Legal Ease: Home care agencies: Coping with terrorism
By Elizabeth E. Hogue, Esq.
Burtonsville, MD
The events of the last several months have precipitated numerous discussions about how home health agencies should respond in the event of an act of terrorism.
Given the state of our nation, such discussions certainly are appropriate, even necessary. That said, there is a tendency among agency staff members to take on more responsibility for patients than is warranted from a risk management point of view and, in many cases, even practical. Such actions can cause problems for home care agencies down the road. Given these parameters, there are certain things home health care agencies should bear in mind:
1. There are limitations on the ability of home health agencies to assist their patients in the event of another terrorist attack.
Staff should be meticulous about drafting policies and procedures on coping with emergencies and, in turn, interacting with patients and their families in ways that do not impose unrealistic, risky responsibilities and expectations on home health agencies. For example, an agency located in an area prone to hurricanes announced that it was the responsibility of home health agencies to evacuate their current patients from the coastal area. The agency drafted a disaster plan that included an obligation on the part of the agency to relocate patients inland in the event of hurricane evacuation. While a noble idea, there is a problem insofar as if agencies with similar disaster plans failed to fulfill this difficult, if not impossible, responsibility, the agency and staff members could be liable for any injuries sustained by patients as a result.
The moral of this story is that agencies should be very careful not to self-impose responsibilities that are unrealistic to fulfill. To help in drafting appropriate steps with regards to patients and emergencies, agencies should visit the Centers for Disease Control and Prevention (CDC) web site at www.cdc.gov/ncidod/hip/Bio/bio.htm.
2. Agency managers should educate staff members about the signs and symptoms of possible disease processes that may be related to bioterrorism.
Staff should be prepared to consider the possibility that patients exhibiting signs and symptoms that ordinarily would be attributed to the flu in fact may be caused by inhalation anthrax. The telltale "black" lesions of skin anthrax also should be recognizable by home care staff. Staff may also benefit from preliminary information regarding smallpox, plague, and other agents of bioterrorism that have recently been presented in the media. For more information on these diseases and their symptoms, agency staff should visit www.bt.cdc.gov.
3. Consistent with the general obligation imposed on agencies by the Occupational Health and Safety Act, agency staff should be educated about how to protect themselves from attack, including bioterrorism.
There is no higher obligation of agencies than to protect their own staff members from harm. For this reason, it is vital that staff be given instructions and guidelines on what steps they should take to protect themselves and their families.
4. The possibility of additional attacks should reinforce for staff the important role that primary caregivers have to play for patients who cannot care for themselves.
In the event of another terrorist attack, it is highly likely that the responsibility to protect patients will fall on primary caregivers. This means that during admission visits, staff should identify multiple primary caregivers who may be available to assist patients in the event that the primary caregiver is unable to do so. If the primary caregivers who are initially identified become unreliable, staff members should act promptly to identify other reliable primary caregivers so that as many patients as possible have multiple primary caregivers. These caregivers obviously should be included in any efforts to educate patients regarding protection in the event of other attacks.
Before the events of Sept. 11, few home care providers could imagine the need to be concerned about the protection of patients in the event of terrorist attacks. In view of what has been learned about such attacks since then, it is clear that the threat is real and may occur anywhere in the country. As always, home care providers will want to be prepared to take realistic steps that do not involve unnecessary risks for agencies and staff members to help ensure that patients are not harmed.
Resources
The Joint Commission on Accreditation of Healthcare Organizations has published The 2002 Self-Assessment Checklist: Hospitals. This book was written to help hospitals prepare for Joint Commission surveys or improve their performance. In addition to covering every standard in the 2002 Comprehensive Accreditation Manual for Hospitals, the new publication includes revised standards regarding patient safety, restraint and seclusion, medical staff, and staffing effectiveness. The book features a test question section, allowing hospitals to identify areas of poor compliance, note actions taken, and track compliance progress. A tutorial instructs on important aspects of conducting a mock survey. The book is available for $65, using order code SAC-02, by calling the Joint Commission Customer Service center at (630) 792-5800 between 8 a.m. and 5 p.m. Central time, weekdays.
HIN publications out
The third edition of Grant Funding for Elderly Health Services now is available from the Health Information Network (HIN). The publication provides information on trends and changing interests of federal, foundation, and corporate grantmakers and shows health care organizations how to write grant-winning proposals. Included in the publication is a listing of available grant funds from federal agencies, charitable foundations, and corporations to health care companies that provide services to the elderly. The cost is $91.50.
Also out from HIN is When Disaster Strikes, a publication written by health care professionals about how to deal with a variety of disasters, from natural disasters to man-made disasters, such as chemical spills and violence. The cost is $103.95. To order either publication, call (888) 446-3530.
[Elizabeth Hogue lives and works in Burtonsville, MD. A complete list of her publications is available. Telephone (301) 421-0143 or fax requests to (301) 421-1699.]
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