Home Health & Hospice Week

If you're worried about efficiently responding to the potential onslaught of flu cases this winter, you aren't alone -- but you can stop outbreaks from streaking through your agency.

While home health agencies in most states staggered under the weight of the H1N1 cases earlier this year, agencies in New York were prepared for anything, said the Home Care Association of New York State's senior director of policy and development Alexis Silver during the recent "Planning for an Influenza Pandemic in the Home Health Care Sector" Web conference, sponsored by the Agency for Healthcare Research and Quality.

Background: New York is no stranger to emergencies between terrorist attacks, floods, hurricanes, and power outages. The state's unique threats forced the home care industry to hammer out hazard planning long before the current H1N1 panic started, Silver told conference listeners. Because the state's disaster framework is well established, home care workers can easily incorporate H1N1 specifics into the steps they already take to keep patients well, such as mandatory immunization.

You can easily incorporate many of Silver's lessons learned for keeping a seasonal or H1N1 flu pandemic at bay. Use these suggestions to get started:

1. Know how many patients you have and what their vulnerabilities are. While it may seem obvious, keeping track of your patients can become tedious as aides miss work due to the flu or another contracted illness. As your staff numbers dwindle, so will your disaster plan effectiveness if you aren't prepared well in advance.

Try this: Create a master list of patients and the aides who care for them. Assign "back ups" for each worker so that there is always someone who understands patients' unique needs to step in when an aide can't be at work. Note in the master list when patients catch the flu along with other information necessary to provide the best care.

2. Know what you'll need. Yes, you order enough supplies and plan for enough workers to accurately care for your patients -- but that only covers normal operations. If a pandemic strikes, you can quickly find yourself without the basic supplies you need to provide quality care while keeping everyone safe, Silver said.

Better: Survey your workers and other agencies to find out what extra supplies you'll need during an emergency. Ask everyone to brainstorm how your needs will increase and what you can do now to prepare. You can even run test drills and other exercises to help better prepare for an emergency, she suggested.

If you aren't sure whether your efforts will pay off, contact other agencies in your area to see if they'd like to collaborate on emergency preparation. Form a leadership team that shares information and works together to incorporate best practices.

3. Plan for staff and transportation challenges. Just getting workers to show up for work can be difficult when the flu is ravaging your area. But even worse is when staffers aren't medically able to receive a flu vaccine, or when vaccinated aides can't get to the patients who need their help, Silver noted.

Try this: Separate your patients at low risk for contracting the flu from those with weakened immune systems. Assign immunized workers to patients at the highest risk for contracting the virus and steer unvaccinated aides to everyone else. Share your strategy with any subcontractors so that everyone is matching patients with aides that are best suited for them.

Next step: Make sure you train unvaccinated aides to use the most advanced infection control techniques so that they further reduce any risks.

4. Root out your weaknesses. Every agency's strengths and weaknesses are different, but if you don't know what they are, you can't adequately plan for them, Silver pointed out. You must investigate past successes and failures to determine what potential pitfalls await you.

Examples: Silver determined that one of New York's weaknesses was communication between providers and para-professional workforce. Providers weren't sure whether para-professionals knew their roles or how they fit into the emergency preparation process. Silver is currently working to increase communication between the two groups, as well as offer further training to New York's para-professionals.

Your job: You must communicate with the providers, emergency personnel, and health workers in your community to ensure that everyone knows both what your role is in preventing pandemics and how you'll be available to help.

5. Educate your patients, too. You can spend all day training your staffers to stop the flu virus' spread, but all that work will mean nothing if your patients take unnecessary risks with their health, Silver stressed. For instance, patients who rush to the hospital emergency room rather than contact your aides when they need help could put themselves on the fast track for an infection, she said.

Best: Teach your patients which medical problems require an ER visit and which they can contact you to help them with. Give them a detailed list of whom to contact and what they can expect from your workers. "In New York, they are working on 911 screening so when people call they know whether it's actually a flu-related incident" that can be treated at home, Silver said.

Goal: You should design your emergencypreparation plans so that both your patients and your staff remain at low risk for either the seasonal or H1N1 virus. "Explain to everyone that your goal is to keep your patients well and your staff members working,"Silver advised.