# 2133
Note: This is the first of a multi-part series I'll be doing on the HHS's recent report on the home health care industry during a pandemic.
The recently released HHS document - Home Health Care During An Influenza Pandemic : Issues and Resources - brings to light a number of difficulties that the home health care industry will face during a severe pandemic.
With more than 17,000 home health care agencies operating in the United States, ranging from small volunteer or non-profit outfits to larger commercial agencies, the scope of their problems and the resources they will have available to solve them are going to vary considerably.
This document therefore must be viewed more as a springboard for discussion than as an actual roadmap for agencies to follow to become pandemic ready - a point that is made early on in the document:
`This report serves as a discussion piece for home health care agencies and others to consider; this is not a Department of Health and Human Services (HHS) guidance.'
For anyone anticipating that home health care services would be commandeered to care for the general public at home during a pandemic, the report states:
In the event of an influenza pandemic, because of anticipated shortages of health care professionals and widespread implementation of social distancing techniques, it is expected that the large majority of individuals infected with the influenza virus will be cared for in the home by family members, friends, and other members of the community � not by trained health care professionals.
In other words, the home health care industry lacks the capacity to provide medical care in the home to the vast majority of pandemic flu victims.
You should therefore dispense with any notion that a home health care nurse is likely to visit you to wipe your fevered brow during a pandemic.
In fact, this report identifies two primary receivers of home health care during a pandemic.
Those medical and surgical patients, not hospitalized because of the pandemic, who are well enough to be discharged early from hospitals to free up hospital beds for more severely ill patients.
Patients who become or already are dependent on home health care services (predominantly elderly persons with chronic disease) and will continue to need in-home care during the influenza pandemic whether or not they become infected with the influenza virus.
Accordingly, the home health care industry will be asked to handle their current patient load, plus the addition of surgical and medical patients discharged early in order to free up hospital beds during a crisis.
This at a time when their own ranks may be severely depleted due to absenteeism.
I'll have more on that, in a future blog.
Since 90% of home health care providers are non-governmental, and this document is not considered `official HHS guidance', much of this report reads like an overly polite to-do list.
You see genteel phrases like "agencies need to ensure' or `Measures that home care agencies can take' littered throughout the document.
While couched in diplomatic language, and at times almost apologetic in tone, the unmistakable message here is that private agencies are going to be expected do a great deal in order to prepare for a pandemic.
These are not mandates, of course.
More like, "They're only suggestions. . .but let's not forget who's making them. "
Sometimes, though, the tortuous diplomatic tip-toeing through the preparedness minefield in this document borders on the absurd. In regards to agencies having adequate resources on hand, the following advice is given:
The HHS Home Health Care Services Pandemic Influenza Planning Checklist recommends that agencies think about whether plans should include at least a week's supply of resources when there is evidence that the potential for pandemic influenza has reached the United States.
This will provide a base until the agency is able to receive direction from its local, State, and Federal government agencies on how and where to access necessary supplies.
This rather tepid advice - that agencies should `think about whether plans should include' - illustrates the difficult position that the HHS, and the authors of this document, are in.
They want to motivate agencies, not frighten them. They want to cajole the industry, not bully it.
They are walking a fine line.
They obviously want agencies to do more than just `think about' these issues, they want them to act. And I'd venture they'd like to see agencies prepared for far longer than a week.
But attempts to mandate specific preparations, particularly before a pandemic erupts, would likely lead to a firestorm of industry protests and a prolonged fight with lobbyists and congress.
As long as they remain `suggestions' instead of regulations, and `advice' rather than mandates, they can be openly discussed by government agencies.
But of course, it remains up to the individual health care agency (or any other private enterprise) to decide whether to prepare for a pandemic, and to what extent.
Perhaps this will ultimately prove to be the true Achilles' Heel of our privatized health care system.
Our dependence upon the willingness (or ability) of profit driven (or worse, non-profit volunteer) private enterprise to absorb the costs of preparing for an extraordinary incident like a pandemic.
I'll have more from this document over the next couple of days, including a look at anticipated absenteeism among home health care workers during a pandemic.
In the meantime, this HHS document is well worth your time to review.
Anyone reading it will, no doubt, come away with the inescapable conclusion that home health care agencies have a tremendous job ahead of them to prepare.
The big unanswered question is: Will the Industry rise to the challenge?
