# Presentation: 756398

## 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](http://www.nahc.org/stateforum/directory.html)_
- Visiting Nurse Association of America (VNAA)
-    _[http://www.vnaa.org/vnaa/gen/html~home.aspx](http://www.vnaa.org/vnaa/gen/html~home.aspx)__ _
- American Association for Home Care _[http://www.aahomecare.org/](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](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**

**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 

-  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](http://www.publichealthlaw.net/)_
* **Thank you!*