Home Care in an Influenza Pandemic: Issues and Resources

1
Home Care in an Influenza PandemicIssues and
Resources

• Alexis Silver
• Senior Director, Policy and Development
• Home Care Association of New York State, Inc.

2
Overview Home Cares Response to Emergencies

• Home care is embedded in community response
  infrastructure
• Has experience in continuity of operations
• Current ability to respond to a pandemic is
  unknown
• Existing patients are a priority before assisting
  with community health care needs

3
Assumptions/Issues

• Home Care will have issues similar to other
  health care settings
• Lack of resources
• Workforce
• Willingness ability to work  
• Travel restrictions
• Health high risk workers
• Training
• Regulatory barriers

4
Emergency Response - Process

• EP activation COOP
• Staff call down alert
• Surge discharge reprioritization of current
  patients
• Geographical nursing
• MOUs/agreements with other home care agencies

5
Home Care Strategies

• Surge Planning
• Regulatory waivers, including abbreviated
  documentation
• Maximum utilization of resources
• Worker training
• Collaboration MOUs
• Volunteers
• Technology

6
Home Care Strategies

• Focus on Infection Control and Occupational
  Health
• PPE guidelines MOUs
• Antivirals immunization
• Just in Time training
• Predetermined guidelines, policy and procedures

7
Planner Strategies

• Recognize home care - essential component of
  health emergency response
• Include home care as a planning partner
• Make no assumptions about the availability of
  home care staff
• Include home care in drills and exercises
• Facilitate local waivers, such as essential
  worker status for traveling staff
• Emphasize community planning collaboration

8
Home Care Resources

• National Association for Home Care and Hospice
  (NAHC) State Association List
  http//www.nahc.org/stateforum/directory.html
• Visiting Nurse Association of America (VNAA)
• http//www.vnaa.org/vnaa/gen/htmlhome.aspx
• American Association for Home Care
  http//www.aahomecare.org/

9
Implications for Home Care During a Pandemic

• Geraldine A. Coyle, RN, EdD, CNAA

10
Implications for Home Care During a Pandemic

• ?Adequate supplies for worker protection
• Sufficient supplies for additional workload
• Personal protective equipment (PPE)
• ?Scope of services staff can provide
• Pre arranged Memos of
  Understanding (MOU) for services
• Same services may be denied or
  referred to other providers

11
Implications for Home Care During a Pandemic

• Educational information for families and patients
  on the use of (PPE) and infection control within
  the home.
• Be knowledgeable about processes in the community
  to manage the increased number of deaths in the
  home during a pandemic.

12
Telehealth Technologies

• Use of electronic information and
  telecommunications technologies to support long
  distance health care.
• More than a dozen states provide medicaid
  telehealth reimbursement.

13
Telehealth Technologies

• Telehealth can
• Allow one nurse to monitor many patients from a
  remote location.
• Establish a basis for intervention and home
  visits based on clinical needs.
• Allows data driven decisions potentially reducing
  hospitalizations.
• Alleviates fear by giving patients and families
  access to their own health data.
• AHRQ Call Center information at
  http//www.ahrq.gov/prep/callcenters

14
Telehealth Devices

• Remote Vital-Sign Monitoring Units
• Small devices monitor and send data on a regular
  basis operating over a standard phone line.
• Increasing use in New York, Pennsylvania, and
  several other states.
• Interactive Voice Response Systems (IVR)
• Used in community health call centers and could
  be adapted to support care, monitor and
  disseminate information during a pandemic.

15
Telehealth Devices

• A wide range of vital sign monitoring devices are
  in use in the VA system.
• Blood pressure monitoring.
• Weight monitoring.
• Digital cameras for wound management.
• Video monitoring for wound management.

16
Legal and Ethical Issues Concerning Home Health
Care During Pandemic Flu or other Public Health
Emergencies

• James G. Hodge, Jr., J.D., LL.M.
• Associate Professor, Johns Hopkins
  Bloomberg School of Public Health
• Executive Director, Center for Law the Publics
  Health A Collaborative at
• Johns Hopkins and
  Georgetown Universities

17
Principal Objectives

• Legal Environment in Declared Emergencies
• Multiple Levels of
• Emergency Declarations
• Legal and Ethical Challenges Concerning Home
  Health Care

18
Emergency Declarations

• Before 9/11/01
• Existing legal infrastructures focused on
  general emergency responses
• All hazards or disasters approach

• After 9/11/01
• Reforms of emergency response laws at every
  level of government to address public health
  emergencies
• Based in part on the Model State Emergency
  Health Powers Act (MSEHPA)

19
Public Health Emergency Defined (1)

• Public health emergency
• An occurrence or imminent threat of an illness
  or health condition that (1) is believed to be
  caused by any of the following
• Bioterrorism
• Appearance of a novel or previously controlled or
  eradicated infectious agent or biological toxin
• Natural disaster
• Chemical attack or accidental release or
• Nuclear attack or accident and

20
Public Health Emergency Defined (2)

• (2) poses a high probability of any of the
  following harms occurring in a large number of
  the affected population
• Death
• Serious of long-term disability or
• Widespread exposure to infectious or toxic agent
  posing significant risk of substantial future harm

21
Multiple Levels of Emergency Declarations
Federal
Emergency or Disaster Pursuant to the
Stafford Act
DHHS Public Health Emergency
State
Emergency or Disaster
Public Health Emergency
Local
Emergency or Disaster
Public Health Emergency
22
The Model State Emergency Health Powers Act

• Government is vested with specific, expedited
  powers to facilitate emergency responses
• Individuals are bestowed special protections and
  entitlements
• State medical licensure requirements standards
  of care may be altered
• Responders may be protected from civil liability

23
Legal Triage During Emergencies
Legal triage refers to the efforts of legal
actors and others to construct a favorable legal
environment during emergencies by prioritizing
issues and developing ethically-sound solutions
that further public health responses.
24
Legal/Ethical Issues Concerning Home Health Care
in Emergencies (1)

• Allocation of scarce resources
• Changes in scope of practice
• Waiver, alteration, or suspension of medical
  licensure requirements
• Home health care worker liability protections
  (employees vs. volunteers)
• Workers compensation protections

25
Legal/Ethical Issues Concerning Home Health Care
in Emergencies (2)

• Patient release policies
• Protections for at-risk populations
• Patient abandonment
• Determinations of reimbursement
• Temporary suspension of regulatory conditions via
  CMS
• Health information privacy

26
Conclusions

• Declarations of public health emergency change
  the legal environment
• These changes can facilitate or impede the
  provision of home care services
• Developing appropriate legal and ethical
  solutions during emergencies is essential
• For more information, please visit the Centers
  website at www.publichealthlaw.net
• Thank you!