# 2137
Note: This is the second of a multi-part series I'll be doing on the HHS's recent report on the home health care industry during a pandemic.
The recently released HHS document - Home Health Care During An Influenza Pandemic : Issues and Resources - brings to light a number of difficulties that the home health care industry will face during a severe pandemic, not the least of which will be the acquisition of patient supplies, PPE's, and antivirals during a pandemic.
As the report states, this may prove difficult. (Reparagraphing & Highlighting mine)
Supplies and Equipment.
Maintaining a flow of supplies sufficient to continue operations, protect healthcare workers, and meet patient needs throughout a pandemic is an obvious necessity and a complicated issue for the home health care agency.
Normal supply sources may be overwhelmed or disrupted, resulting in supply shortages.
This report goes on to recommend that home healthcare agencies anticipate their role in the distribution of . . .
`.... supplies specifically needed for surge patients and supplies for surge and existing patients that are not usually provided, such as food, water, or medications.'
Finally, agencies need to ensure that their workforce has the essential protective equipment needed to safely care for patients, including NIOSH-certified N-95 filtering face-pieces or higher rated respirators as feasible.
With the exception of the weasel wording at the end, this sounds like a pretty strong call to arms.
The `as feasible' at the end, does give me some pause. Who decides what is feasible, and by what criteria?
"Sorry, we would have liked to have bought N95 masks for our employees, but it just wasn't feasible."
OSHA (Occupational Safety & Health Administration) recently released estimates on what quantity of PPE's healthcare workers would need over the period of a 12-week pandemic wave.
While dealing with masks, HCWs (Health Care Workers) would also need gloves, gowns, face shields or goggles, along with other infection control supplies.
While none of these `guidance documents' carry the force of law, it would be difficult for any agency to argue that they weren't adequately informed of the pandemic threat, and of the need to prepare.
Not to put too fine a point on all of this, but it would seem likely that any agency that fails to take reasonable steps to protect their employees during a pandemic could be called upon to defend their actions at some point.
I'm not a legal expert, but it would seem prudent to me that agencies gather the pertinent HHS, CDC, and OSHA guidelines and have a long discussion with legal counsel over potential liability issues.
Similarly, the CDC recently released proposed guidelines on the stockpiling of antivirals for Very high and High Risk Employees. Home health care workers, by definition, will almost all fall into the `HIGH RISK' category according to this OSHA graphic.
Occupational Risk Pyramid for Pandemic Influenza
As this HHS document states, Home Health Care workers will be at a heightened risk for contracting pandemic flu.
An obvious factor in the ability of the workforce to work during a pandemic is infection. A significant share of the home health care workforce likely will become infected with the influenza virus and be unable to report to work.
Estimates based on past pandemics suggest that at least 25 percent of the workforce overall will become infected.20 Today these estimates likely would be mitigated in the event of a pandemic by government use of antivirals.
I will break in at this point to ask exactly how the `government use of antivirals', which has already been stated to be reserved for treatment only, not prophylaxis, will mitigate the percentage of healthcare workers infected?
Unless I'm missing something, this seems to be a rather optimistic assumption. But I digress.
An HHS proposed guidance as of June 2008 (not an agency determination or policy), recommends that healthcare workers who have direct high-risk exposures to pandemic influenza patients as well as front-line emergency services (e.g., law enforcement, fire, and emergency medical services personnel) receive pre-exposure prophylactic antivirals.
The burden of providing this antiviral outbreak prophylaxis falls on the employer, and reportedly will not come from the National Strategic Stockpile. A 12 week pandemic wave would require roughly 80 Tamiflu per HCW (Health Care Worker), at a cost of approximately $500.
While the initial cost is an inhibiting factor, getting prescriptions for all employees (who, frankly, tend to change jobs a lot), storing the meds, and distributing them are all obstacles that need to be addressed as well.
Admittedly, all of this places a heavy burden on home health care providers, many of which are either small entities operating on a shoestring budget, or in some cases, non-profit outfits. Whether they are capable of meeting these challenges is unknown.
While directed primarily at the home health care industry, the challenges listed in this document are largely shared by all health care providers, along with many first-responders.
The assumption that during a pandemic, supply lines will continue as normal, is seriously in dispute. There are good reasons to believe we could see prolonged shortages of many goods, including disposable PPE's such as masks, gloves, and gowns.
Agencies and facilities that fail to prepare, in advance, for a pandemic are likely to find their ability to provide life-saving and mission critical services may be severely compromised.
It would seem in the interest of individual communities, and our nation as a whole, to find ways to support these home health care agencies before and during a crisis.
Outreach to local businesses, civic groups, and religious groups would be one way to achieve this. In the past we've seen private fund raisers to purchase bullet proof vests for police officers in many communities.
Perhaps this is a model that we can use to help purchase antivirals and PPE's for nurses and first responders before the next pandemic.
Tomorrow, in Part 3, I'll look at absenteeism among home health care workers during a pandemic.
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