FAQ #42: December 4, 2020 – Containing Answers from December 2nd
Answers to Staff Questions on Employee Health and Safety, Supplies and PPE, Patient Care and Clinical, and HR Policies
The following FAQs were adapted from questions submitted by VNSNY staff for the CEO Conference Calls hosted by Marki Flannery on Wednesday, December 2nd.
Patient Care and Clinical
Q. My question has to do with quarantine status. If the healthcare working or the PT has a family member that tests positive for the virus and is asymptomatic, what is the expectation for the PT or healthcare worker? The healthcare worker contacted the CERT team and was advised to go to work since the PT is negative with no symptoms. What is the expectation for the PT who has been exposed and is living with a positive case? Even if the PT dons PPE, isn’t the PT putting other patients at risk?
A. Tony Dawson, Vice President for Quality and Customer Experience: So first, yes you can continue to work. We ask you to make sure that you are signing in and completing the health care assessment each day before you come to work.
As long as you have no signs or symptoms and you wear the appropriate PPE for the patients you are taking care of, you can continue to work. If at any time you develop signs or symptoms, then please call the CERT team immediately and stay off work.
As for taking care, obviously this is a complicated issue because you’re at home with somebody who’s positive. And the piece on that is to maintain as much social distance as you can. Obviously if this is a child that’s difficult to do; trying to isolate children at home is certainly a challenge. But as much as you can maintain your distance from them and/or wear a face covering or mask while you’re in the home with them. That will decrease your exposure or your potential exposure.
You can also come to one of the regional offices where we have testing up and running and we can test you as many times as you want to get tested. Please take advantage of that.
Q. The workflow to deal with capacity issues can be quite challenging. First for the home care coordinators to wait for a case to be set up in order to know the assigned team wastes precious time. This presents an additional stress for late referrals especially if capacity needs to be cleared. Next, the teams get understandably annoyed with the HCCs releasing cases so when we send out emails to them it’s imperative that they respond to us promptly. There are times that I have sent out one or two emails concerning capacity issues for patients and I do not receive a response. It’s not acceptable to read an email and not respond. In addition it would help if phone numbers on the branch directory were updated now that most team leaders are working remotely. This current process utilizes precious time needed to work on cases, call patients and respond to case managers. Moreover, case managers in our hospitals are getting frustrated by our capacity issues and want to refer to other agencies or make dual referrals. Please assist with a better workflow for HCC to address the current capacity challenges. Thank you for your time.
A. So I hope that this issue has been addressed directly in the operation. I would hope it would have been. And I’m sure Andria who‘ll be speaking in a moment will follow–up with Sue Caputo and Jennifer Brullo to make sure that these issues are being addressed. Andria anything you’d like to address in relation to this concern at this time?
Andria Castellanos, Chief of Provider Services: I want to let the writer of this know that both Business Development and CHHA Operations realize that this is a challenge and they’ve been meeting frequently to identify ways that we can improve the process.
Today it‘s a manual process and we‘re looking into potential solutions to help streamline and improve the process. And we hope to have a systematic way to do this in the very near future. We do understand it’s important to communicate regularly and to provide accurate information.
I do want to say that when you get an email you have to realize with a question like this about a patient there‘s somebody on the other end waiting for a response. And not to answer or respond to an email ever or in a timely fashion is really irresponsible and unacceptable. And so everybody does need to realize that when somebody asked the question in an email a prompt reply is really important. Somebody is awaiting again for a response that involves a patient on the other end.
So it is my hope the teams are working on this. We hope to get a system solution to our capacity challenges. And we do and will continue to have some capacity challenges for obvious reasons. More of our staff are testing positive for COVID and we hope that there is an end in sight to that. We know that there is with the potential of the vaccines coming, but we‘re still in the period of time where people are being exposed. We also have leaves of absence and vacations are coming up for people. And so all of that will lead to capacity issues that we are having and quite frankly every other CHHA in the city is having.
And so we are trying to manage all that very carefully and it is a complicated issue. So thank you Marki and thank you to the writer for being so eloquent in asking the question.
Q. Patients are uncomfortable inserting our reuse thermometers in their mouth during COVID. Can VNSNY issue us digital skin thermometers? This is much more sanitary.
A. I know this question’s come up before. Tony can you take this question?
Tony Dawson:Sure good morning. So we sent out comms about this a couple of weeks ago. You should not be reusing thermometers. If you’re bringing a thermometer to the patient’s home that patient should be using that thermometer. That should not be reused on different patients.
We have many, many thermometers in stock so please only use the thermometer for that individual patient. Do not be bringing them from home to home.
Q. How long do our patients that were COVID-19 positive continue to be noted as such under the point of care visit alert? For patients that had COVID-19 months prior it’s misleading, sometimes confusing when there is no documentation to confirm or deny that the patient is still COVID-19 positive.
A. Some patients still have this alert on their charts. Some staff and disciplines are only making calls to these patients while others are making in-person visits. This is an issue. As a field staff I’m suggesting that the point of care visit alert be updated.
Andria Castellanos: We will take this back to our clinical team and have them take a look at it. It is a fantastic point. And if we’re not updating this alert correctly it’s really important that we do. So we’ll take it back and make sure that we have these updates in place as appropriate.
Tony Dawson:I’ll follow through with the CHHA Leadership Team to make sure that we are keeping ahead of that as best we know.
Q. It would be so convenient if field clinicians could get an app on the tablet or phone for faxing instead of taking the time to travel and park when making a trip to the office. Sometimes I need to fax applications to a doctor to sign on behalf of the patients or fax for other reasons.
A. Michael Bernstein: I don’t know if it is available. I do know that we will do what we do with the questions that we can’t provide the correct answer in this format is take it to the right people. In this case we have people within our IT department who understand the applications that can be loaded onto tablets or VNSNY issued phones with potentially a faxing app solution. So it’s a great idea because it will save time and make everyone more efficient and we’ll see what can be done.
Note: Since the conference call on Wednesday, a workgroup has been assembled to address this need.
Q. Some hospice patients and families have asked for visiting staff to show proof of a negative COVID test at the time of the visit. I understand VNSNY has recently provided increased access to testing. Are staff expected to show proof of negative tests upon request?
A. So there is no requirement that staff show proof of negative tests upon request and there is no requirement that staff be tested unlike what is required in the nursing homes and assisted living facilities.
If you get the rapid COVID test at one of our sites you are loading an app on your phone which will have the result but it is not an expectation to show proof of a negative test upon arrival in a patient’s home.
Tony Dawson:Just one add on. If you do not have the app or you do not have access to the app because we don’t have that at every site, we’re also giving you a letter to say that you’re negative. So we will give you proof that you had a test so you will have that information.
Q. The parking permit is expiring soon. Is there a chance that it’s going to be extended again?
A. I certainly hope so. And this question comes up every week and we are advocating to get the parking permits extended again and ideally made permanent.
Our experience with the city is that they wait until the last minute to give us a response and that‘s happened on multiple occasions now and my sense of it is it’s probably going to happen again. But that doesn’t mean we’re not trying. We are continuing to advocate to get these parking permits extended and made permanent and as soon as we get a response, we will be letting you know.
HR Policies / Pay and PTO Policies
Q. I would like to know how to bank the two hours for Christmas Eve.
A. Marian Haas, SVP Human Resources: The instructions for how to bank the two hours of Christmas Eve time in the event that you are unable to take the time off on Christmas Eve will be released shortly. I’m not going to go through them in detail right now because they depend upon your status. So watch for that announcement. That does come out every year. It is set up so that you’re able to do that. Thank you.
Supplies, Masks and PPE
Q. I‘ve decided to send picture of the PPE face shield that we‘re being provided in a Start of Care kit. This is inadequate to provide protection when providing care. Please advise.
A. Tony Dawson: I have checked and these are old supplies. We have much better face shields available now, so please take them to the bag rooms and we will issue you an appropriate face shield. We absolutely have better ones then you sent us in the picture. Thank you for sending this.
Michael Bernstein, Chief Experience Officer: Every time you pick up a COVID bag from the bag room take the time to open it up and check the PPE that is in there. If there‘s something that you are uncomfortable with, right then and there make the change.
Occasionally — and it should be happening often — there are masks or face shields that are from when this all started back in March or April and we’ve got better PPE now. So take the time to look in your bag and correct it right there. And the bag rooms have been told to be responsive and swap out if a change needs to be made.
Employee Health and Safety
Q. Do we need to make an appointment before getting a COVID-19 test at a VNSNY site?
A. No you do not need to make an appointment. Look up the dates, times and locations to identify where the testing is being held because it’s not at every site every day. So please check on the calendar to see where it is on the day you’re planning to go, get your tests. And you do not need to make an appointment. You can show up and they’re not very busy. But if they’re busy you might just have to wait for the person who administers the test to be ready for you.
Q. Why can’t Partners in Care set up at 1199 location in downtown Brooklyn, New York to give rapid coronavirus testing?
A. Our employees provide the testing at our locations. So if Partners in Care employees would like to get these rapid COVID tests — and I hope you take advantage of them — you would need to look at one of our locations to get your testing done then. If we were to go to 1199 location, we would have to test anybody who showed up. And we don’t have the appropriate waiver to test people who are not our employees.
Again all of the Partners in Care staff are welcome to take advantage of these COVID tests at all of the locations, and we have locations across the city now where there is availability to get the COVID test.
Q. I recently received the Abbott Labs rapid COVID test at 41st Street and thankfully tested negative. Can you speak to the efficacy of the Abbott Rapid Test? Are PCR tests available as well? If not is there a plan for PCR test to become available especially for field clinicians?
A. We do not have plans to provide PCR testing. Those would have to be done at one of the sites available throughout the city either through the Health and Hospitals Corporation that is doing this testing for free, or other locations, and that would be have to be done at employee expense because their health insurance is not going to pay for routine testing.
In terms of the Abbott rapid COVID test efficacy — we have just a couple of minutes left in the call. Do Andria or Tony want to speak to that or perhaps provide some information separately?
Andria Castellanos: Marki I think what we can do is provide that information directly. I want to get it completely accurate. The efficacy of the rapid test is less than the PCR test. It’s I believe somewhere in the 80% range, somewhere between 80% and 89%. I don’t have the number memorized so we can get that to the person who is asking.
What I do want to say is that there‘s a fantastic website that tells you where you can get tests from Health and Hospitals Corporation and other testing in the city. And it also tells you the wait times for Health and Hospitals Corporation testing sites. So it‘s a really good resource. It tells you by ZIP Code where you live, where they all are, what kinds of tests they are, et cetera. You can check that site here: https://www.nychealthandhospitals.org/test-and-trace/testing/
Note: A follow up on the efficacy of the Abbott rapid COVID test from Dr. Jay Dobkin:
Like most of the other antigen tests it’s less sensitive than the PCR — which may actually be a good thing, because the PCR may remain positive for days to weeks after people are no longer infectious.
The initial data submitted to FDA for these tests showed sensitivity and specificity in the high 90’s, but this came mostly from symptomatic patients and left open the question of using it for screening purposes. Recently there have been several studies reported which are reassuring. One large study found a 92% sensitivity and almost 99% specificity compared to PCR in asymptomatic people.
I think this shows that these tests are useful for screening, but the field is evolving rapidly. Something cheaper and easier that could be self-administered and done frequently would clearly be a step forward. Home saliva tests are an example that will be available soon.