COVID-19 / Coronavirus Guidance On Caring For People at Home
Hospice, home health and home care agencies provide care to millions of people in their own homes. For those of you providing this essential care, Senior Options shares these home care specific guidelines to help keep family caregivers, employees and patients safe. This article addresses the following questions:
  1. What Guidance is the CDC providing for caring for a person in the home?
  2. When can patients with COVID-19 end home isolation?
  3. How Do We Best Manage Patient Care with Limited PPE Supplies?
  4. What Telehealth services can we provide in the 1135 Waiver for Face-to-Face and for routine visits?
  5. What are the implications of the Medicare Home Health Agency discharge planning regulations for patients with COVID-19?
  6. What are some useful links to monitor?

1. What Guidance is the CDC Providing for Caring for a Person in The Home?

If you are caring for someone at home, the CDC advises the following:  monitor for emergency signs prevent the spread of germs , and  treat symptoms .
  • Monitor the person for worsening symptoms. Know and educate your patients and caregivers on the emergency warning signs.
  • Keep the patient’s healthcare provider’s contact information on hand.
  • If they are getting sicker, call their healthcare provider. For medical emergencies, call 911 and notify the dispatch personnel that they have or are suspected to have COVID-19

If COVID-19 is suspected, have the person stay in one room, away from other people, including yourself, as much as possible.
  • If possible, have them use a separate bathroom.
  • Avoid sharing personal household items, like dishes, towels, and bedding
  • If facemasks are available, have them wear a facemask when they are around people, including you.
  • If the sick person can’t wear a facemask, you should wear one while in the same room with them, if facemasks are available.
  • If the sick person needs to be around others (within the home, in a vehicle, or doctor’s office), they should wear a facemask.
  • Wash your hands often with soap and water for at least 20 seconds, especially after interacting with the sick person. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Avoid touching your eyes, nose, and mouth.
  • Every day, clean all surfaces that are touched often, like counters, tabletops, and doorknobs. Use household cleaning sprays or wipes according to the label instructions.
  • Wash laundry thoroughly. If laundry is soiled, wear disposable gloves and keep the soiled items away from your body while laundering. Wash your hands immediately after removing gloves.
  • Avoid having any unnecessary visitors.
  • For any additional questions about their care, contact their healthcare provider or state or local health department.

Provide symptom treatment. 
  • Make sure the sick person drinks a lot of fluids to stay hydrated and rests at home.
  • Over-the-counter medicines may help with symptoms.

' 2. Per the CDC, When Can Patients with COVID-19 End Home Isolation (staying home)?

People with COVID-19 who have stayed home and are home isolated can stop home isolation under the following conditions:
  • If they do not have a test to determine if they are still contagious, they can leave home after these three things have happened:
  1. They have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fevers) AND
  2. Other symptoms have improved (for example, when their cough or shortness of breath have improved) AND
  3. At least 7 days have passed since their symptoms first appeared.

  • If they will be tested to determine if they are still contagious, they can leave home after these three things have happened:
  1. They no longer have a fever (without the use medicine that reduces fevers) AND
  2. Other symptoms have improved (for example, when their cough or shortness of breath have improved) AND
  3. They received two negative tests in a row, 24 hours apart. Their doctor will follow CDC guidelines.

' 3. How Do We Manage Patient Care with Limited PPE Supplies, under current CDC guidance?

Updated PPE recommendations for the care of patients with known or suspected COVID-19 states, "based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP."
  • Facemasks protect the wearer from splashes and sprays.
  • Respirators, which filter inspired air, offer respiratory protection.

Eye protection, gown, and gloves continue to be recommended. If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.

Agencies should take actions to mitigate any resource shortages and show they are taking all appropriate steps to obtain the necessary supplies as soon as possible. For example, if there is a shortage of ABHR (alcohol based hand rub), it is expected that staff have access to and practice effective hand washing with soap and water.

Make sure your team members are educated on when PPE is needed and how to don and doff PPE. Here is a link for instructions on donning and doffing N95 respirators, at  https://www.registerednursern.com/how-to-don-and-doff-n-95-mask-respirator/ .

To learn more about Healthcare Supply of Personal Protective Equipment, visit CDC at https://www.cdc.gov/coronavirus/2019-ncov/hcp/healthcare-supply-ppe.html.

' 4. What Telehealth Services Can We Provide in The 1135 Waiver for Face To Face And For Routine Visits?

An individual’s home is generally not an eligible originating site for telehealth, but under the new 1135 waiver, this will be waived during the emergency. This will now allow telehealth services to be provided in all settings – including at a patient’s home.

Currently, CMS allows for use of telecommunications technology that have audio and video capabilities that are used for two-way, real-time interactive communication. For example, to the extent that many mobile computing devices have audio and video capabilities that may be used for two-way, real-time interactive communication they qualify as acceptable technology.

Routine structured telecommunication visits can be provided by Hospice and Home Health agencies, but currently remain un-billable. Here is some additional information:
  • All of these home health and hospice visits should be documented in detail in and logged separately for future reference.
  • CMS confirmed on March 20, 2020 that the waiver that permits a physician to conduct a visit using a two-way real time audio-visual technology such as Skype and Face time was issued by the Office of Civil Rights to lift restrictions on HIPAA compliance. These modalities are not HIPAA complaint and therefore limits their use as telehealth technologies.
  • This HIPAA waiver aligns with recent legislation that lifted these limitations for telehealth.
  • These waivers together allow the physician to use telehealth including Skype and FaceTime with a patient in their home.

Because these technologies may be used as a physician visit  they are also permitted to be used for the Home Health F2F encounter. Unfortunately, it has been made clear that in current language allowing F2F requirements are NOT to be applied to hospice patients . Advocating bodies, such as LeadingAge, NHPCO, and NAHC have all requested lifting this and many other restrictions. Senior Options will continue to monitor, and inform you of any changes. NHPCO provided this update regarding hospice services:  https://www.nhpco.org/wp-content/uploads/3-18-20-Update.pdf

In addition, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. For more information, please see this CMS link  https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

NOTE: Applications not allowed include   Facebook Live, Twitch, TikTok, and similar video communication applications.

' 5. What Are the Implications of the Medicare HHA Discharge Planning Regulations for Patients With COVID-19?

Medicare’s Discharge Planning Regulations (which were updated in November 2019) Page 4 of 7 requires that Home Health Agencies assess the patient’s needs for post-HHA services, and the availability of such services. When a patient is discharged, all necessary medical information (including communicable diseases) must be provided to any other service provider. For COVID-19 patients, this must be communicated to the receiving service provider prior to the discharge/transfer and to the healthcare transport personnel

' 6. What are some useful links to monitor?

Senior Options provides advisory services and operational support to nonprofit senior living organizations wishing to serve seniors beyond the walls of their campuses. For more information about Senior Options contact Nancy King, DM, President of Senior Options at 757-496-1464 or Joan Noe, Account/Project Manager and Client Liaison at 757-496-1724, or visit  www.senioroptions.net .
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