Differences in Rural and Urban Home Healthcare Agency Responses to the COVID-19 Pandemic

Background

U.S. Home healthcare agencies (HHAs) are key providers of skilled care. Rural HHAs face unique challenges that may affect care quality. With COVID-19 impacting urban and rural communities differently, we examined how HHAs experienced and responded to the pandemic by rurality.

Methods

We conducted a nationally representative survey of 1501 HHAs (11/2022-03/2024), and received 474 responses (41% rural). Urban/rural status was based on agency office location. Weighted frequencies and means were calculated; χ2 or t-tests assessed urban-rural differences.

Results

Geographically, staffing skill-mix was similar. During the pandemic, more rural HHAs reported no change in primary admission sources or issues with patient admissions, and more frequently implemented policies to limit staff/patient exposure to COVID-19 (i.e., paid sick leave for staff). Throughout 2020, rural HHAs relied more on infection prevention and control (IPC) guidelines from local hospitals and healthcare organizations and were neutral about the helpfulness of federal COVID-19 regulations. Staffing shortages were widespread, but rural HHAs relied more on flexible staffing arrangements to address shortages. Only 75% of both rural and urban HHAs had programs to support patient and caregiver well-being, and 63% had such programs for staff.

Conclusions

HHAs, especially in rural areas, faced significant challenges during the pandemic. Strengthening rural workforce pipelines and establishing regional staffing pools may help mitigate some of these staffing vulnerabilities. Rural HHA reliance on local IPC guidelines and neutral views on federal regulations highlight the need to better align federal and local guidance to improve coordination and preparedness for future infectious disease emergencies.