s home. Mining the data (below) shows a significant upswing in visits involving running errands. This correlates well with anecdotal evidence of difficulties associated with procuring routine vital supplies and provides further evidence that older adults were heeding warnings to remain indoors as to not expose themselves to unnecessary risks. Thankfully, the millions of phenomenal in-home helpers in our country are ensuring that their care-recipients are well-stocked with all their daily essentials.
When we overlay this data on visits associated with medical visits (below), we see a more sobering picture. There has been a marked decline in visits where helpers are taking their care-recipient to medical visits. Optimistically, we hope that these older adults have access to high-quality telemedicine visits, but there is a real chance that they are just foregoing their routine medical check-ups.
This presents a potential upswing post-pandemic in mortality due to mismanagement of chronic disease conditions and highlights the need to continue to allow access to routine medical care even in light of this pandemic. This echoes the thesis of one of the recommendations set forth by Emanuel et al in their commentary in the New England Journal of Medicine: “There should be no difference in allocating scarce resources between patients with Covid-19 and those with other medical conditions.”
The next graph identifies the total trends of care at home segmented out by average hours of care and average number of visits per week. While visits per week show a slight upward trend, we think it is more likely this is within the error bars. However, hourly totals of care per week have increased, suggesting older adults are relying upon their caregiver for longer each visit.
We believe this data underlines two important points. First, the in-home caregiver is absolutely critical to the long-term wellbeing of our older adults. These caregivers provide our older adults with the conduit to obtain critical supplies. This importance is made evident by the increase in utilization of the home caregiver during the start of the pandemic. As a society, we need to celebrate them, pay them well and support them well-beyond this pandemic. Second, models of healthcare need to expand to reach these isolated older adults to ensure that their health remains a priority even as the world struggles with the fallout of an unprecedented crisis. New solutions need to be deployed rapidly not only to meet demand now, but to gather success metrics to ensure solutions persist long-term. The trend to decentralizing health and long-term care away from institutions and facilities and into the home is not only the approach consumers demand, but is the right approach pandemic or not.
We are well aware of the limitations of our data. We wish they weren’t there but they are. The sample size isn’t large enough, there is sample bias due to the subset, we didn’t control for every variable, etc. We know and it hurts our hearts. That being said, all the conclusions are meant to be qualitative and meant to provide a glimpse into the impact of the pandemic on older adults — beyond the measurement of sickness and death. We’re here to support those living in the between.
Jessica Faulk on The Helper Bees team carried out all calculations and created all graphics. She is awesome.