“The home care population includes the elderly and individuals with multiple underlying chronic conditions who are at greatest risk from COVID-19,” noted HCA President Al Cardillo in a statement to the media last week. “Individuals in quarantine, as well as those self-isolating and possibly living with COVID-19 undetected, are residing at home in most cases.”
To quantify this level of vulnerability, an HCA survey of 300 home care providers last week found that over 14,000 patients at home are classified, by state emergency preparedness protocols, as priority level 1. These are patients whose needs are so severe that, without home care, they would face a rapid, life-threatening deterioration in their health.
This 14,000 is based on a sample (roughly one-fifth of all the home care providers in New York State). Therefore, a great many more patients across New York State have such medically severe needs (i.e., they are ventilator dependent) that they cannot go without care. And they are living at home where these needs are met by a home health agency.
Home care is keeping these — and many thousands of other patients — from needing to go to the hospital or nursing home. They do so at quieter times or, as now, amid the din of a global health emergency like COVID-19 that is placing enormous new stresses on the health care system.
In short, home care needs priority access to supplies, regulatory relief and financial assistance in its work at the front lines.
Policymakers must understand this, and respond accordingly. Many have. Over the past week, the state Department of Health has worked admirably and responsively on many critical requests for regulatory waivers that are necessary for home care to reduce exposure — and mitigate risk — among patients and the hundreds of thousands of personnel who deliver care in patients’ homes.
These flexibilities are also necessary for providers coping with chronic workforce shortages so that personnel, procedures and attention are devoted to the areas and functions commanding greatest attention for the safety and well-being of patients at a time when personnel may be unable to work due to sickness or as school closures put restrictions on the availability of working parents to meet caseload demands.
Home care’s needs are unique. Infection-control and screening practices differ in the home environment, where RNs must assess a patient not only for symptoms but for all the other environmental or social contacts a patient has had at home and in the community. These differences must be accounted for in the state policy support structure.
In more normal times, home care nurses, aides and therapists often inconspicuously serve the needs of 900,000 New Yorkers, but they need your attention now. As you’ll read elsewhere in the March 2020 edition of Capitol Report, home care has confronted unique barriers in this crisis that demand attention.
For one, home care services need to be explicitly included in local directives on the prioritization of supplies. The overwhelming majority of providers indicate they do not have sufficient personal protective equipment.
Home care staff also need to be explicitly regarded as “essential personnel” because restrictions on mass gatherings have led local law enforcement to question home health aides and other personnel traveling in the execution of their duties.
These are just some of the many issues that HCA has been working to resolve on behalf of providers and the staff they serve. We look to you for support in this effort.