Webcast Outline: July 8, 2208

PlanFirst: Episode 005: Home HealthCare during an Influenza Pandemic
Airdate: July 8, 2208
2:00pET – 3:00pET
Slide Text v1

Home Care in an Influenza Pandemic: Issues and Resources

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

Overview: Home Care’s 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

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

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

Home Care Strategies

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

Home Care Strategies

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

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

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/html~home.aspx
• American Association for Home Care
• • http://www.aahomecare.org/

Implications for Home Care During a Pandemic

• Geraldine A. Coyle, RN, EdD, CNAA

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

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.

Telehealth Technologies

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

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

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.

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.

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 Public’s Health: A Collaborative at Johns Hopkins and Georgetown Universities                                                                

Principal Objectives

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

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

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

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

Multiple Levels of Emergency Declarations

• Local
• • Emergency or Disaster
  • Public Health Emergency
• State
• • Emergency or Disaster
  • Public Health Emergency
• Federal
• • Emergency or Disaster Pursuant to the Stafford Act
  • DHHS Public Health Emergency

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

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.

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

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

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 Center’s website at: www.publichealthlaw.net
• Thank you!