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Home Care in an Influenza Pandemic:Issues and Resources : 

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 : 

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 : 

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 : 

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 : 

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

Home Care Strategies : 

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 : 

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 : 

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 : 

Implications for Home Care During a Pandemic Geraldine A. Coyle, RN, EdD, CNAA

Implications for Home Care During a Pandemic : 

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 : 

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 : 

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 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 : 

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 : 

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 : 

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 : 

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

Emergency Declarations : 

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 – 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) : 

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 : 

Multiple Levels of Emergency Declarations Local State Federal Emergency or Disaster Public Health Emergency Emergency or Disaster Public Health Emergency Emergency or Disaster Pursuant to the Stafford Act DHHS Public Health Emergency

The Model State Emergency Health Powers Act : 

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 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) : 

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) : 

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 : 

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!