Coronavirus Daily Update: Home Health Care Getting More Attention; Puzzling COVID-19 Symptoms

During this critical time, Home Health Care News remains committed to bringing you all the essential news related to home-based care operations. At the same time, we also recognize the seriousness of the COVID-19 pandemic. In addition to our regular content, we’ll continue to highlight industry-related developments and mitigation strategies in this rolling bulletin.

What you need to know from Friday through Sunday (April 24-26)

— Seniors with the COVID-19 virus may have atypical symptoms, physicians say. Instead of a fever, cough and shortness of breath, they may instead sleep more, become dizzy and stop eating. These puzzling indicators complicate the process of recognizing the infection, which can be dangerous for seniors, who tend to be more at-risk than the rest of the population.

— CMS announced Sunday it is suspending its advance payment program and also “reevaluating” its accelerated payment program. HHCN has the story here.


— More than half of the February’s workforce have lost jobs, had their hours reduced, taken a pay cut or been furloughed as a result of the COVID-19 outbreak, according to Kaiser Family Foundation statistics

— Home health care is increasingly being recognized as the new front in the coronavirus war.

— President Trump signed the new $484 billion coronavirus relief bill into law on Friday. The vast majority of the fund is for replenishing the Paycheck Protection Program (PPP). In addition, $60 billion will go to small lenders and community banks and another $60 billion will go to the Economic Injury disaster loan program, which will benefit small businesses in disadvantaged areas. Another $75 billion is included for hospitals, while $25 billion will go to expand testing. 


— The federal government is attempting to create a fairer system for dispersing COVID-19 funds when applications open Monday for the second round of PPP relief loans, according to ABC News.

What you need to know from Thursday (April 23)

— Another 4.5 million Americans filed for unemployment last week, the Department of Labor (DOL) reported. The number of job losses since the coronavirus outbreak began has now soared above 26 million, erasing the roughly 23 million labor market gains since the Great Recession more than a decade ago. Many of these unemployed individuals may seek jobs within the home-based care sector, as most providers are constantly looking to hire to help meet rising demand for their services.

— More than 10,000 residents and staff in long-term care facilities across the U.S. have died from COVID-19 infections, according to a new Kaiser Family Foundation analysis. That number is an undercount, as not all states are currently reporting such data.

— The House overwhelmingly passed legislation providing roughly $484 billion in coronavirus relief for small businesses and health care organizations. The latest relief package also includes funding for expanded medical testing. Of the $484 billion, at least $310 billion will be used to replenish the Paycheck Protection Program, which quickly ran out.

— The Home Care Association of America (HCAOA) has issued new guidance for U.S. home care agencies when dealing with possible COVID-19 exposure. The guidance includes recommendations for agencies, clients and caregivers. For example, in the event a caregiver is potentially exposed to the virus and can’t be tested, he or she should self-quarantine for 14 days. If symptoms appear, that worker should only return to work after three conditions are met: 72 hours go by with no fever without the use of antipyretics, all other symptoms go away and a minimum of seven days pass after symptoms first start.

— The U.S. Department of Health and Human Services (HHS) is gearing up for another emergency funding round to help health care providers manage through the coronavirus. Starting Friday, the department will distribute a total of $40 billion, sending extra financial support to health care providers in rural areas and COVID-19 hotspots.

What you need to know from Wednesday (April 22)

— Interim Healthcare Inc. has launched, which aims to be a resource for home-based care providers having difficulty securing PPE.

— The FDA has authorized its first in-home diagnostic test for the COVID-19 virus, the agency announced. The kit contains a swab that enables the patient to collect a sample. The FDA said tests should be available to patients through prescription in the coming weeks. LabCorp, the producer of the tests, says it will give priority to health care workers and first responders.

The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) released a statement emphasizing the dire need for more PPE and COVID-19 testing for nursing and assisted living facilities. The lack of PPE and testing for these facilities shines a light on just how difficult it is to acquire these resources for home health agencies, which are on a tier even lower on the priority list.

— An infectious disease specialist outlined the unique challenges that rural communities face in the fight against the coronavirus. They’re less susceptible to the outbreak because of heightened isolation and less public transportation. These communities are, however, less likely to have jobs that can be done from home and are more reliant on frequent town gatherings.

— While CMS granting further telemedicine capabilities to providers has been a welcomed update, it also has raised concerns about billing fraud. The sudden increase in access to telehealth and reduced guardrails to preventing fraud could present future problems, Kaiser Health News suggests.

— The National Mobilization Against Sweatshops (NMASS), a grassroots labor organization based in New York City’s Chinatown, has stepped up to acquire and distribute PPE to home health care workers.

Interim Healthcare launches PPE website

Florida-based Interim HealthCare, a franchiser that provides home care and home health, among other services, launched a website Wednesday to help the home-based care industry better access PPE.

In tandem with its parent company, Caring Brands International (CBI), Interim has sourced, vetted and negotiated resources such as disposable gowns, surgical masks, digital thermometers, hand sanitizers, latex gloves, KN95 masks and other equipment, making it all available via

“Interim HealthCare has always played a leading role to ensure clinicians and caregivers have the support and resources they need to care for our most vulnerable populations,” Jennifer Sheets, CEO of Interim Healthcare, told Home Health Care News in an email. “After quickly mobilizing our own effort to source, vet and negotiate critically-needed PPE for our network, we continue to work tirelessly to ensure all care providers are fully-equipped to safely enter any client’s home. As we expect a surge to home care services over the next few weeks, to help COVID-19 patients recover at home, our clinicians and nurses must be protected.”

What you need to know from Tuesday (April 21)

— The U.S. News & World Report listed home health and home care workers among those with the most job security amid the coronavirus. In Minnesota, data shows that less than 5% of those in nursing — a category which includes psychiatric aides and home health workers — have filed for unemployment during the COVID-19 emergency.

— Congress and the White House have finalized a $484 billion coronavirus relief package, which would provide more funding for small business loans, hospitals and coronavirus testing. The Senate approved the measure Tuesday, with the House expected to vote on the legislation Thursday.

— Kindred Healthcare LLC has cut wages for many of its employees by 10%, and CEO Benjamin Breier is taking a 15% pay cut, a Louisville, Kentucky news station reported. Kindred Healthcare is owned by Humana and two private equity firms, Welsh, Carson, Anderson & Stowe and TPG Capital. It doesn’t appear that there have been any pay cuts at Kindred at Home, which is separate.

— President Donald Trump has announced that he plans to start suspending immigration into the U.S. The goal is to “protect the jobs of our GREAT American Citizens,” he said in a tweet. Though the proposal is still being drafted, experts expect certain industries will be exempted.

— Crude oil values hit historic lows Monday, with prices turning negative. In other words, traders were paying people to take it off their hands. The never-before-seen occurrence caused the Dow to plunge more than 600 points, another example of how the coronavirus continues to wreak havoc on the economy.

April 20

— The Partnership for Quality Home Healthcare (PQHH) wrote to CMS, urging the agency to consider paying home health providers for telehealth visits and more flexible certification requirements. Providers that signed the letter include Bayada Home Health Care, LHC Group and Kindred at Home, in addition to Encompass Health’s home health and hospice segment.

— Health officials in North Carolina believe at least 14 cases of the coronavirus can be traced back to a home health agency in Rutherford County, according to local newsroom WLOS. Home health agencies can often help prevent the spread of the virus, but, like other providers, are left vulnerable when not fully equipped with appropriate PPE.

— In a Los Angeles Times op-ed, Sirina Keesara and Nicholas Bott argued on behalf of hospital-at-home models. Keesara is an obstetrician-gynecologist and fellow at Stanford University’s Clinical Excellence Research Center, while Bott is a clinical neuropsychologist and associate fellowship director at the center. “Most hospitalizations for patients with mild or moderate illness require a set of initial tests, a daily evaluation from a doctor, intravenous medication on occasion, and check-ins from a nurse a few times a day,” they wrote. “All of this can be provided in a patient’s home with current technology.”

— More home health agencies are reporting challenges associated with clinicians refusing work due to PPE shortages. They include Reliance Home Senior Services, a home health aide agency with about 350 employees in Massapequa, New York. “We’re having an abundance of people calling us for care in the house after they tested positive, and you can’t get caretakers to go to the house for them,” Dana Arnone, owner of Reliance, told Newsday.

— While there are signs that coronavirus cases are starting to level off in some places, the threat of the virus is continuing to grow in others, according to The New York Times. Growth has been particularly evident in Massachusetts.

LUPA rates rising

The Washington, D.C.-based PQHH — an industry association representing many of the largest home health providers in the country — implored CMS to take several key steps to further support in-home care during the coronavirus emergency.

“As you know, the nature of this crisis is like nothing the nation has ever experienced and the entire health care sector (including the home health provider community) has been challenged in ways that were not imaginable,” PQHH wrote to CMS. “Home health providers are experiencing significant difficulties in providing critically needed care to existing Medicare patients (whose fears about COVID19 infection cause them to restrict access to the home), a severe reduction in referrals from hospitals, nursing homes and physicians, and a significant increase in low utilization payments (LUPA payments) in place of full episode payments for existing patients. In addition, staffing challenges are widespread, with personal protective equipment (PPE) in short supply and increased costs for training, screening and other activities related to COVID19.”

Specifically, PQHH called for telehealth payment as well as flexibilities surrounding signed orders and certifications.

A lack of telehealth reimbursement, in particular, has caused “extreme hardship for providers,” in part by dramatically increasing LUPA rates.

Early data from PQHH suggests that providers are experiencing at least a doubling of their 2019 LUPA visits.

“While telehealth visits certainly do not take the place of in-person visits, during the [public health emergency], it would make policy and public health sense to facilitate telehealth for home health providers by instituting a temporary payment mechanism to count them as in-person visits,” PQHH noted.

For daily updates from the week of April 13, click here.

For daily updates from the week of April 6, click here.

For daily updates from the week of March 30, click here.

For daily updates from the week of March 23, click here.

For daily updates from the week of March 16, click here.

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