Posted Sunday, May 2, 2021
Infection Control and Emergency Preparedness have taken a front seat in Home Health and Hospice Agencies due to the COVID-19 PHE. No agency has been untouched by the staffing issues, supply issues and process changes that have come up during this past year. This PHE has put all our Emergency Preparedness plans and Infection control processes to the test, and most have failed. Our programs were created with short-term crisis management in mind. The PHE has required us to develop endurance and play the long-game with our programs.
CMS blanket waivers have eased the burden for agencies by removing certain requirements such as the hospice volunteer requirement, Annual On-site supervision requirement for C.N.A.’s and the education requirement for C.N.A.’s, and, of course, the addition of telehealth visits for Face-to-Face Encounters and in hospice during the PHE. Additionally, among the waivers they narrowed the scope of our QAPI efforts to Infection Control while retaining the requirement that agencies address adverse events.
These waivers were intended to free up needed staff to provide patient care. Telehealth, now a permanent addition to hospice regulations, will now be available as an additional tool to support these patients at home as long as it does not replace necessary in-person visits and is included in the plan of care. The HEAT Act (Home Health Emergency Access to Telehealth Act) proposes to Medicare reimbursement for home health visits furnished via telehealth during the PHE. It was sent to the Finance committee last October. We are waiting to learn which, if any, other flexibilities will be become permanent additions to home health and hospice regulation.
The CDC published specific guidelines for managing COVID-19 patient’s in Home Health and Hospice and guidelines for infected or exposed staff to return to work. When agency personnel are involved in care with people with confirmed or suspected COVID-19:
- Adhere to relevant infection prevention and control (IPC) practices as described in the Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
- Refer to the Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2 for questions about testing.
- Following possible exposures to SARS-CoV-2 while providing patient care, home health agency personnel can refer to the Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19 for information on recommended work restrictions.
- For more information, the Centers for Medicare & Medicaid Services (CMS) has provided Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs) and Religious Nonmedical Healthcare Institutions (RNHCIs)pdf iconexternal icon.
Per the CDC, decisions about return to work for healthcare personnel should be made in the context of local circumstances using a symptom-based strategy. The time period depends on the severity of the illness and if they are severely immunocompromised. Asymptomatic personnel who are fully vaccinated do not need to be restricted from work.
- COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers April 8, 2021 https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf
- Return to Work Criteria for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance) Feb. 16, 2021
- Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to SARS-CoV-2 Mar. 11, 2021
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