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
- Visiting Nurse Association of America (VNAA)
- American Association for Home Care
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!
