Home Health Providers Prepare for ‘Very Tough Winter’ Ahead

The seven-day average for new COVID-19 cases hit 68,767 on Sunday, shattering the previous high set in July. Meanwhile, Friday and Saturday took over as the two highest days for new cases since the pandemic began.

Despite mitigation efforts and progress on rapid testing, the U.S. is firmly in the middle of a third surge, one that even rivals spring’s initial outbreak in terms of raw numbers. Home health providers have yet to feel the full effects of this latest swell, but many believe another round of patient-volume disruption could be on its way if the situation isn’t contained.

“We are certainly seeing an uptick in COVID-19 cases in the geographic areas VNA Health Group serves,” Dr. Steven Landers, the organization’s president and CEO, told Home Health Care News. “The number of COVID-19 related hospitalizations and home health referrals have increased in October, but are not yet anywhere near the crisis levels we experienced in April and May.”

VNA Health Group is among the largest independent, nonprofit home-based care providers in the nation, operating across New Jersey, plus parts of Ohio and Florida. Its front-line workers have cared for several hundred COVID-19-positive seniors over the past eight months.

In the Pacific Northwest, Washington-based EvergreenHealth Home Care is similarly not experiencing a major influx of COVID-19 patients at this time, Chief Home Care Officer Brent Korte told HHCN. Nonetheless, the hospital-affiliated home health provider and COVID-19 pioneer remains nimble in its planning, should volumes and circumstances suddenly change.

“Since the onset of the pandemic, EvergreenHealth Home Care has operated under the assumption that a surge could come at any time, and we are prepared to handle an increase in [COVID-positive] patients,” Korte said. “We have been preparing nonstop for the past eight months, since we cared for the first COVID patients in the U.S. in early March.”

A spokesperson for a large, multi-state post-acute care provider with a home health services line likewise told HHCN his organization isn’t experiencing a current surge in COVID-19 patients nor a decrease in volumes.

The ‘steep slope of the curve’

Health experts had long been anticipating a winter surge, materializing right around the Nov. 3 presidential election. But unlike past spikes isolated to one state or one region, the current surge is geographically diverse, with outbreaks across the Midwest, Great Plains and the South, in addition to certain metropolitan markets.

In El Paso, Texas, for example, intensive care units hit full capacity on Saturday, according to The Washington Post. In Utah, the state hospital association warned that the state may soon have to implement a “crisis standards of care,” prioritizing care toward younger patients more likely to recover.

All signs suggest the nation is once again at a “dangerous tipping point,” former U.S. Food and Drug Administration Commissioner Scott Gottlieb told CBS News.

“We’re entering what’s going to be the steep slope of the curve,” Gottlieb cautioned.

When home health providers did see a sudden COVID-driven dip in patient volumes, it came toward the end of March and early April, when hospital systems halted elective surgeries and individuals declined visits due to exposure concerns. After that drop is when providers began to then see the continuous flow of COVID-19 patients onto home health services.

Data gathered by home health and hospice technology company Homecare Homebase (HCHB) confirms that in-home care providers are not seeing the same kind of volume swings — yet.

After the spring decrease, home health admissions rapidly climbed to pre-pandemic levels by the end of May and early June, the HCHB data shows. Admission numbers then gradually increased to a near-term, relative high until late-September, apart from a minor blip between mid-July and mid-August.

New data suggests admissions are trending slightly downward again in October.

Source: Homecare Homebase

On its end, the Visiting Nurse Service of New York (VNSNY) — the biggest nonprofit home-based care provider in the country — is not seeing a significant upswing in COVID-19 cases at this time. Additionally, its volumes remain steady.

“We’ve been able to recover fairly smoothly from the drops in service that we saw earlier in the year,” Andria Castellanos, VNSNY executive vice president and chief of provider services told HHCN. “Our volume continues to improve each month as our referral sources normalize. Of course, we are monitoring the numbers very closely every day, throughout the day, and we are in constant communication with our clinicians and the physicians, hospitals, nursing homes, assisted living facilities and other partners that VNSNY serves.”

While there is a clear surge in new cases, Dr. Anthony Fauci, the nation’s top infectious disease expert, pointed out the U.S. is still in the first broader “wave.”

“We’ve never really had waves in the sense of up and then down to a good baseline,” Fauci said Monday at the All Markets Summit. “It’s been wavering up and down. So now we’re at the highest baseline. … [It’s] kind of semantics. You want to call it the third wave or extended first wave. No matter how you look at it, it’s not good news.”

Staying vigilant

If home health providers do ultimately experience an uptick in COVID-postive patients, they’ll be prepared. Most have never stopped stocking up on personal protective equipment (PPE) or refining their operational protocols.

That includes VNSNY, said Castellanos, who heads up the organization’s COVID-19 Emergency Response Team.

“VNSNY has developed a new PPE procurement supply chain,” she said. “We now have an adequate supply of PPE available for all of our staff, who are well trained and updated on all protocols. We understand that changes can happen very quickly, and our staff and Emergency Response Team are on alert 24/7 and in sync — ready to respond immediately [if needed].”

In addition to PPE and protocols, providers are also in better shape when it comes to staying connected and supporting their clinicians in the field.

As in-home care providers head into “a very tough winter ahead,” EvergreenHealth Home Care is focused on keeping staff safe, delivering high-quality care and making sure its workers all have jobs that aren’t going away, Korte noted.

“I recently had the opportunity to round with our clinician care teams, and while everyone is experiencing and embracing the challenges of the COVID-19 pandemic in their own way, especially when it comes to missing our personal connections with one another, we’re working together to find creative ways to stay connected and empower each,” he said. “We are in a hiring mode currently — so our staff are thankful to have security in their jobs as so many people in our community have been hit by the economic downturn.”

VNA Health Group, too, is focused on protecting its patients and staff. Part of that has meant implementing an aggressive employee influenza-vaccination campaign to protect workers from the flu, which could potentially be devastating when paired with the COVID-19 virus.

Even with all the planning, preparation and caution, home health providers will still have to keep their fingers crossed that the public at large takes the current surge seriously, Landers added.

“We are hoping that the people in the communities we serve will be vigilant about the public health measures that can bring this back down so that we don’t revisit those earlier high levels of infections and deaths,” he said.

The post Home Health Providers Prepare for ‘Very Tough Winter’ Ahead appeared first on Home Health Care News.

Assisted Living Facilities Still Restricting Home Health Providers

Home health providers have been on the front lines of the COVID-19 crisis since its outset, yet a primary concern remains being left behind by legislators, whether that’s on a state or federal level.

Reimbursement for telehealth services is still on the forefront of everyone’s minds. But there are less-covered issues that haunt providers as they continue to deal with the ongoing public health emergency, too.

There are still severe restrictions on access to patients in facilities, for example. Additionally, the existing nursing shortage has only grown worse.

The main concerns moving forward will continue to be taking care of patients and dealing with the challenges of COVID-19 and the Patient Driven Groupings Model (PDGM). But advocating on behalf of the home health industry cannot stop in the meantime, Dr. Steve Landers, the president and CEO of Visiting Nurse Association Health Group Inc., said on a Wednesday webinar hosted by Blacktree Healthcare Consulting

“I think we’ve got to stay really front and center on [telehealth] and not get left behind,” Landers said. “Because other people are going to be providing telehealth into the home and into the community. That’s going to be a part of the delivery system going forward. And I think we in [home health] should be the leaders.”

VNA Health Group is one of the largest independent, nonprofit providers of home-based health services in New Jersey, northeast Ohio and southeast Florida. Headquartered in New Jersey — a part of an area the virus wreaked havoc on early — the provider had already cared for nearly 650 COVID-19 patients by the end of May, Landers told Home Health Care News.

Amid the pandemic, hospitals have been granted the ability to bill for outpatient remote services in the home, yet home health providers are still not able to do so.

There is also a mounting concern over new, restrictive immigration laws that could affect the nursing workforce in home health, Landers said.

“It’s not been a hot topic, but I’d love to see more done for the nursing workforce,” Landers said. “Our nursing schools are turning away tens of thousands of qualified applicants every year because they don’t have capacity to take them on. And on the other end, we’re losing more nurses every year than we’re putting in, … and now we’ve restricted immigration. We’ve got a big nursing challenge, and I personally would like to see some government intervention on expanding training for nurses.”

An additional hurdle in the past has been that nursing programs had prioritized institutional settings, which led students to believe that hospitals and specifically emergency rooms were the be-all and end-all.

Industry insiders are hoping that stigma changes with care moving further into the home during COVID-19 and better home health education becoming more ubiquitous.

“[There was always] this mindset that you had to have all this acute care experience before you can be successful in the home,” Mary Gibbons Myers, president and CEO of Johns Hopkins Home Care Group and president of Home & Community-Based Services for Johns Hopkins Health System, told HHCN in May. “But what we’ve been thinking over the last couple years is that we really need to go upstream and look at the institutional or the educational setting, making sure that the curriculum is changed so that instead of focusing people on critical care and hospital settings, [we’re looking] at the entire continuum of care … .”

One measure that was applauded at the beginning of COVID-19 in some circles, but has since become problematic, is the isolation of home health workers from institutional settings over the last five months.

That’s put the patients at an even further risk at times, Brent Korte, chief home care officer at EvergreenHealth, also said on the webinar.

“[We’ve been trying to] fight back to make sure that we have access to assisted living facilities and skilled nursing facilities,” Korte said.

EvergreenHealth was one of the first providers in the entire country to be hit by COVID-19 in the U.S., way back in February. Based just outside of Seattle, it is one of the largest home health and hospice providers in the Pacific Northwest.

The not-for-profit provides about 250,000 visits per year and is affiliated with a local hospital system.

A few months ago, when EvergreenHealth was blocked from seeing a patient to check on wounds, she eventually developed a stage-4 tunneling cubitus ulcer that led to her death.

“There can obviously be a very negative impact from not being able to see patients,” Korte said.

The cutoff from facilities has also had other negative impacts as well, such as staggering declines in mental health for isolated seniors unable to see their families.

New legislation decisions — or lack thereof — are bound to be a topic throughout the COVID-19 crisis, including whenever a new stimulus package is agreed upon. For home health providers, each one could mean the world.

The post Assisted Living Facilities Still Restricting Home Health Providers appeared first on Home Health Care News.