• Emily Franzosa, Kimberly M Judon, Eve M Gottesman, Nicholas S Koufacos, Tessa Runels, Matthew Augustine, Christine W Hartmann, and Kenneth S Boockvar.
• Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA. emily.franzosa@va.gov.
• J Gen Intern Med. 2022 Jun 1; 37 (8): 183018371830-1837.

BackgroundHome health aides are important but often overlooked members of care teams, providing functional and emotional support to patients. These services became increasingly important during the COVID-19 pandemic as older adults faced disruptions in in-person medical services and family caregiving. Understanding how aides supported healthcare teams is important for informing emergency planning and better integrating home health services with primary care.ObjectiveTo describe aides' roles in supporting veterans and working with primary care teams during COVID-19 and identify COVID-related changes in tasks.DesignSemi-structured interviews.ParticipantsEight home health aides, 6 home health agency administrators, and 9 primary care team members (3 RNs, 3 social workers, 3 MDs) serving veterans at a large, urban, Veterans Affairs medical center.ApproachCombined deductive and inductive analysis to identify a priori concepts (aide roles; changes in tasks and new tasks during COVID-19) and emergent ideas. Aide, administrator, and provider interviews were analyzed separately and compared and contrasted to highlight emergent themes and divergent perspectives.Key ResultsParticipants reported an increase in the volume and intensity of tasks that aides performed during the pandemic, as well as the shifting of some tasks from the medical care team and family caregivers to the aide. Four main themes emerged around aides' roles in the care team during COVID-19: (1) aides as physically present "boots on the ground" during medical and caregiving disruptions, (2) aides as care coordination support, (3) aides as mental health support, and (4) intensification of aides' work.ConclusionsHome health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. Integrating aides more formally into healthcare teams and expanding their scope of practice in times of crisis and beyond may improve care coordination for older veterans.© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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