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BACKGROUND/OBJECTIVES COVID-19 required rapid innovation throughout the health care system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide. DESIGN Cross-sectional qualitative design using semi-structured interviews and inductive and deductive thematic analysis. SETTING HBPC practices in the New York City (NYC) metro area during spring 2020. PARTICIPANTS HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators and social workers/social work coordinators (n=13) at 6 NYC-area practices. RESULTS Participants described care delivery and operational adaptations similar to those universally adopted across health care settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients. CONCLUSION NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork and partnerships with outside providers. As the pandemic continues to surge around the US, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges. This article is protected by copyright. All rights reserved.
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