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Home healthcare agencies aren't gambling that the country will never see another killer flu pandemic like the one of 1918. Instead, plans are already underway to determine how the home healthcare industry would react to a major flu pandemic, which experts say is inevitable.

Are We Ready?

There is little doubt that a flu pandemic would create big challenges for our healthcare system, and this would be especially apparent in home health nursing. "In a pandemic, the most critically ill people will go to the hospital. We will need to discharge those who are not as critical, even though they may be acutely ill, to the home or to other healthcare settings," says Sally Phillips, RN, PhD, director of Public Health Emergency Preparedness, AHRQ. "Suddenly, we will have a new population of acutely ill patients in the community," she adds.

Home care nurses may have to use skills that are not typically required in the home setting. "They would need to make acute care assessments and perform acute care interventions," says Laura Kolmas, RN, Medical Review, coder and Infection Control nurse, Valley Home Care, Valley Health System, Paramus, N.J. Home care nurses may provide more end-of-life care. "Home care nurses may see more patients dying at home, and agencies will need to provide support and training," adds Phillips.

The Best Laid Plans

The most difficult challenge to manage could be staffing. "Who is going to be well enough to work and who is going to be willing to work and expose themselves to this virus," says Kolmas. In an area of healthcare that faces challenges in recruitment and retention, adequate staff is a real concern.

In 2005, a survey was conducted of more than 6,400 employees in 47 hospitals, long-term care facilities, and outpatient centers in the New York City area. The survey questioned participants about their willingness to report to work in different scenarios from mass casualties to a SARS outbreak. Although more than 80% of the respondents said they would be willing to work during mass casualties, only 48% said they would be willing to report to work during an infectious disease outbreak, citing concerns for their own and their families' health (www.pandemicflu.gov/plan/healthcare/homehealth.html).

"We need to look at how we will help our healthcare providers," says Phillips. "How do we get them to go into the homes of sick people and how do we help them to stay well so they can go to work?" Education of staff on the needs and responsibilities that nurses have in this situation will be essential, according to Kolmas. "We must ease their fears and teach them how to prevent exposure for themselves and their families," she adds.

More Patients, More Care

In addition to caring for this new population of patients, home care nurses will face other challenges. "Home care nurses would continue to see their normal population of patients, and they would be challenged to manage their care at home, because it would be less likely that they could refer them to the hospital," Phillips adds.

Home care nurses would also be asked to check on other family members who had become ill. "This is part of our assessment process. If nurses see another family member becoming ill, they investigate the patterns of infection, and if necessary, call the physician, get treatment orders, and add the person to the service," says Karen Grant, RN, MS, CPHQ, director of QI and staff education, Valley Home Care.

As healthcare agencies become more aware of emergency preparedness, they are making plans for the overflow and surge of patients to and from hospitals.

"In our emergency plan, we can pull a report at any time that prioritizes our patients by a numerical score. Patients in category one are those we must see; they may be bedbound, have daily IV infusions or insulin administration, or require some other kind of daily treatment. Hospice patients are seen every day," explains Grant.

Patients in category two have more flexible requirements; a patient may need wound assessments, but may have family members who change the dressings and can report on wound alterations.

Patients in category three are seen once a month for specific procedures. "These scores help us to see which visits can be more flexible and allow us to direct our resources where they are most needed in an emergency," Grant adds.

The Right Resources

Grant says that home care agencies will be looking to government agencies for help with supplies and educational materials. "We would need guidance about where to obtain prevention supplies, specifically the recommended N-95 Mask, and how many we should have on hand, and we would need educational materials for families," she adds.

Home monitoring systems would play an important role in a flu pandemic. Grant sees an increased need for telehealth use. "We use 90 monitors to measure vital signs, including pulse, blood pressure, pulse oximetry, blood glucose, and weight, and we are getting 10 more. We need to consider whether home care agencies should be getting more to use during a pandemic," Grant says.

The Time Is Now

Government agencies are encouraging healthcare providers to learn about nursing care in a flu pandemic. "N.J. DHSS has been preparing for this since 1999. We released our first plan in 2002 and have revised it five times since then. We are asking providers to think about how a pandemic would affect their agencies," says Tom Slater, spokesman for the N.J. DHSS. They offer a range of materials on their website at www.NJflupandemic.gov.

It is obvious that education will be the key for healthcare providers and the public. Slater says, "We need to teach people how to stay healthy and to encourage them to get flu vaccinations. Although the possibility of a pandemic is frightening, we must remember that in a flu pandemic, most people survive."

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Carol Nelke Dunbar, APRN, is a contributing writer for Nursing Spectrum. To comment, e-mail editorNJ@nursingspectrum.com.

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