Bill stabilizes patients' care during crises

Home health care providers now must provide a plan for patients during an evacuation. Officials say it's a much-needed step.

By ALISA ULFERTS

© St. Petersburg Times, published May 7, 2000

Michele Baker's phone rang Friday morning as she monitored a subterranean muck fire burning 35 feet below Hudson.

The caller was legislative aide Amy Merrill, who told Baker that Bill 430 -- the one Baker had pushed for years -- had just passed the Legislature.

"This has been three years of effort and prayer," said Baker, the county's emergency management director.

Largely because of Baker's efforts, home health care companies, hospices and nurse registries now must note in a patient's chart where he or she will go during an evacuation -- and how the companies plan to continue caring for the patient.

In some cases, that could mean following patients into public medical shelters.

Baker has been working with Rep. Mark Ogles, R-Bradenton, since 1997 to get legislation passed that would require home health care companies and similar agencies to coordinate care for their patients during hurricanes.

Hospitals and nursing homes already must develop plans to care for patients during emergencies. But residents who are recovering at home or who need help with daily tasks such as bathing often don't get the care they need during evacuations.

Many of those patients end up in public shelters, which often lack enough nurses to care for them, Baker said.

"Our goal has been to bring all the rest of the (companies) to the table legally," Baker said.

The bill that passed Friday requires those health care companies to develop emergency plans, which will be reviewed by the health departments if state money is made available, and it could require the companies to shoulder some of the staffing burden at shelters.

That would help Pasco's health department, which loans its nurses to shelters during disasters, said department spokeswoman Becky Thomas.

Although that's not usually a problem if the evacuation only lasts for a day, complications arise if the shelters must stay open for a week or longer, Thomas said.

"There's no way we could staff a shelter that long and still run a health department," Thomas said.

But if the state wants county health departments to review all the health care companies' disaster plans, it will have to ante up some additional employees, Thomas said. The bill assigns responsibility for shelters' medical staffing to the county departments of health, but encourages them to work with emergency management departments.

"We need a full-time person to coordinate that," Thomas said.

Last year the bill passed the House of Representatives, but the legislative session ended before the Senate could vote on it, said Merrill, Ogles' legislative aide.

Although the bill passed both legislative bodies this year, Baker and Merrill still didn't get everything they wanted. Rather than the roughly $4-million it would cost to enact the entire bill, the Legislature gave them $600,000 for the first year.

A large chunk of the $4-million would have gone to hire about 57 health department employees to review the home health care companies' emergency plans and coordinate medical staffing at the shelters.

That won't happen this year. But a provision in the bill allows counties to require the health care companies to submit their plans for review if the health department and the county commission find some other way to pay for it.

"We knew we weren't going to get that whole appropriation," Merrill said. "It's kind of like we are getting positioned to do this."

Baker said, "This wasn't going to be the end all, be all. We'll have to come back" to the Legislature for more money.

So what will the $600,000 pay for? It likely will get the ball rolling on a statewide task force to analyze the state's medical shelter needs. The bill also provides two additional state Health Department employees to help with that.

Merrill said she and Baker were able to get the $600,000 because it was the same amount Gov. Jeb Bush had suggested the state spend on a pilot program to better staff special-needs shelters. And in its first year, the bill probably will focus on the three regions proposed for the study: the southeastern and southwestern parts of the state, plus the Panhandle, Merrill said.

The bill has not been without its critics. Some have worried that their companies would be liable to provide care to patients in evacuation zones. But a provision of the bill exempts companies from having to provide care in difficult conditions, such as when roads are closed.

But Diane Johnson-Hamill, who works at the Pasco office of home health care company Gentiva Health Services, says the bill is a smart way to protect the safety of patients.

"I think it had to happen for patient safety," Johnson-Hamill said.

Johnson-Hamill said Gentiva already does most of what the bill requires. The company maintains a list of patients living in evacuation zones who cannot skip treatments during an emergency. Gentiva keeps track of where those patients plan to go and arranges for transportation if needed. Johnson-Hamill said Gentiva also keeps track of which employees are available to help staff special-needs shelters and passes that on to the county.

Johnson-Hamill praised Baker's office for taking the initiative to organize health care companies in Pasco via a special-needs task force before legislation required it.

"It's a pretty well-oiled machine," she said.

-- Alisa Ulferts covers Pasco County government. She can be reached in west Pasco at 869-6244 or (800) 333-7505, ext. 6244. Her e-mail address is ulferts@sptimes.com.

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