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AHRQ Releases Report on Home Healthcare During a Pandemic

By Crystal Franco, July 14, 2008

On July 8, 2008, the Department of Health and Human Services (HHS) Agency for Healthcare, Research and Quality (AHRQ) released a report1 on the issues and resources associated with home healthcare during a pandemic. According to AHRQ, there are nearly 18,000 different home healthcare organizations operating in the U.S., ranging from home healthcare agencies to hospice facilities, and most are non-governmental and non-profit institutions. HHS’s report offers insight on how the home healthcare sector may engage in community pandemic planning processes. It also covers the categories of supplies and resources that may be needed for home healthcare during a pandemic, as well as potential barriers to participation.

This report was generated with input from a panel of experts in home healthcare and emergency/disaster preparedness and is meant to serve as the basis for ongoing discussion and pandemic planning in the home healthcare sector, not as official federal guidance for stakeholders. The report was produced with funding from the Office of the Assistant Secretary for Preparedness and Response (ASPR) and in coordination with the Centers for Disease Control and Prevention (CDC).

The Home Healthcare Sector Must Plan for a Pandemic

It is expected that during a pandemic, the home healthcare sector will be called upon to help care for patients who have been discharged from hospitals, but who still require some level of care, or who are sick, due to flu or other illness, but do not meet triage criteria for hospitalization. The report urges home healthcare entities to prepare for their potential role in a pandemic by planning with their local preparedness communities. This type of collaborative process can help overcome some barriers to participation, such as unresolved legal and ethical issues and problems with reimbursement policies.

Staffing Problems Likely to be Exacerbated by Crisis

HHS’s report also identifies major challenges, such as staffing and maintaining a strong home healthcare workforce in the face of a surge in numbers of patients. According to AHRQ, the sector already faces workforce shortages due to difficulties in recruitment and retention. Additionally, the report indicates that staffing may be limited in a pandemic by staff illness and inability or unwillingness of workers to report for work, and suggests that specialized training may be required both before and during a pandemic.

More Patients with More Problems

Also noted is that the types of patients requiring home care will change dramatically: patients may require a greater level of care than is typically required in the home, and workers will have to be prepared to address a wider range of medical problems than usual. Home care providers may also be called upon to serve as reliable sources of medical information.

Home Healthcare Sector will be Critical to Response

The report concludes that the home healthcare sector will be critical in a pandemic response and should be integrated into community planning efforts, but also concludes that the sector’s resources will be stretched. Thus, AHRQ recommends additional research on existing home healthcare surge capacity, training needs, and legal and ethical issues surrounding patient care and sharing of supplies during a pandemic.

References

Knebel A, Phillips SJ, eds. Agency for Healthcare Research and Quality. Home health care during an influenza pandemic: issues and resources. Rockville, MD: Agency for Healthcare Research and Quality; July 2008. http://www.pandemicflu.gov/plan/healthcare/homehealth.html. Accessed July 11, 2008.