Barriers and facilitators to providing home-based care in a pandemic: policy and practice implications.

OBJECTIVE: The purpose of this study is to describe the experiences of home-based care providers (HBCP)  in providing care to older adults during the pandemic in order to inform future disaster planning, including during pandemics. DESIGN: Qualitative inquiry using an abductive analytic approach. SETTING AND PARTICIPANTS: Home-based care providers in COVID-19 hotspots. METHODS: Telephone interviews were conducted with 27 participants (administrators, registered nurses and other members of the allied healthcare team), who provided in-home care during the pandemic in Medicare-certified home health agencies. Interviews focused on eliciting experiences from HBCP on challenges and successes in providing home-based care to older adults, including barriers to care and strategies employed to keep patients, and providers, safe in their homes during the pandemic. RESULTS: Data was distilled into four major themes that have potential policy and practice impact. These included disrupted aging-in-place resources, preparedness actions contributing to readiness for the pandemic, limited adaptability in administrative needs during the pandemic and challenges with unclear messaging from public health officials. CONCLUSIONS: Home-based care plays an essential role in maintaining the health of older adults in disaster contexts, including pandemics. Innovative solutions, informed by policy that generate evidence-based best practices to support HBCP are needed to reduce barriers and increase protective factors, in order to maintain continuity of care for this vulnerable population during disruptive events.

"Helping fill that gap:" a qualitative study of aging in place after disaster through the lens of home-based care providers.

BACKGROUND: During a disaster, home-based care fills the critical need for continuation of health care. Home-based care is intended to function using existing care delivery models, continuing to provide care for patients wherever they are located, including in shelters and hotels. Home-based care providers are often the closest in contact with their patients -seeing them in place, even throughout a disaster- through which they develop a unique insight into aging in place during a disaster. The purpose of this study was to identify individual and community-level support needs of older adults after a disaster through the lens of home-based care providers. METHODS: Using qualitative inquiry, five focus groups were conducted with home-based care providers (n = 25) who provided in-home care during Hurricane Irma and Hurricane Harvey. Participants were identified by contacting home health agencies listed in an open-source database of agencies participating in Centers for Medicare and Medicaid Services programs. Data were coded using an abductive analytic approach, and larger themes were generated in light of existing theory. RESULTS: The results were distilled into eight themes that related to the importance of community and family, informal and formal supports throughout the disaster management cycle, maintaining autonomy during a disaster, and institutional and systemic barriers to obtaining assistance. CONCLUSIONS: In this study, home-based care providers described the challenges aging adults face in the response and recovery period after a large-scale disaster including maintaining continuity of care, encouraging individual preparedness, and accessing complex governmental support. Listening to home-based care providers offers new and important insights for developing interventions to address social and health needs for older adults aging in place after a large-scale disaster.

Home-Based Care and Mental Health during a Disaster: A Qualitative Analysis.

Disasters adversely affect individuals' mental health; yet, research is scant on the mental health needs of frontline workers during and immediately after disasters. Our study explored this gap through the perspectives of home-based care providers (HBCP) who provided care during and after Hurricanes Irma and Harvey. In this qualitative study, five in-person focus groups were held between January and November 2019 with 25 HBCP drawn from home health care agencies in southern Florida and the Greater Houston Area. Four themes were identified using an abductive analytic approach: HBCPs' disaster-related mental health needs; HBCP resilience in the context of disaster; psychological tensions associated with simultaneously caring for self, family, and patients; and supporting patients' mental health needs during and after disaster. Our data suggest that HBCP may benefit from formal training and interventions to support their own mental health as well as that of their patients in the context of disasters.

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers.

Head Start is a federally funded program for children (3-5 years) from low-income families. In the Fort Peck Native American Reservation, tribal Head Start teachers have reported high stress in supporting children experiencing adverse childhood experiences. Thus, we adapted the Little Holy One intervention (ClinicalTrials.gov: NCT04201184) for the teachers' context and culture to enhance psychological health and well-being. Within a participatory framework, the eight-step ADAPT-ITT methodology was used to guide the adaptation process: assessment; decision; adaptation; production; topical experts; integration; training; and testing. For Step 1, we purposive sampled 27 teachers, ancillary staff, and parents to understand teachers' stress, support mechanisms, and interest in an intervention via focus groups (n = 9) and individual interviews (n = 18). Qualitative data underscored teachers' experiences of stress, depression, and need for support (Step 1). Iterative feedback from a tribal advisory board and Little Holy One designers rendered selection of five lessons (Step 2, 5), which were adapted for the teachers via theater testing (Step 3, 4). Community capacity assessment revealed their ability to implement the intervention (Step 6). Testing of this adapted intervention in a feasibility trial (steps 7, 8) will be reported in a future publication. A rigorous systematic process within a participatory framework allowed intervention adaption based on community input. Leveraging "culture as treatment" may be useful for enhancing psychological health outcomes for Native Americans who historically underutilize existing psychological services. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-022-00070-3.

Perspectives from a Predominantly African American Community about Biobank Research and a Biobank Consent Form.

Minority populations have been underrepresented in clinical trials, as well as in research biobanks that are created to conduct research with participants' biospecimens and related medical and research data. Biobank research raises issues about informed consent and privacy and the confidentiality of participants' personal data. Our study involved three focus groups of 10 adults each that were conducted in a medically underserved, predominantly African American community to elucidate questions and concerns regarding an institutional biobank. Transcripts from the discussion were qualitatively analyzed. Three main themes that arose from the focus groups included the importance of trust, the importance of the community in research, and suggestions to improve trust. The concerns identified in this study provide a starting point for future research to help research institutions become more trustworthy to the communities they serve.

Strategies for culturally safe research with Native American communities: an integrative review.

Background: A history of unethical research and deficit-based paradigms have contributed to profound mistrust of research among Native Americans, serving as an important call to action. Lack of cultural safety in research with Native Americans limits integration of cultural and contextual knowledge that is valuable for understanding challenges and making progress toward sustainable change. Aim: To identify strategies for promoting cultural safety, accountability, and sustainability in research with Native American communities. Method: Using an integrative review approach, three distinct processes were carried out: (1) appraisal of peer-reviewed literature (Scopus, PubMed, and ProQuest), (2) review of grey literature (e.g. policy documents and guidelines), and (3) synthesis of recommendations for promoting cultural safety. Results: A total of 378 articles were screened for inclusion, with 55 peer-reviewed and grey literature articles extracted for full review. Recommendations from included articles were synthesised into strategies aligned with eight thematic areas for improving cultural safety in research with Native American communities. Conclusions: Research aiming to understand, respect, and acknowledge tribal sovereignty, address historical trauma, and endorse Indigenous methods is essential. Culturally appropriate, community-based and -engaged research collaborations with Native American communities can signal a reparative effort, re-establish trust, and inform pragmatic solutions. Rigorous research led by Native American people is critical to address common and complex health challenges faced by Native American communities. Impact statement: Respect and rigorous methods ensure cultural safety, accountability, and sustainability in research with Native Americans.

Alternative Care Sites During the COVID-19 Pandemic: Policy Implications for Pandemic Surge Planning.

Alternative care sites (ACS) across the United States were widely underutilized during the coronavirus disease (COVID-19) outbreak, while the volume and severity of COVID-19 cases overwhelmed health systems across the United States. The challenges presented by the pandemic have shown the need to design surge capacity principles with consideration for demand that strains multiple response capabilities. We reviewed current policy and previous literature from past ACS as well as highlighted challenges from the COVID-19 pandemic, to make recommendations that can inform future surge capacity planning. Our recommendations include: (1) Preparedness actions need to be continuous and flexible; (2) staffing needs must be met as they arise with solutions that are specific to the pandemic; 3) health equity must be a focus of ACS establishment and planning; and (4) ACS should be designed to function without compromising safe and effective care. A critical opportunity exists to identify improvements for future use of ACS in pandemics.

Differential signaling during macropinocytosis in response to M-CSF and PMA in macrophages.

The cellular movements that construct a macropinosome have a corresponding sequence of chemical transitions in the cup-shaped region of plasma membrane that becomes the macropinosome. To determine the relative positions of type I phosphatidylinositol 3-kinase (PI3K) and phospholipase C (PLC) in this pathway, we analyzed macropinocytosis in macrophages stimulated by the growth factor macrophage-colony-stimulating factor (M-CSF) and by the diacylglycerol (DAG) analog phorbol 12-myristate 13-acetate (PMA). In cells stimulated with M-CSF, microscopic imaging of fluorescent probes for intracellular lipids indicated that the PI3K product phosphatidylinositol (3,4,5)-trisphosphate (PIP3) appeared in cups just prior to DAG. We then tested the hypothesis that PMA and DAG function after PI3K and prior to Ras and protein kinase C (PKC) during macropinosome formation in macrophages. Although the PI3K target Akt was activated by M-CSF, the Akt inhibitor MK-2206 did not inhibit macropinocytosis. The phospholipase C (PLC) inhibitor U73122 blocked macropinocytosis by M-CSF but not PMA. Macropinocytosis in response to M-CSF and PMA was inhibited by the Ras inhibitor farnesyl thiosalicylate (FTS), by the PKC inhibitor Calphostin C and by the broad specificity inhibitor rottlerin. These studies support a model in which M-CSF stimulates PI3K in macropinocytic cups, and the resulting increase in PIP3 activates PLC, which in turn generates DAG necessary for activation of PKC, Ras and the late stages of macropinosome closure.