Hospices facilities across country might face state-mandated flu vaccines
NY agencies already face Nov. 30 deadline for seasonal flu
Hospice and other health care providers were not given much notice when the New York Department of Health adopted an emergency regulation in mid-August requiring all health care providers who have direct patient contact to receive a flu vaccination by Nov. 30.
Even though this state regulation applies only to New York health care workers, hospice managers in other states should pay close attention, suggests Phyllis Wang, president of the New York State Association of Health Care Providers (HCP) in East Greenbush, NY. "I am a member of several national listservs, and there is a lot of discussion in different states about mandatory flu vaccines," she says. "Many states are focusing on the H1N1 flu and vaccine, but some are looking at seasonal flu as well,"
The New York regulation addresses two types of flu vaccinations, says Wang. Hospice and home health agencies are required to vaccinate all personnel who have direct contact with patients or who have frequent contact with employees who have direct contact with patients for seasonal flu, at no cost to the employees, she says. "These vaccinations must be completed by Nov. 30 in order for employees to continue working with patients," Wang says. The other section of the regulation requires the same groups of employees to receive the H1N1 flu vaccine when it is released as a full vaccine, she says. At this time, the expectation is that some people receiving the H1N1 vaccine might need two doses, so employees might receive a total of three vaccinations this season, she explains.
The New York regulation raises multiple issues for hospice agencies around the country who might be forced to scramble to offer these vaccines. "Cost is an issue for agencies that have not typically provided free seasonal flu vaccinations to all employees because there is no funding available to offset the cost of the vaccine as well as the cost of administering the program," Wang says. "It is expected that there will be federal and state funds for the H1N1 vaccine, but there is none for the first vaccination that [New York] agencies must provide."
Finding the vaccine might pose a problem for smaller agencies that don't typically provide flu clinics for employees, says Wang. "Larger agencies that typically provide the vaccinations on a voluntary basis will have already ordered vaccines and set up a process to vaccinate employees," she says. Smaller agencies can contact public health departments to see if their employees can get the free flu shots through them, but the health department clinics might not have ordered enough vaccine to cover additional people, including health care workers, who decide to get a flu shot as a result of the publicity this year, she says.
Even if an agency can find the vaccine and cover the cost, there are other challenges to overcome. The greatest challenge, even for agencies that have provided flu vaccinations in the past, are the tracking and documentation requirements for the program, says Rae Szymanski, executive vice president and chief operating officer of Visiting Nurse Association of Hudson Valley in Tarrytown, NY. "I anticipate that as different state health officials consider mandatory flu vaccinations, they will not create as cumbersome a system that New York's mandate includes," she says. The documentation required by the New York health department includes the lot number of the vaccine, as well as information about who administered the vaccine, where it was administered, and date and time of administration.
"This will be a tracking nightmare, especially if we do have the H1N1 vaccine to administer because it [might] require two doses," Szymanski adds. "The same information will need to be collected for employees who receive their vaccination from their private physician, a community clinic, or other provider."
Another challenge is what to do with employees who refuse the vaccination.
"Employees can show proof of a medical reason that they cannot get the vaccine, but there is no other reason that an employee can refuse to be vaccinated," says Mary Nicholson, director of patient services for the Visiting Nurse Service (VNS) of Rochester and Monroe County in Webster, NY. "This means that any New York employee who has not been vaccinated by Nov. 30 cannot have contact with patients," she says.
Although the Department of Health suggests that these employees be moved to nonpatient-contact jobs, that move is not feasible in hospice or home health, she points out. Although other states might allow other exemptions, such as religious, in additional to medical exemptions, hospice facilities need to plan how to handle nonvaccinated employees if their state does not allow additional exemptions, she suggests.
While the New York Department of Health does not say that nonvaccinated employees without an option to move to nonpatient care jobs must be fired, realistically there are few options for hospice and home health, admits Wang. "This adds an extra burden on agencies that are experiencing staff shortages, and it places a burden on the employees who face unemployment," she says. "Although everyone in health care understands the importance of vaccinations and protecting patients from exposure, there are some people who don't want to get them."
Reaching every employee will be difficult for any agency in any state, says Nicholson. "We have a mobile, remote work force that communicates through point-of-care technology and lives many miles from our office," she says. Aides will be the toughest group to reach due to transportation difficulties and the time it takes away from their patients, Nicholson says. "Pulling aides and nurses from patient visits affects revenues for the agency on top of the expense of administering the vaccinations," she explains.
Volunteers who have direct contact with patients also must receive the vaccinations, says Nicholson. "We have 2,500 volunteers in our Meals on Wheels program; some of them corporate volunteers, so ensuring that they are all vaccinated is a challenge we haven't figured out yet," she says.
Although 100% vaccination isn't realistic due to medical contraindications, agency managers can increase employees' compliance by offering a breakfast or lunch or any kind of a big kickoff event such as ones the United Way holds to launch its annual fundraising campaign, suggests Barbara B. Citarella, RN, BSN, MS, CHCE, president and CEO of RBC Limited, a home care consulting firm in Staatsburg, NY. "Provide education about the importance of the vaccine," Citarella says. Most importantly, she says, "Relate it to personal preparedness and family safety. In addition to keeping patients safe, the employees will be keeping their loved ones safe."
Need More Information?
For information on strategies to meet mandates for influenza vaccines, contact:
Barbara B. Citarella, RN, BSN, MS, CHCE, President and Chief Executive Officer, RBC Limited, 48 W. Pine Road, Staatsburg, NY 12580. Telephone: (845) 889-8128. Fax: (845) 889-4147. E-mail: www.rbclimited.com.
Mary Nicholson, Director of Patient Services for the Visiting Nurse Service (VNS) of Rochester and Monroe County, 2180 Empire Blvd., Webster, NY 14580. Telephone: (585) 787-2233.
Alexis Silver, Vice President for Policy and Clinical Affairs, Home Care Association of New York State, 194 Washington Ave., Suite 400, Albany, NY 12210. Telephone: (518) 426-8764. Fax: (518) 426-8788. E-mail: [email protected].
Rae Szymanski, Executive Vice President and Chief Operating Officer, Visiting Nurse Association of Hudson Valley, 540 White Plains Road, Suite 300, Tarrytown, NY 10591-5132.
Phyllis Wang, President, New York State Association of Health Care Providers, 99 Troy Road, Suite 200, East Greenbush, NY 12061. Telephone: (518) 463-1118. Fax: (518) 463-1606. E-mail: [email protected].
The Centers for Disease Control and Prevention's web site on influenza contains updates on the spread of the disease and guidance for the prevention and treatment of different types of influenza, including H1N1. A special section for clinicians provides guidance on treatment of special audiences, including young children, patients with cardiovascular disease, and immuno-suppressed patients. Go to www.flu.gov.
The Home Care Association of New York offers an emergency preparedness web site specifically for home care and hospice providers. Go to www.homecareprepare.org and select "pandemic" in the top navigational bar. A list of information links, as well as planning tools to prepare for flu pandemic are available.
The Hospice and Palliative Care Association of New York State offers tools hospice managers can use during flu pandemic. Go to www.hpcanys.org. Select "resources" on top navigational bar and then "pandemic flu provider resources." Scroll down to "tools" for two severe symptom management charts, including one for adults and frail elders.
Hospice and other health care providers were not given much notice when the New York Department of Health adopted an emergency regulation in mid-August requiring all health care providers who have direct patient contact to receive a flu vaccination by Nov. 30.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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