Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
How long did home care agencies have to prepare for Hurricane Sandy?
Home care agencies, like all health providers, have only a matter of days to prepare for a specific weather event like Hurricane Sandy. However, disaster preparedness planning is a core function of home care service providers.
New York State, in particular, has a rigorous set of regulatory guidelines for emergency preparedness in home care. These guidelines are reinforced by best-practices and routinely tested at the provider level to ensure that there are no gaps in an organization’s communications, logistics, or readiness systems when an event does occur.
What did this preparation involve?
For preparedness purposes, home care providers maintain an up-to-date and specially coded roster of their patients, many of whom are extremely vulnerable, may live alone at home in the community, and require special attention during an extreme weather event like Hurricane Sandy. These patients are classified and coded according to the severity of their health and assistive needs so that home care agencies and emergency responders can access these patients on a triage basis, focusing attention on those patients needing the most attention first in an emergency.
These patients may include persons with disabilities needing assistance with evacuation, technology-dependent patients requiring electricity to maintain life-sustaining medical equipment, or elderly patients who do not have local family or informal caregiver assistance to help in an emergency. Because these and other patients are served by home care agencies on a daily basis, the agency is very well equipped to assist emergency management officials in assuring the safety of these patients, along with continuity of services.
In addition, even before a disaster strikes, another of the home care agency’s core roles is to ensure advance communication and outreach to all patients and their families. The main purpose of this outreach is to assess – and anticipate – the patients’ individual needs and alert patients to potential evacuation orders. Agencies must similarly keep an open line of communication with their staff, to ensure that personnel are safe and are ready to assist individuals in need.
These are just some of the many preparations that go into disaster-response pre-planning on the agency level. Other work includes continuity-of-operations planning and surge capacity planning should mass casualties occur and require hospitals to open up bed capacity by discharging patients to home care. There are many elements that go into emergency preparedness planning in home care.
How were patients prepared for the storm?
Patient preparation and education are also core functions of the home care agency. In its very holistic approach, home care attends not only to the patient’s medical and assistive needs but also the patient’s environmental needs. Therefore, personal safety and emergency planning at the household level are key elements of the patient’s ongoing plan of care.
Home care staff are experts at ensuring patients have enough nutrition, medication and supplies ready in the event of an emergency. This may include helping a patient prepare a ‘go-bag’ containing prescriptions, family contact or insurance information, identification, and other essential items that can be obtained quickly should a patient need to be evacuated to an emergency shelter.
The transit system was shut down during Hurricane Sandy. How did home care agencies make sure that food packages were still delivered to their patients?
Home care providers have dealt with all sorts of emergency events in the past, including major flooding last year from Hurricane Irene which devastated much of upstate New York. But what made Hurricane Sandy particularly unique was the impact on transit services and the corresponding level of traffic congestion in very population-dense areas like New York City.
Knowing the risks ahead of time, home care agencies made every effort to move up home visits in advance of the storm wherever possible to assess the patient’s home environment and ensure adequate supplies, especially for those patients who were anticipated to be sheltering in place (at home).
But beyond nutritional preparations, home care agencies also provide important medication-management services, wound care, skilled nursing assessments, vital-sign monitoring, therapy, assistance with mobility and activities of daily living, and a range of other services that these medically complex patients depend upon every day.
Agencies worked to provide as many of these services as possible in advance of the storm but they also continued to do so during the storm and in its aftermath, by delivering services to patients who had transferred to emergency shelters or, in most cases, by continuing to provide services in the patients’ homes.
Throughout this event, we have heard remarkable stories of the valor of home care personnel in their efforts to reach patients, climbing to the top floors of high-rise buildings to check in on patients with disabilities who were unable to evacuate or to administer needed insulin treatments. Their stories and their dedication to patient care are inspirational.
What work needs to be done in the aftermath of the storm? Have you learnt anything from Hurricane Sandy that will help you to prepare home care agencies for any future storms?
Agencies must work with their patients to regroup and recover. In some cases, the home care organizations may have suffered major damage and will have to make repairs, restore critical infrastructure and/or restock needed supplies. Patients’ homes may be damaged, which means that the social work arm of many home care operations may need to assist patients in working through housing issues.
In the future, our organization will be looking for ways that allow regulatory flexibility during events like these to ensure the smooth functioning of our home care system. This may include regulatory flexibility in the area of personnel assignment or time deadlines for filing of reimbursement claims or for obtaining medical orders.
We also have learned from this event that the loss of transportation and fuel shortages precipitated by this crisis will require follow-up action to educate emergency management officials about the urgent need for priority status in home care. This would include exempting caregivers from certain travel restrictions that may be imposed during a time of crisis or ensuring access to fuel supplies so that providers can get the services to patients in need. We will be looking to discuss these major issues with state and federal policymakers to ensure an adequate regulatory and funding structure for home care providers to do their critical work during an emergency.
Where can readers find more information?
Our organization maintains a website about home care emergency preparedness. The website is www.homecareprepare.org. It contains a Home Care Emergency Preparedness Manual that details the many components required of home care agencies in their emergency plans.
Under the “About” page, readers can see a one-page issue briefing with further details about the role of home care in emergency preparedness. We will also soon be posting to this page stories about the work of home care agencies in response to this event and other emergencies.
About Joanne Cunningham
Joanne Cunningham is President of the Home Care Association of New York State which represents approximately 400 home care providers serving the medical, social, assistive and therapeutic needs 400,000 patients in their own homes.
Previously, Ms. Cunningham served as Executive Director of Healthcare Trustees of New York State, an affiliate organization of the Healthcare Association of New York State (HANYS). She spent twelve years working in health policy and advocacy in Washington, D.C. as HANYS' Vice President for Federal Relations, and as the primary federal health care advisor to Congressman Edward J. Markey (D-MA), a senior member of the House Energy and Commerce Committee; Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee; and former Governor William Donald Schaefer (D-MD).