Home Health & Hospice Week

Warning: Sick, FMLA leave legislative changes could pack a wallop.

The problems the 2019 novel coronavirus brings are legion. But home care heroes across the nation are fighting the good fight against the virus and the fallout it brings — or are preparing to.

From coast to coast, providers and industry members report these top problems in the face of COVID-19.

1. PPE. Home health and hospice agencies are facing a shortage of personal protective equipment including gloves and masks.“Home care is not alone in experiencing shortages of PPE,” notes Mary McGoldrick, a nurse consultant with Home Health Systems Inc. “It’s a problem in all healthcare sectors,” McGoldrick says.

A recent survey conducted by the Home Care Association of New York State found that 67 percent of home care and hospice agency respondents could not secure enough PPE. See the survey results at https://hca-nys.org/covid-19-impact-on-home-care-by-the-numbers.

If you’re like most agencies, your “regular supply chain” is probably out of PPE like gowns, surgical masks, N95 disposable masks, hand sanitizer and gloves, notes the administrator of a home health agency in the New Orleans area, who requested anonymity. (For tips on tackling these top trouble spots, see story, p. 85.)

2. Staffing. Maintaining adequate staffing is a “hot spot” for home health, observes Cindy Krafft with Kornetti & Krafft Health Care Solutions.

“It is hard enough for home care agencies to keep staff under the best of circumstances, so I think we will see a large drop in available homecare clinicians,” expects consultant Sherri Parson with Quality in Real-Time.

Multiple factors are impacting agencies’ clinical staffing, experts note: school closures requiring staff to stay home with children; workers deciding they don’t want to risk COVID-19 exposure; and clinicians self-quarantining due to suspected exposure.

Plus: “As our staff continue to be out in the communities caring for patients, I expect a loss of available staff as they fall ill themselves,” Parson tells Eli. That will increasingly affect staffing levels as the virus spreads.

3. Labor law changes. The Families First Coronavirus Response Act, signed into law March 18, requires paid sick leave and paid Family and Medical Leave Act leave effective April 2.Providers will receive a tax credit for their leave payments.

Right now, home care providers are trying to figure out if they are considered exempt as health care providers under the new law. And the law also contains an exemption for employers with fewer than 50 employees when the pay would jeopardize the viability of the business, but the hardship waiver process is still fuzzy.

Providers will have to wait on the Department of Labor’s guidance for health care providers to determine whether they must pay the weeks of leave required under the law, the National Association for Home Care & Hospice notes.

4. Regulatory requirements. A host of regulatory requirements including payment requirements, the homebound definition, terminal prognosis related to COVID-19, and more stand in home health and hospice agencies’ way in responding to this crisis, industry members say. The federal government can remedy many of these impediments and aid the fight against the pandemic.

Providers are frustrated with “little movement” from the Centers for Medicare & Medicaid Services on many vital issues, Krafft relates.

5. Entrance denial. Patients at home are denying entrance to home care workers, and nursing facilities are denying entrance to hospice workers, sources relate.

6. Prioritizing care. Triaging visits as activity ramps up is another hot spot, Krafft shares.