Eclipse Phase: Examining Global and Local Pandemic Vulnerabilities Among Home and Community Based Services Recipients and Providers in Pennsylvania; a Case-Based Report During the Year 2020

Abstract

As the US population ages, more and more senior citizens are receiving care and services in their homes rather than in nursing facilities, a trend that is only set to accelerate over the coming decades. This project examines the US home-based health care system, including the service providers and service recipients, to illuminate unexplored systemic vulnerabilities to a pandemic or other health crisis. Interviews of relevant current and former employees of the Commonwealth of Pennsylvania, a perspective absent from the existing literature, use the coronavirus disease 2019 (COVID-19) pandemic of 2020 as a natural experiment, demonstrating heretofore theoretical vulnerabilities. Several themes recurred repeatedly during these interviews. First, that planning was inadequate; that the structural weaknesses of the workforce raised in the previous chapter are not only real but understated; and that the service delivery systems and their administrators were able to innovate and adapt to challenging new conditions more rapidly than anyone expected. (111) The experiences of the first full year of the pandemic, January 2020 to January 2021 offer visceral lessons to be learned to better prepare providers for inevitable future pandemics and health crises.