Policies and Procedures Preventing a Clash Between HR

Policies and Procedures: Preventing a Clash Between HR and Clinical KENNY W. KEITH LYNLEE WELLS PALMER Harbuck Keith & Holmes, LLC Email: lpalmer@hkh. law kkeith@hkh. law Website: www. HKH. law

Covid-19 COVID-19 Covid-19 is spread from person to person through droplets in the air, very similar to how influenza is spread. Symptoms may appear 2 -14 days after exposure, although this may change as the virus is more closely studied. Currently, there are 164 reported cases of Covid-19 in the U. S. with 11 deaths. Nineteen states have reported cases of Covid-19, Alabama is not one of these states, however, nearby Georgia, Florida, Tennessee, and North Carolina have each reported at least one confirmed case.

Symptoms of Covid-19 Fever or High Fever (100. 4 or greater in adults) Cough Shortness of Breath, particularly if accompanied by chest pain, disorientation, or bluish lips or nail beds The CDC recommends you call your doctor* if you have these symptoms, particularly if you have been in contact with someone known to have Covid-19 or have traveled to an area with widespread Covid-19 activity. *CALL FIRST. The idea is to avoid spread. Your doctor can direct you to the appropriate treatment center.

High Risk Groups “A Senior Housing Nightmare” Older adults: Age 60 and older People who have serious chronic health problems such as heart disease, diabetes, COPD or other lung diseases The immunocompromised

A World of Recommendations Should facilities screen, monitor, or limit visitors? Facilities should screen visitors for international travel within the past 14 days to restricted countries. The restricted country list is at https: //www. cdc. gov/coronavirus/2019 ncov/travelers/index/html Facilities should screen visitors for signs and symptoms of a respiratory infection such as cough, fever, sore throat, and/or difficulty breathing. Facilities should screen visitors for contact with someone who has Covid-19 or who is being monitored for possible illness

More Recommendations Starting right now, if you have not done so already, post notices for visitors who are sick to stop visiting with their loved ones. To the extent possible, provide other options for visitation such as Skype or Facetime, or even provide additional telephone options for those who may need assistance with making calls

More. Yes. More. Monitor staff compliance with handwashing/alcohol based hand gel usage requirements Be sure that staff know to immediately report symptoms of infection with Covid-19 in residents and visitors Staff should be reminded/inserviced on proper cleaning of equipment, surfaces, work areas, and other shared spaces…and don’t forget the telephone!

And a little more…… Plan Now: Policies and Practices A resident is suspected of having Covid-19 infection. What do you do? Notify your local health department immediately. Isolate to avoid spread: This includes respiratory isolation precautions for staff as well as finding an appropriate place/room for the resident. Transfer practices: Unless the resident’s condition has declined to the point where he/she requires a higher level of care you may be in a position where you will retain that resident because of lack of other options. Plan now as to how staff will manage care, dietary needs, and activity needs. If transfer is required, notify the receiving facility and EMS of the resident’s illness. .

And last, but not least……. . Stay abreast of new developments Assign someone to monitor this situation on a real time basis. Resources include: : The Centers for Disease Control ADPH ACHA CMS

COVID-19, the Flu, and Other Communicable Diseases CDC Guidance for Employers: • Actively encourage sick employees to stay home • Separate sick employees • Emphasize respiratory etiquette and hygiene by all employees • Perform routine environmental cleaning • Keep tabs on employee travel

Sick Policies - Emphasize the importance of keeping residents from contracting disease - Be flexible with sick policies and consider relaxing them during the pandemic - If you have contract employees (agency nurses, for example), talk to the company supplying them about precautions they are taking. - Bottom line: if an employee is sick, that employee should not be working during the COVID-19 outbreak (or, really, ever)

Separate Sick Employees • Send them home! • If they are unable to leave immediately due to transportation or other issues, keep them separated from other employees and residents.

Employee Travel • What to do when an employee vacations or visits relatives in areas where COVID-19 has been detected? • Forced testing? • Quarantine?

Mandatory Vaccination • No vaccination for COVID-19 yet • For other contagious diseases, such as the flu, can the facility require a flu shot? • Highly recommended by CDC • Can make the flu shot mandatory, but keep in mind religious opposition and allergies

Attendance Policies • Call-off policies: must notify in advance • No call/no show policies

Attendance Policies and Survey • Staffing must meet both the requirements under licensure AND the specific needs of the resident population. • Look closely at your resident population and imagine the “worst case scenario” such as an evacuation due to natural disaster or a fire. Do you have enough staff to safely evacuate your facility? • Look closely at your resident population. Based on the needs of these residents, do you have enough staff to ensure that they receive the care they need? • Of course, the answer is “Yes!” But show me. Prove it up. And what is your process for ensuring the answer stays Yes!

And speaking of attendance Training records and training verification Don’t forget that inservice and training attendance can be just as important as job attendance. ADPH licensing requirements for training and education must be documented for each staff member. Inservices required under a POC much be documented as well. As a best practice, if a staff member does not complete the required training, for whatever reason, remove that person from the schedule until the training is complete.

Progressive Discipline Progressive discipline requires: • Policies • Documentation of policy violations • Consistency • Careful documentation • What you should include • What you shouldn’t include • Records Management • Investigation file separation

What Should a Disciplinary Form Contain? • Limited facts about what employee did (NOT resident names) • Identification of the policy/policies violated • Where the employee is in the disciplinary process • What the employee should do to improve • Consequences of failure to improve • Date of the disciplinary action • Signature of employee, person giving discipline, and witness • Who, what, when and where. The why is usually for the employee to explain.

Job Descriptions and Performance Evaluations • Set expectations via the job description • Evaluate expectations via progressive discipline and performance evaluations • Be truthful and accurate • Be consistent • Conduct annually

Statements • Important documentation tool • MUST be signed • MUST be dated • MUST be responsive to the investigation • She told me that, but she didn’t put it in her statement

Responding to Disciplinary Matters Your progressive discipline policy allows you to demonstrate corrective measures put in place in a contemporary time frame. It provides you with a way of showing oversight of facility staff and staff actions. It can be an adjunct to facility investigations and quality assurance practice measures.

Confidentiality • HIPAA policy • Remind employees that this includes: • No removal of any documentation from building, even if you want to work on it at home • No photographs on your phone • No patient notes on your phone

HIPAA Reporting A reminder A HIPAA breach must be reported across many levels depending on the size of the breach. Large breaches, or breaches where security measures were poor or non-existent may result in serious fines or in some cases, jail time.

How to avoid an unhappy Hippo. Quick strategies for compliance Password protection Need to know only basis Encryption Deletion of former employees from system Usage monitoring

Questions? Kenny W. Keith, Esq. Lynlee Wells Palmer, Esq. Harbuck Keith & Holmes LLC 3595 Grandview Parkway, Suite 400 Birmingham, Alabama 35243 (205) 547 -5540 lpalmer@hkh. law kkeith@hkh. law