“At Home, with Care”: Lessons from New York City Home-Based Primary Care Practices Managing COVID-19

Emily Franzosa
Ksenia Gorbenko
Abraham A. Brody
Bruce Leff
Christine S. Ritchie
Bruce Kinosian
Katherine A. Ornstein
Alex D. Federman
Case Example
January 2021


Home-based primary care programs made rapid adaptations of care delivery due to COVID-19, and this flexibility may support new opportunities to care for older, medically complex patients safely in their homes.


The COVID-19 pandemic required innovation throughout the health care delivery system. Home-based primary care (HBPC) practices sought to reduce the exposure of medically complex older patient populations to the virus while maintaining needed services through hands-on care. This qualitative study analyzed the strategies of New York City-area HBPC practices to inform future planning efforts for HBPC programs.


Adaptations to HBPC programs in response to the pandemic included changes to care delivery and internal operations. HBPC programs made patient-facing adaptations such as increased monitoring and addressing of isolated patients’ needs, including thorough assessments for medication and medical supplies, caregiver supports, housing and food security, and goals of care. Practices also screened for social isolation, anxiety, and depression, and connected patients to mental telehealth services. Practices balanced in-person and virtual care while engaging local and community providers, for example, by deploying community paramedics to deliver pulse oximeters to “COVID-suspect” patients. Modifications to internal operations focused on fostering supportive team environments. Changes included increasing the frequency of virtual all-staff huddles and providing enhanced emotional support to staff to reduce burnout related to increased patient mortality.


Responding to the COVID-19 pandemic within HBPC models required rapid change in both care delivery and operations. HBPC programs strived to maintain patient trust and strengthen the team bond of HBPC providers. Many of these adaptations can be adopted (or continued) in the post-COVID environment to better serve homebound older adults, but require payment and policy changes to adequately support HBPC programs.

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