Resources and Considerations for Consumers, Designated Representatives & Workers

Updated 4/29/2020:

On April 26 2020, the Department of Health issued updated Interim Guidance re: Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments.

This guidance document seeks to clarify the order of priority in which COVID-19 testing will be made available. Notably, per this policy, Personal Assistants in CDPA belong to priority category 3.

A summary of each category, by priority:

1. People who are experiencing symptoms of COVID-19, particularly if they belong to an at-risk population;

2. People who have been exposed (within 6 feet) of someone who is a confirmed positive case;

3. Individuals who are employed as health care workers, first responders, etc.

On April 14, 2020, the Department of Health issued interim guidance on the Executive Order requiring employers to provide face coverings to employees. 

It is unclear from this guidance whether the fiscal intermediary or consumer is responsible for procurement and distribution of masks to personal assistants. Individual fiscal intermediaries will need to make their own decisions about how to comply with this guidance. 

This requirement is for face coverings, not masks, and the guidance defines face coverings as including, but not limited to: cloth (e.g. homemade sewn, quick cut, bandana), surgical masks, N-95 respirators, and face shields.

CDPAANYS has sought clarification from the Department of Health regarding several matters, including this most recent interim guidance on face coverings. If additional clarification or guidance from the Department becomes available, it will be posted here. 

Consumers & Designated Representatives may not be required to purchase face coverings using their own money.

—

Updated 4/8/2020: NYSDOH has updated their guidance on Authorization of Community-Based Long Term Services & Supports Covered by Medicaid. New Personal Assistants in CDPA are still required to have a health assessment, immunization record & tuberculosis test, even though many clinics are closed. 

Updated 4/8/2020: Your PAs may be eligible for paid COVID-19 leave if they have been ordered to be quarantined or isolated. Click here for more information. 

Updated 3/25/2020: Department of Homeland Security has announced temporary flexibility on requirements for I-9 Compliance.

Updated 4/8/2020: The Governor’s PAUSE Act, which shuts down non-essential businesses through April 29, does not apply to CDPA. Fiscal intermediaries and personal assistants are essential healthcare workers. 

CDPAANYS strongly encourages consumers and designated representatives to discuss or otherwise communicate the following with your personal assistants and informal support networks. The ability to plan ahead is critical in ensuring safety. 

Consumers should begin communicating with their PAs now to develop a plan in the event that the consumer and/or one or more PAs become ill with COVID-19.

If you are in immediate danger because a worker has taken ill and/or not shown up, you should immediately call 9-1-1 and remain calm. Do not travel to a hospital, emergency room or clinic without an appointment. Many are not accepting walk-ins and you may be turned away at the door. 

Areas to consider when developing a plan for COVID-19: 

  • Who will provide backup? Begin searching and training potential backup workers.
  • If the consumer becomes ill, what steps will be taken to prevent the virus from spreading to PAs? Does the consumer have masks, gloves, alcohol swabs? 
  • Contact your managed care plan or social services district to request additional hours for increased housekeeping services to ensure adequate cleaning in the home, as recommended by the federal government.
  • What happens if only one PA is available to a consumer for an extended period of time? How does this impact overtime, as well as the PA and consumer’s well-being?
  • Is there a means for the consumer to hire additional PAs in the event that all of his or her PAs fall ill?
  • What is the emergency plan in the event that a PA is ill and cannot come to work?
  • What is the emergency plan in the event that the consumer needs urgent assistance while the PA is not working? 
  • Has the consumer developed a plan with their doctor or medical provider to obtain respiratory devices or other medical equipment if necessary?
  • In the event that access in and out of the consumer’s or PA’s city, town, neighborhood, community, or even building is limited or stopped by officials, how will they ensure that their PA can reach them?
  • Alternatively, what if the PA is stuck with the consumer and cannot reach their family?

New York State Department of Health COVID-19 Website

Link: https://www.health.ny.gov/diseases/communicable/coronavirus/ 

Updated at least once daily. Includes updates on number of cases, key policy and emergency guidance for health care providers, and prevention and disease resources for the public.

    NMD (Neuro-Muscular Dystrophy) United “COVID-19 (Novel Coronavirus) Plan and Preparation Guide for Adults Living with Neuromuscular Disabilities”

    Link: https://docs.google.com/document/d/1XijlvgjO7ntCLohevgOuVrB5II4sgws4elFeRJZvJ4k/edit

    NMD United is a group of individuals living with NeuroMuscular Dystrophy. Two members of the group are CDPAANYS’ own T.K. Small and Kendra Scalia. This group put together an excellent resource for individuals as they seek to prepare for and deal with the Coronavirus. In their words, “The goal of this guide is to provide our readers with fact-based, reliable resources that educate our community on how to reduce and prevent the spread of COVID-19, while also providing practical coping tools and life-management strategies that can be used not just for this specific situation, but for addressing any viral or bacterial infection risk.” The guide includes an entire chapter on managing your personal care.

    Center for Disability Rights “Action Steps for Attendant Service Users in Response to Coronavirus Disease (COVID-19)”

    Link: http://cdrnys.org/blog/programs-services/action-steps-for-attendant-service-users-in-response-to-coronavirus-disease-2019-covid-19/

    This guide, put together by the Center for Disability Rights in Rochester, provides a step by step list of action steps consumers and personal assistants can take to protect themselves against COVID-19 and influenza. It specifically stresses the importance of backup assistance and informal supports in the event a personal assistant falls ill and cannot work, as well as the importance of having enough food and personal supplies in the home to last over periods of time.

    Centers for Disease Control (CDC) Resources

     

    CDC Steps to Prevent Illness

    There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. If you think you have been exposed and have a fever or cough, call your doctor or medical professional right away and stay home.

    The virus is thought to spread mainly from person-to-person.

    • Between people who are in close contact with one another (within about 6 feet).
    • Through respiratory droplets produced when an infected person coughs or sneezes.

    These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

    Link: https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html

    CDC Identifies “High Risk” Groups”

    Experts remain uncertain about the true figures of infections worldwide, but conclude that the majority of patients will experience mild symptoms. However, older adults and those with chronic lung and heart conditions are at an elevated risk of hospitalization and serious health consequences if they contract the virus. If you or someone you know is high risk, please consider the following:

    • Have a plan in place if you or someone in your household becomes ill.
    • Avoid cruise ships, restaurants and other crowded areas.
    • Have essential supplies, including medications, on hand.
    • Be prepared to “shelter in place.”
    • Prepare for changes regarding work, school closings and childcare needs.

    Link: Get Your Household Ready for COVID-19

    https://www.cdc.gov/coronavirus/2019-ncov/community/home/get-your-household-ready-for-COVID-19.html

    Link: People at Risk for Serious Illness from COVID-19

    https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

    CDC Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19) (February 12, 2020)

    The CDC has issued guidance for homecare workers and families nationwide to help determine the continued stability of consumers’ supports and help prevent the spread of the virus.

    Link to home care worker guidance (English): https://www.cdc.gov/coronavirus/2019-ncov/downloads/guidance-home-care.pdf

    Link to preventing spread of COVID-19 (English): https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html

    Spanish version: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread-sp.html 

    Chinese version: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread-chinese.html

    General Tips

     

    Practice Social Distancing
    Avoid busy public places wherever possible to limit exposure to the COVID-19 virus. Decline invitations to social events like weddings or family reunions. Wherever possible, opt for telehealth appointments instead of going in person to a doctor’s office or clinic. For food and essentials, many restaurants and supermarkets offer pickup or delivery options. 

    Self-Care at Home
    If you feel isolated or lonely, know that millions of other people around the world and in your community feel the same way. Be sure to take a break from the constant stream of news. Keeping informed is important, but so is managing anxiety and stress. If possible, open a window or step outside for some fresh air. 

    Click here for a compilation of resources on managing anxiety & stress.

    Resources and Considerations for Fiscal Intermediaries & Healthcare Providers


    Updated 4/29/2020:

    On April 26 2020, the Department of Health issued updated Interim Guidance re: Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments.

    This guidance document seeks to clarify the order of priority in which COVID-19 testing will be made available. Notably, per this policy, Personal Assistants in CDPA belong to priority category 3.

    A summary of each category, by priority:

    1. People who are experiencing symptoms of COVID-19, particularly if they belong to an at-risk population;

    2. People who have been exposed (within 6 feet) of someone who is a confirmed positive case;

    3. Individuals who are employed as health care workers, first responders, etc.

    On April 14, 2020, the Department of Health issued interim guidance on the Executive Order requiring employers to provide face coverings to employees. 

    It is unclear from this guidance whether the fiscal intermediary or consumer is responsible for procurement and distribution of masks to personal assistants. Individual fiscal intermediaries will need to make their own decisions about how to comply with this guidance. 

    This requirement is for face coverings, not masks, and the guidance defines face coverings as including, but not limited to: cloth (e.g. homemade sewn, quick cut, bandana), surgical masks, N-95 respirators, and face shields.

    CDPAANYS has sought clarification from the Department of Health regarding several matters, including this most recent interim guidance on face coverings. If additional clarification or guidance from the Department becomes available, it will be posted here. 

    Consumers & Designated Representatives may not be required to purchase face coverings using their own money.

    —

    Updated 4/8/2020: NYSDOH has updated their guidance on Authorization of Community-Based Long Term Services & Supports Covered by Medicaid. New Personal Assistants in CDPA are still required to have a health assessment, immunization record & tuberculosis test, even though many clinics are closed. 

    Updated 4/8/2020: You may be required to offer paid COVID-19 leave to employees who have been ordered to be quarantined or isolated. Click here for more information. 

    Updated 3/25/2020: Department of Homeland Security has announced temporary flexibility on requirements for I-9 Compliance.

    Updated 4/8/2020: The Governor’s PAUSE Act, which shuts down non-essential businesses through April 29, does not apply to CDPA. Fiscal intermediaries and personal assistants are essential healthcare workers. 

    CDPAANYS is committed to helping you understand Best Practices and how to proceed in a way that protects and safeguards your employees, your consumers, and your consumers’ personal assistants. 

    COVID-19 will place enormous stress on FIs at a time when agencies are already struggling. FIs will need to make a host of decisions. We will never be able to adequately plan all scenarios that will arise during an unprecedented global pandemic of this sort; however, to the extent we plan in advance, we can help to mitigate those unplanned instances that will inevitably arise.

    Considerations for FI Planning:

    Factors that FIs should think through before they arise include (this list is inherently not complete):

    • In the event that all of a consumer’s PAs except one become ill; how will you handle overtime requirements? What, if any, systems will you put in place to protect both the consumer and the worker from injuries and deterioration due to excessive work (for instance, nobody can work 24/7).

    • What resources can you make available to consumers:
      • Masks (if they become ill with the virus)
      • Latex gloves
      • Alcohol swabs
      • Proper handwashing techniques
      • Information on COVID-19 symptoms and what to do if symptomatic?
      • Information on handling respiratory conditions that may be new to a consumer as a result of becoming infected with COVID-19, and how to talk to their health care provider about it in advance
      • Medical supplies, such as:
      • Educational resources
    • How will you help consumers build a plan for the next few weeks (or longer). See below where we offer resources and planning questions for consumers.
    • Is your office and your operations set up to work remotely? What steps need to happen to allow you to do so? How quickly can you implement them?
    • Estimates indicate that the infection rate could be as high as 70%. In the event that 70% of your office staff is missing, how will you effectively maintain operations?
    • How will you manage assessments for PAs and consumers during this period? 
    • How will you handle consumers who call to inform you that their workers have all fallen ill with COVID-19 and that they need additional staff?
    • Do you have contingency plans in place in the event that travel bans are imposed on cities, towns, neighborhoods, or even buildings?
    • Have you communicated to staff that under no condition should they come to work if they feel remotely ill? Do you have paid sick leave to encourage this?
    • Have your reviewed all PA and consumer authorizations and health assessments for the next 30 days, notifying consumers and their PAs if they will be needed? If DOH does not suspend these rules, advance notice will be mandatory.

      Articles from Bond Schoeneck & King – Updated Daily

       

    • Link to all articles
    • Financial Assistance for Health Care Providers
    • Emergency FMLA Expansion Act & Paid Sick Leave
    • Summary of NY COVID-19 Leave Law

    NYSDOH COVID-19 Guidance For Authorization

    THIS DOCUMENT HAS BEEN UPDATED 4/8/2020.

    On March 18, 2020, the Division of Long Term Care issued COVID-19 Guidance for the Authorization of Community-Based, Long-Term Services and Supports Covered by Medicaid.

    If you have issues, or are experiencing systemic issues related to COVID-19 and CDPA, please send them to covid19@cdpaanys.org.