FAQ #29 September 10, 2020 from CEO Conference Call 9/1
Answers to Staff Questions on Employee Health and Safety, Patient Care, HR Policies, and Return to Work
The following FAQs were adapted from questions submitted by VNSNY staff for the CEO
Conference Calls hosted by Marki Flannery on Tuesday, September 1st.
Employee Health and Safety
Is VNSNY prepared with a backup plan in case a second wave of COVID occurs as the flu hits the field staff causing a shortage of nurses and therapists to see patients?
We are actively recruiting because that is something that we have been working on – rebuilding our workforce. We need to do that every day. So we are actively recruiting staff so that we can continue to be able to accept patients. The reality is that we need to hire more staff and we need to retain more staff, and we are working aggressively to make that happen.
If COVID hits and the flu hits, hopefully our staff would have had flu shots that will minimize the impact. But if we have reductions in availability of field staff, unfortunately, what happens is we have to reduce the number of patients we take under care. And that’s not good for New York.
So we are looking to build our workforce. But we cannot hire and have staff on the payroll when we don’t have adequate work for them. So it’s a balancing act to be able to manage that – within a fine line.
If there is a second wave of COVID and the flu causing the shortage of field staff, will there be layoffs for the office staff again?
So first we’re hoping that if everyone gets a flu shot like we’re asking them to do, the flu will not get in the way of staff getting sick and create any shortages of staff. If there is a second wave of COVID, which we’re hoping there won’t be, we can’t predict now what that will do in terms of our volume or of staff who may not be available to work.
To clarify, we have had no staff layoffs. We had some furloughs which is different than a layoff. And we are hopeful that we will not have to incur additional furloughs. But until we know more about whether or not there is a wave and the impact of it, it’s very hard to predict that at this point.
If there is a second wave, what indicators will we use to identify that it is underway and what actions will we take as an agency?
So I’m going to start and then my colleagues may choose to add. So you may be aware that every day we receive information from the State Department of Health, the Governor’s Office and the New York City Mayor’s Office regarding data related to the COVID-positive rate in our area, as well as the number of individuals who are showing signs of infection.
And as you know, in my remarks I quoted that hospitalizations have dropped. There was one COVID death in New York State on Sunday, and none in the city. There are significant numbers of COVID tests performed, and the infection rate in New York is very, very low.
So we will continue to monitor those results. And I promise you that our governor and mayor and other officials, including the health department leadership, are going to be monitoring them even more so. And if there is a second wave, they will announce that wave and they will make decisions about what can and cannot be done.
We’re hopeful that New Yorkers will continue to be smart about washing their hands and wearing face masks and social distancing. We’ve done a great job here in New York so far and our surrounding states. And hopefully we will continue to behave in that way.
And then if there is a second wave, we will take whatever actions are necessary to protect our staff and protect our patients. And so it’s hard to say what we will do specifically at this moment because we’re very optimistic that there will not be a second wave. I do encourage as I’ve mentioned in my remarks that everyone get a flu shot. I think one of the challenges that we will face as a country is differentiating between the flu and COVID. So people who get flu shots are less likely to get the flu so hopefully we can minimize the incidence of the flu and minimize the worry that people might be COVID positive if they’re not.
So I would turn to Andria, Tony and Michael to see if they have anything they’d like to add to what I just said.
Michael Bernstein, Chief Administrative Officer: VNSNY has built up a 90-day supply of all of the important PPE that we would need if in fact there is a second wave. And as you all know when this all started, we had to acquire all the PPE, but now we have plan and we have an outside warehouse and we have a distribution solution that could enhance our ability to get the PPE to people. So that’s one of the things that we have done.
The other is we have had 27 different groups assembled for what the industry called the hotwash which means a review of what we did well and what we did poorly throughout the pandemic so far. Those results have been compiled and they’re great learnings for us in order to ensure that if there is a second wave we’re in a better position to move quickly and efficiently and get things done.
So those are two of a number of steps that have been underway to prepare if, unfortunately, this pandemic comes back hard.
Tony Dawson, Vice President of Quality and Customer Experience: So just all to remind you that the CERT team is still in existence. We’re still here every day to help you. We monitor the number of calls and monitor those occurrences, so that is another way that we keep an eye on what’s going on with the pandemic and keep an eye on the trends. And if anybody has any questions, please reach out to the CERT team.
HR Policies / Pay and PTO Policies
As you may know, the school system is only offering a hybrid option. Do you have any assistance options for childcare services in Westchester? I have to pay for three kids to go to daycare now since they only go to school two days a week. Is VNSNY able to help their Westchester field staff with this added expense?
I would love to say we can do more but we’re not in a position to start paying for daycare services for our staff. As you know, as an organization we’ve had some financial challenges for a number of years and we are working really hard to stabilize our organization from a financial standpoint. And we have incurred some significant expenses this year and a reduction in volume. So we are not able to take on the expense of paying for childcare or daycare for staff. If we do hear of options that are available in the community, we will absolutely share them with you.
**You may find some useful resources on the Westchester section of the COVID hub on the VNSNY intranet. In addition, the Child Care Council of Westchester has some information on finding childcare during the COVID-19 pandemic.
I understand things being considered for workers with children under the age of 18. What about workers with elderly or sick parents?
Please be assured we are taking that into consideration as well. I’m not sure if the survey addressed that, and if it did not, we will make sure to capture that. And again, people will have an opportunity to speak with their supervisors and if you have individual concerns, you need to voice them. And we will do all we can within reason to make sure we meet our operational needs to accommodate staff with concerns. So we’ve done that so far and we will continue to do everything we can to protect our staff and their family members and the patients that we serve.
Any update on bike reimbursements? It seems counterintuitive to incentivize driving over biking.
So my response to that is generally if you’re riding a bike, you’re not incurring gas expenses, you’re not incurring parking expenses and you’re not incurring toll expenses. So the goal is not incentivizing driving, it’s reimbursing for expenses that folks are incurring to be able to get where they need to go.
If people are utilizing City Bikes and there is an expense associated with that, I can ask our Human Resources Department to evaluate whether or not we can reimburse for City Bikes, but, you know, it is not just using the money to reimburse for expenses that don’t exist. So I’ll ask my colleagues if they have any other thoughts or suggestions related to that question.
Michael Bernstein: The only thing I would say is thanks to these calls, last week there were some questions about bike storage if you use your own bicycle to get to the 220 location. And last Friday there was an e-mail sent and a posting on our intranet with detailed information about what needs to be done to secure bike storage. And, one of our colleagues in the Human Resources Department, Ami Thakker, volunteered to assist [email protected] So, the feedback that we get through these calls is very helpful to making sure we can communicate good information out to people. Thank you.
Patient Care and Clinical
I have co-workers on other teams complaining that they don’t have enough cases for the day while my team doesn’t have enough RNs to work. We have at least 10 cases to cover for the day which is overwhelming. Why can’t the RNs or others float like they did in the past?
Andria Castellanos, Chief of Provider Services: I know that our teams work really hard to move staff around to cover all the cases. And sometimes this does and will require staff to float to other areas. There’s every effort made to balance the daily schedule to ensure we have coverage for all of our patients.
But I would say that if you particularly and specifically have a concern, meaning this happens over and over and over again, you should reach out not only to your manager, if you’re not getting an appropriate response, but I know that the regional vice presidents would be interested in hearing about this and you should feel free to reach out to your regional vice president so they can help your manager figure out a better system for balancing the schedule.
Now that the CDC has shown that they are not making decisions based on science after last week’s decision on who should get a COVID test, is VNSNY still obviously taking their guidance going forward or will VNSNY be seeking other sources.
Tony Dawson: So we don’t just base our protocols on the CDC. We also base it on the Department of Health which gives us guidance along with CDC, FDA and others. And we work with a team of physicians from infection control and our infection control nurse practitioner who also gives us research data and other data that we look at with regard to how we develop our protocols and how and when we see our patients. So it’s not just based on the CDC. But great question. Thank you.
What is the amount of COVID positive patients now under VNSNY, not history?
I believe the number is probably a couple of hundred between Hospice, Home Care and Partners in Care. Can any of my colleagues correct or confirm that number is about right?
Andria Castellanos: Yes, it’s probably a couple of hundred at this point. We can get that exact number but it is going down every week and we are getting very few COVID positive patients referred to us at this point.
Michael Bernstein: As of last week. between Home Care and Care 360 Solutions, we were caring for less than 130 confirmed COVID-19 patients at that point in time. So I think the answer that Marki and Andria’s provided is accurate. Less than 200 for sure at this period of time.
A patient used to be positive COVID two months ago; turned to negative. This time the patient came back to VNSNY again with no information of COVID status. Should I follow protocol A?
Tony Dawson: If the patient came back on service and we don’t know the COVID status of the patient then we should follow Protocol A for the time being, but we should check what that COVID status is. We should try and find out from the physician what the status of that patient is and then follow the appropriate protocol.
If the patient is negative, then we can follow protocol B. If the status is unknown, follow Protocol A until we have further information on the patient. That’s the safest thing for the patient and for the staff, until you know more.
Marki Flannery: You can always call the CERT team so that you can get an answer immediately on these types of questions.
What can I do if my patient is going out in the streets more often than is necessary during this crisis? I am worried about being exposed to the coronavirus. I would really like someone to advise the patient that the situation is serious and the road trips should be reduced and scheduled to avoid both herself and the aide contracting the virus. This is something that should be done without the patient realizing that the aide has reached out for help.
So we will reply to this person directly to get some more detail so that we can do some follow up. But in the meantime, Andria or Tony, do you have any recommendations for this person on what they might be able to do? It sounds like this might be an aide who is having this question.
Andria Castellanos: As Marki said, we’ll reach out to this person individually because it sounds like that the client needs some education and needs to have a discussion about what is really safe activity and what is unsafe activity.
And there are ways for patients to be safe or clients to be safe outside. So, obviously, making sure that when this person goes outside that they’re always masked, that they perform hand hygiene, et cetera. This is a question from a home health aide. The aide can always reach out to the nurse and the nurse can provide some direct education to the patient. Also if there’s family involved, working with the family to try to educate them is another avenue to go down with this client. So those are some of my suggestions right now, but we’ll reach out directly.
Return to Work
Thank you for these conference calls. What is the status of staff going back to 5 Penn Plaza?
Michael Bernstein: With respect to 5 Penn Plaza and our real estate, as we said all along, we wanted to understand how things would work out with the volunteers and the other people who were asked to come back to 220. We were going to give that four weeks. It’s been a little over four weeks and we are very pleased with what has happened at 220, and we’re still learning about certain things.
What we’re going to do is look at the spaces we have for community mental health services because many of those grant-funded programs have an obligation to see individuals in person. And the Department of Health, the City of New York would like us to know what our plans might be for that, and because they have multiple spaces, we are taking a look with some experts including architects about configuring those spaces.
And as soon as we accomplish that task, we will be looking at both the 5 Penn location and our Brooklyn office as sort of next in line. So the short answer to the question is we do not yet have a timeline for offering the opportunity for anyone to come back to 5 Penn, but if you are someone who would like to have an office space to work because your remote work situation is not something that you remain comfortable with, we do have a number of processes that would allow you to get space at 220 if that works for you, including something we call “desk for a day”, but also other ways for you to find office space, if connectivity is an issue for you or that’s something you’d like to do. You can find all that information on the operation workplace tile on the VNSNY intranet.
While we wait to see how COVID and this flu season go, will we be able to continue to work from home? My concern is that with the flu season approaching there’s a likely chance you will get a second wave and we’d likely to continue to work from home while we see if there’s an increase in COVID cases.
So flu season is not going to result in a second wave of COVID. They are two different conditions. There’s a risk that we can confuse them. But flu is not COVID.
Right now we expect that we will continue to have some staff working from home. But we are looking at where there are certain areas where some staff are better served to be in the office. There are some staff that want to be in the office, and we have been conducting surveys to evaluate how we can best address operational needs, as well as employee needs, while also maintaining social distancing. So we are addressing our workspace in such a way to make sure that those who are in the office are able to be safe.
We are looking to increase the number of staff that are working from the office, and we will be addressing that on a department and role basis. Nothing will be sprung upon you or anyone else. We will address this in the most feasible way possible to take into account employee concerns.
Supplies, Masks and PPE
My main concern is the universal precautions preparation and keeping the supplies available.
So I understand your concern about supplies being available and we are watching it like a hawk. So I’m going to ask Michael to reassure you about what we’re doing to make sure that we have these supplies available for our staff.
Michael Bernstein: We believe that we do by setting a goal of having a 90-day supply and having a pipeline to refill that supply if we have to use the important items, from face coverings and face shields to gowns and gloves and so on. And we believe that we have found an appropriate way to store and distribute those supplies to all parts of the workforce to make it as safe and effective as possible.
We learned a lot from the last six months. We think we’ve made improvements and we have a high degree of confidence that we can keep supply available.
Administrative
How many staff have resigned or retired early since the pandemic started or have gone out on disability related to COVID?
So I don’t have specific detail on the number of staff who retired early or resigned because of the pandemic or disability related to COVID. But I do have data overall on our turnover rates, which have gone down since the pandemic began. So that’s positive news. We’re finding more people have actually stayed with the organization. Andria, anything you want to add to that?
Andria Castellanos: We have actually seen stabilizing in the workforce during the COVID pandemic. Our rates of people staying with the organization have actually increased, and the rates of people leaving the organization have actually decreased when we compare ourselves to the same period last year in 2019.
Is VNSNY CHOICE changing their MLTC care model? Increases in census continue to be reported but I have not noticed any job postings for MLTC care coordinators.
So, I know that we had a dip in census back in April. We had over 1,000 patients who died, and so there have been some declines in census.
Overall, yes, the census has increased. But much of the add of patients also offsets losses of patients. So when you spread that over our entire region, it is not a significant number of case increases per care coordinator, because I do know that we are maintaining those numbers. So if there are vacancies, I’m sure that they are going to be posting those positions.
What are some examples of changes proposed from the hotwash?
Michael, do you have any information on that yet? I have not heard the results of the hotwash yet.
Michael Bernstein: I think the person who asked the question is on the call. I appreciate the fact that we’re able to ask questions in real time. And I’d like to give you a sense of an answer, but I also want everyone on the call to know that the hotwash has just been completed. And even Mark hasn’t seen the recommendations yet.
So I don’t want to get out too far in front, but I want to be respectful of the desire to understand what we are contemplating doing. So here’s an example: we are already looking at a new system that would allow us to reach staff in an emergency, and for all business areas to enhance the communication system that we have previously used.
Another thing that we’re going to look at is how to better centralize and communicate updates on regulatory information which seemed to change almost daily with respect to both our health plan business and our provider business.
There are a number of other areas. Another example is – have we created the right tools and resources, or can we do more to remotely onboard new hires into the workforce; like Marki was just talking about, if we had sickness and callouts, would we be able to effectively onboard clinical staff and other staff. So thanks for the question. More to come on this as it rolls out.