Research Results of “Home Quarantine and Informal Home Care during COVID-19”
Facing the surging need for home quarantine and informal home care during COVID-19, CCOUC conducted a series of study, including a territory-wide large scale random digit dialing telephone surveys from 22 March to 1 April 2020 of 765 individuals aged 18 or above in Hong Kong and a review on implications of home care in COVID-19.
To facilitate community knowledge transfer, CCOUC Director Professor Emily Chan and Deputy Director Professor Kevin Hung release the following research findings to the news media on 9 June 2020.
Home Quarantine and Caregiving to Non-Infected Family Members during COVID-19
- A quarter (25.1%) of respondents (n = 192) reported that they engage in regular home care responsibilities during the COVID-19 epidemic.
- Heavy burden: Among these 192 respondents, more than half reported the need to take care of 2 or more family members (take care of 2 family members: 35.4%; 3 or more family member: 18.8%; 1 family member: 45.8%).
- Double Burden: Over half of these 192 respondents were economically active, bearing a double burden of working and being the primary care provider.
- Care for older people and disabled: Quite a number of these respondents had been caring for frail older adults (28%) and those with disabilities (7.4%).
- Lack of community support: A fifth (20%) of the care providers reported that they previously used community services and centres (e.g., school and day care centre) before COVID-19. Among these community service users, about 40% had stopped or decreased the use of those services due to closure during the epidemic.
- Lack of knowledge and psychological stress: A proportion of these informal home care providers reported having inadequate knowledge about the healthcare duties required and increased psychological stress.
- 4.2% of respondents (n = 32) reported that they practiced home quarantine for COVID-19, where 71.9% (23/32) were voluntarily and 28.1% (9/32) were compulsorily quarantined.
- History of recent travel abroad (13/32 = 40.6%) and close contact with confirmed patients (6/32 = 18.8%) were the most cited reasons for home quarantine.
The Forgotten Informal Home Care Providers
- People in need of home care are not limited to those related to COVID-19.
- Other patients: A large proportion of home care recipients include patients with chronic diseases, mental disorders, or disabilities who require essential life-sustaining care, health maintenance support, and supplementary care during this pandemic.
- Infants, young school-aged children (affected by school closure), and older people might be healthy but dependent individuals who need home care.
- Vulnerable people living alone: It is important to identify a suitable support model for people living alone—e.g. a buddy system.
- Home care for people living in informal settlements and other special dwelling conditions, e.g. bond room/subdivided housing, multiple-dwelling units, and displaced refugee settings.
- Home care for severely ill patients: Culturally and gender 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.
- Caregivers of multiple care recipients: It is important to identify caregivers with a disproportionate care burden, such as those with multiple care recipients.
- Domestic violence: Public health measures, such as home isolation designed to support disease control and prevention, might have unintended consequences and has been associated with increases in domestic violence toward women recorded globally during lockdowns.
- Resources: There should also be information and material resources, mental health support, salary package with special annual leave for care providers, and flexible workplace policies to enable informal home care duties.
- Ways to improve informal home care: Health outcome monitoring, feasibility evaluation of telemedicine, provision of disease-specific advice, home schooling support, and capacity-building for care providers could all help to enhance the quality of informal home care.
- Clinical outcomes of home care recipients: There is a lack of studies in clinical outcomes of care recipients associated with home care.
- Further research is needed to direct policy, guidelines, resources, clinical support, quality assurance, and monitoring and outcome evaluation for informal caregivers.
- Research is required to examine how the closure of elderly residential care facilities and schools has placed additional burdens on informal care providers.
- Chan EYY, Gobat N, Kim JH, Newnham EA, Huang Z, Hung H, et al. Informal home care providers: the forgotten health-care workers during the COVID-19 pandemic. Lancet. 2020. doi:https://doi.org/10.1016/S0140-6736(20)31254-X
- Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health. 2020; 17:3869.
- Chan EYY, Gobat N, Hung H, MacGregor H, Wong E, Cheung A, Huang Z, Hung K, Kim JH, Lo ESK, Tam Z, Wong CS. A review on implications of home care in a biological hazard: The case of SARS-CoV-2/COVID-19 (Health-Emergency and Disaster Risk Management (Health-EDRM) Technical Brief Series #202001). Hong Kong: CCOUC; 20120 May 27, 31 p.