Staffing of Facilities and Programs During a Pandemic
PDF Version of DQA 09-050
(PDF, 52 KB)
Staffing of Facilities and Programs During a Pandemic
This Division of Quality Assurance (DQA) memo expands upon information
previously provided in DQA Memos 09-018, 09-020 and 09-030, regarding Novel
Influenza A (H1N1) / 2009 (Swine Flu).
The purpose of this memo is to identify planning resources for staffing
shortages when a pandemic is occurring.
During pandemics, emergency declarations may be made by government
agencies that allow waivers or variances to regulations and requirements.
These waivers may address staffing criteria. Because of the differences
between various provider settings, it is not practical to determine staff
shortage thresholds that could trigger waivers. Although staffing waivers or
variances may be considered, providers need to have plans in place to deal
with staff shortages caused by pandemic illness.
Pandemic Planning For Staffing:
General pandemic planning checklists can be helpful to assure that basic
staffing considerations have been addressed in a provider's pandemic plan.
Samples of pandemic checklists can be found at:
Long-Term Care and Other Residential Facilities Pandemic Influenza
Planning Checklist http://pandemicflu.gov/professional/hospital/longtermcarechecklist.html
Home Health Care Services Pandemic Influenza Planning Checklist
Medical Offices and Clinics Checklist
Hospital Pandemic Influenza Planning Checklist
Other disaster or hazard planning checklists that may be helpful:
In addition, providers may consider implementation of a non-punitive sick
leave policy that addresses the needs of ill and symptomatic personnel and
provider staffing needs during various levels of a pandemic health crisis.
Staff members may report to work while symptomatic because of fear of
attendance policies and place patients or residents at risk of exposure to
influenza. Components of the policy could include the following:
- The handling of personnel who develop symptoms while at work.
- Guidance regarding when personnel may return to work after having
- A system to track annual influenza vaccination of personnel. (Having a
system in place to track annual vaccination will facilitate
documentation and tracking of pandemic influenza vaccine in personnel.)
- During times of pandemic when different vaccines are available for
multiple types of influenza, all personnel vaccinations should be
Sampling of Checklist Items Specific to Staff Shortages
- A contingency staffing plan has been developed that identifies minimum
staffing needs and prioritizes critical and non-essential services on the
basis of essential operations. Some examples to consider include: meals vs.
activities in a nursing home, therapy versus hydration, blood pressure
medications vs. antacids, etc. Providers need to assess the care or services
that should be provided and prioritize critical items that must be done and
those that may be delayed during the crisis.
The contingency staffing plan includes a strategy for cross-training and
reassignment of personnel to support critical services.
The contingency staffing plan considers alternative strategies for
scheduling work shifts in order to enable personnel to work longer hours
without becoming overtired.
Specific criteria for declaring a "staffing crisis" that would
enable the use of emergency staffing alternatives.
Strategies have been developed for supporting personnel whose family and/or
personal responsibilities or other barriers prevent them from coming to work
(e.g., strategies that take into account the principles of social distancing
when schools are closed, care of children and elders, transportation,
reasonable accommodation or state governmental mandate).
Strategies for collaborating with local and regional planning and response
groups to address widespread healthcare staffing shortages during a crisis,
including the development of memorandums of advanced agreement (MAAs) and
memorandums of understanding (MOUs) with regional and tribal healthcare
partners. A resource that can be used for agreements can be accessed at: http://www.wha.org/emergencyPreparedness.aspx
Staff is the most critical asset of programs that deliver health care
services. During a pandemic or crisis, providers will need to determine how
they will meet residents' prioritized needs as internal staff resources
become limited. Programs regulated by the Division of Quality Assurance (DQA)
should follow the guidance provided below to determine if waivers or
variances may be available for relief of staffing requirements.
Section 1135 Waivers for H1N1 Influenza Pandemic
Effective October 29, 2009, the Secretary of Health and Human Services
has invoked her wavier authority under Section 1135 of the Social Security
Act. This allows for the waiver or modification of certain Medicare and
Medicaid requirements to ensure that sufficient health care items and
services are available to meet the needs of individuals enrolled in Social
Security Act programs in the emergency area and for the time periods covered
by the 1135 authority.
The Centers for Medicare & Medicaid Services' (CMS) Regional Office
is authorized to issue waivers of certain Medicare and Medicaid regulations.
Presently, CMS is not accepting "anticipatory" waivers. CMS has
indicated that they will not be issuing waivers until there is an actual
need to waive a requirement. No waivers will be granted in anticipation of
needing more beds, longer patient stays or other related issues. .
Submissions by providers to conduct business under the flexibilities
afforded by the Federal waiver should be sent to email@example.com with a
courtesy copy to Alfred.Johnson@dhs.wisconsin.gov.
Exceptions to State Regulations for H1N1 Influenza Pandemic
While CMS may grant exceptions to federal requirements, CMS lacks the
jurisdiction to grant exceptions to state rules or regulations if required
under state law. That authority rests with the Department of Health
Services. The Division of Quality Assurance is aware that, in addition to
requesting a waiver of a federal requirement, providers may need short-term
reprieve from State of Wisconsin regulations, if so; please send those
requests to Alfred Johnson, Director of the Bureau of Technology, Licensing
and Education at: Alfred.Johnson@dhs.wisconsin.gov.
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