All alone: A qualitative study of home health aides' experiences during the COVID-19 pandemic in New York

•Question What are the infection prevention, control needs, and challenges of home health aides (HHA) during the coronavirus disease 2019 (COVID-19) pandemic?•Findings In this qualitative study of 25 English and Spanish-speaking HHAs in the New York metropolitan area, common challenges included limited access to information and dilemmas related to enhanced COVID-19 precautions.•Meaning HHAs are critical to the successful implementation of infection prevention and control in home care. Strategies to manage COVID-19 in home care should improve communication processes between nursing staff and HHAs. Despite their integral role, Home Health Aides (HHAs) are largely unrecognized as essential to implementing effective infection prevention and control practices in the home healthcare setting. We sought to understand the infection prevention and control needs and challenges associated with caring for patients during the pandemic from the perspective of HHAs. From June to August 2020, data were collected from HHAs in the New York metropolitan area using semi-structured qualitative interviews by telephone; 12 HHAs were interviewed in Spanish. Audio-recorded interviews were transcribed, translated and analyzed using conventional content analysis. In total, 25 HHAs employed by 4 unique home care agencies participated. HHAs had a mean age of 49.8 (± 9.1), 24 (97%) female, 11 (44%) Black, 12 (48%) Hispanic. Three major themes related to the experience of HHA's working during the COVID-19 pandemic emerged: (1) all alone, (2) limited access to information and resources, and (3) dilemmas related to enhanced COVID-19 precautions. Hispanic HHAs with limited English proficiency faced additional difficulties related to communication. We found that HHA communication with nursing staff, plays a key role in infection control efforts in home care. Efforts to manage COVID-19 in home care should include improving communication between HHAs and nursing staff.