With yet another winter storm barreling through the Northeast on Tuesday, home health providers prepared to work in crisis mode. But while recent news stories have highlighted the dedication of home care workers to do their jobs in extreme circumstances, the home health field as a whole could benefit from a more uniform set of emergency preparedness standards, according to a newly published analysis.
Home health providers trying to formulate a disaster response plan may encounter inconsistent and at times “divergent” recommendations for best practices, and there is significant variation in the plans that agencies already have adopted, the analysis found. It was undertaken by researchers affiliated with the University of California, Los Angeles and other institutions in the state. They identified 11 peer-reviewed scholarly articles on the subject of home health emergency prep and analyzed them to determine “common practices.”
“The most notable finding is that there is a significant amount of variability in the reported practices, activities, and recommendations from the field,” the authors wrote in their article, which appears in the journal Home Health Care Management & Practice.
Furthermore, there are some potentially problematic aspects to the most commonly mentioned recommendations for how providers should respond to extreme weather or other emergencies. The most frequently mentioned best practice in the reviewed articles was for home health agencies to plan for communication with state and local authorities. However, Hurricane Katrina illustrated how these lines of communication can break down, suggesting that home health agencies should consider how to be self-reliant, the authors wrote.
Certain seemingly crucial considerations were covered sparsely in the existing literature, the authors determined. Only three of the reviewed articles brought up surge capacity—that is, the ability of a provider to deliver care if patient load were to increase substantially. This could occur during an emergency event, if hospitals need to shift discharge people in order to accommodate an influx of more acute patients. And only two articles recommended registering patients with the utility provider if they are on essential electrical equipment. There also was no generally accepted method for classifying certain patients as high-risk and prioritizing their care during an emergency.
The very role of a home health provider during a crisis is to some extent unclear, the investigators noted. This could be addressed to some extent by federal regulations: Medicare-certified home health agencies might have to adhere to baseline emergency preparedness guidelines proposed in 2013 by the Centers for Medicare & Medicaid Services. In the meantime, it remains more of an open question.
“While the role of the home health agency is not necessarily to be the ‘first responder’ in the case of an emergency, home health agencies do have a responsibility to ensure that their patients are as self-sufficient as possible if an emergency were to occur,” the study authors wrote.
The findings led the investigators to formulate four broad recommendations for home health agencies:
- Have a formal, written plan
- Determine surge capacity, including how limited staffing during a disaster could affect this
- Develop a standardized risk classification
- Consider unique needs of home health patients
Not all home health companies currently have formalized disaster plans that meet these recommendations or those offered by organizations such as the National Association for Home Care & Hospice; however, recent news reports have shown the lengths to which home care workers are going during emergencies like the blizzards in the Northeast.
“At the height of the blizzard she made her way to the client’s home, fixed her tea, lifted her into bed, and, perhaps most important, offered her companionship,” The Boston Globe wrote of home care worker DeKayla Graham in a front-page story on Jan. 28. And with more heavy snow on the way early this week, local news shone a light on how home medical equipment providers in Virginia were getting ready to keep patients safe and secure.
Written by Tim Mullaney