Leadership and clinical roles in pandemic response

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03/04/2020
By Michael Reinemer

The recent coronavirus pandemic is a good reminder that we should be planning now for the next pandemic. And the one after that. These events are matters of “when” they will hit, not “if.”

Natural disasters—whether severe ice storms, Hurricane Katrina or pandemics—also have reminded HME providers that they are first responders and should be built in to disaster protocols.  

There’s no excuse for Americans to get caught flat-footed, since we have done plenty of thinking, planning and responding already.

In 2008, the Agency for Healthcare Research and Quality, part of the Department of Health and Human Services, convened a two-day meeting to highlight issues and resources about “Home Health Care during an Influenza Pandemic.”  The resulting 85-page report has been worth reading ever since. The participants included physicians and public health representatives from universities, HHS, the Centers for Disease Control and Prevention, the Department of Defense and county health officials, as well as home health and HME providers. I participated as the representative from the HME sector.

The assumptions were that this event would quickly overwhelm hospitals and the need to quarantine patients would be paramount. Therefore, most people infected with a severe pandemic flu virus would receive care “in the home by family members, friends and other members of the community—not by trained health care professionals.”

It was a wide-ranging conversation that explored the basic needs and the outer limits of what a catastrophic outbreak would mean, ranging from the health needs of a massive, self-quarantined population to shortages of supplies, including body bags. 

The report covers issues like role clarification locally and nationally, supplies and equipment needs, reimbursement, tests and exercises, communications, workforce concerns, telehealth and legal issues.

While the initiative focused on home health agencies, there are implications for HME providers, too. A few basic take-always:

  • The home care sector will serve as an essential component of surge capacity in a pandemic.
  • Home care must be actively involved in planning and collaboration across all health care sectors.
  • Home-based care and monitoring technologies should be considered.
  • The surge of patients will strain the home health workforce.


A 2009 survey of HME providers found that 53% had established plans for responding to a flu pandemic and 23% had stockpiled related supplies such as N95 masks. The survey, conducted by the AAHomecare, was conducted in the wake of the swine flu outbreak. How many are prepared now?

Looking at the bigger picture, preparations for dangerous pandemics should be taken seriously by everyone in every corner of our society because they will require actions wider than health care and medical workers.

In 2003, I spent two days with Toronto public health officials during the SARS outbreak (Severe Acute Respiratory Syndrome) as part of a U.S. delegation from the National League of Cities to gather lessons learned. Toronto was struck by SARS but quick and heroic actions by their public health personnel contained it and may have prevented that very deadly disease from becoming a full-blown disaster for North America.

A few take-aways from that experience are worth remembering. While geared for local officials, they are apt for home care providers, as well:

Prepare

  • Train and prepare for biological threats.
  • Review and establish clear legal powers and lines of authority to respond.
  • Develop a system for recording and tracking all related but unbudgeted costs.

Coordinate

  • Keep government offices in the loop.
  • Manage medical information about infected people.
  • Set up a mechanism to update all employees.

Communicate

  • Coordinate messages to ensure they are consistent, correct, and frequent.
  • Target communications to key constituencies and audiences.
  • Prepare for an onslaught of questions that require both medical and practical answers.


The key lesson for HME providers: You have leadership and civic roles, as well as clinical responsibilities, in a pandemic. Plan for it, be at the table and demand recognition for your role as part of the response team. Again, this is about when, not if. 

Michael Reinemer is a communications strategist in Washington, D.C. He was VP for policy and communications at AAHomecare, 2004-13.

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