Home Health & Hospice Week

Staff shortage looms on the horizon.

Home health and hospice agencies that aren’t anywhere near COVID-19 outbreak areas are still feeling the heavy burden of preparing for the newly declared pandemic.

On March 11, the World Health Organi­zation pronounced the coronavirus COVID-19 a pandemic. “In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled,” said WHO Director-General Tedros Adhanom Gheb-reyesus.“There are now more than 118,000 cases in 114 countries, and 4,291 people have lost their lives,” he said.“In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher.”

At press time, the United States recorded nearly 1,000 of the world’s confirmed cases of COVID-19, with outbreaks being centered in Washing-ton state, California, and the New York City area.

Department of Health and Human Services Secretary Alex Azar already declared a nationwide Public Health Emergency effective Jan. 27. That PHE paves the way for potential future waivers for Medicare providers. The Centers for Medicare & Medicaid Services already limited survey activities to high-priority cases in a March 4 memo to State Survey Agency Directors.

In response to the climbing COVID-19 rate, CMS has issued provider-specific “Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19),” including to hospices on March 9 and HHAs on March 10 (see related story, p. 75). The guidance in the home health and hospice documents largely overlaps.

“The home and hospice care industry is more likely to be impacted by a public health emergency than any other type of health care provider due to the very nature of its practice, which is a one-on-one health care delivery system,” warns emergency preparedness expert Barbara Citarella with Limited Healthcare & Management Consultants in a COVID-19 guidance document posted on the National Association for Home Care & Hospice website.

Many home care and hospice patients fall in the groups most vulnerable to the illness — those who are elderly, particularly 80 and older, and those with other conditions such as heart disease, lung disease, and diabetes.

Will Worker No-Shows Begin?

Experts are worried about the impact that the coronavirus’ spread will have on home care providers, their staff, and their patients.

Home care providers already are falling victim to the supply shortages plaguing the rest of the nation, on items ranging from hand sanitizer to face masks. Home care providers encountering a patient with suspected or confirmed COVID-19 should wear a gown, particulate respirator mask that has been fitted, goggles, and gloves, Citarella’s guidance notes.

Home care providers may see an influx of patients as COVID-19 spreads, in part due to concerned family members moving their loved ones out of nursing homes, the Washington Post predicts.“Some have wondered whether they should remove older relatives from these communities out of fear that the residences could become the next Life Care Center of Kirkland, Wash.,” the Post says, referring to the nursing home where a reported 18 residents have died of the virus so far.

For example: Veronique Littlefield told the New York Times that she moved her 86-year-old mother home after she was potentially exposed to the coronavirus at Life Care Center. Her mother had been transferred to a hospital and the family had to decide where to take her after discharge, says the Times. With the aid of hospice, the family set up a hospital bed in their home, quarantined themselves, and became round-the-clock caregivers. None of them, including her mother, has developed any symptoms.

Home health aides are already in short supply, due in part to low pay and lack of benefits for many aides, notes Mother Jones magazine. And due to the nature of their jobs, they obviously can’t work remotely.

In the cases of hospitals that have treated COVID-19 patients, liberal self-quarantining for staff who came into unprotected contact with patients is being used. If home care workers start to self-quar­antine, “this could potentially be catastrophic,” Danielle Darby of RCM of Washington told National Public Radio. There simply are not enough staff to serve patients, particularly well trained and experienced aides.

More problems: “Many home health aides … do their jobs with less support and access to protective equipment than caregivers at live-in facilities,” Mother Jones argues. And the magazine cites a 2010 study published in the American Journal of Disaster Medicine that found “a large proportion of [home healthcare workers] reported that they would be either unable or unwilling (or both) to provide care to their current (83 percent) or new (91 percent) patients during a pandemic.”