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Overview of Home Care and Hospice in New York State
New York State has the most comprehensive and diverse home and community based care system in the nation.
The scope of home care is broad. It encompasses a wide array of both health and supportive services delivered at
home by home care agencies and programs, as well as hospices. Home care agency clients cross the spectrum of
care—from seniors who need assistance with activities of daily living to remain in their homes; to new mothers,
discharged quickly following childbirth with a few postpartum nursing visits for mom and newborn; to postsurgical
patients needing assistance with wound care; to the chronically-ill who are maintained with skilled supervision,
support services, home modification and equipment. Hospice specializes in the care of extremely needy patients
and families (children, adults, elderly) with palliative/end-of-life care needs.
Home care agencies and programs provide post-acute, rehabilitative, supportive and complex long term care for
medically needy elderly, adults and children. Home care agencies are sponsored or operated by free-standing
entities (e.g., private agencies or voluntary agencies like Visiting Nurses), hospitals and nursing homes. Home care
providers are state and federally certified or state licensed. New York’s agencies cover the entire state and serve
several hundred thousand cases annually.
Hospice providers provide comprehensive end of life care to patients and their families. Hospices also provide
professional services to chronically ill and seriously ill individuals through their palliative care programs. Hospice is
provided wherever the patient is living including the home, group homes, assisted living facilities, nursing homes,
hospice residences and hospitals.
Home care agency services include professional services (including care management, nursing, physical therapy,
occupational therapy, speech pathology, medical social work, audiology, respiratory therapy, nutritional counseling
and other), aide care (including home health aide, personal care aide, housekeeper), telehealth services, and other
support services (including home adaptations, home delivered meals, social day care).
Hospice services include professional services including nursing, physician, medical social work, spiritual care,
nutritional counseling, bereavement and other counseling, medications, medical supplies and equipment,
volunteers, and hospice aides/homemakers. Professional services can also include all levels of therapy. Hospice is
the professional care manager across all levels of care that the patient requires.
Generally, for home care, post-acute, skilled services are covered by Medicare and by commercial insurance; chronic
or extended care and services are covered by Medicaid; and private paying individuals may pay for either or both.
Hospice is covered by Medicare, Medicaid and private insurance.
Home care providers include all levels and types of agencies and programs, including:
• Certified home health agencies (CHHAs)
• Licensed home care services agencies (LHCSAs)
• Long Term Home Health Care Programs (LTHHCPs)
• Managed long term care (MLTC) plans
• Hospice
• Home and community based waiver programs
• Consumer Directed Personal Assistance Programs
New York’s home care system also includes an array of special needs programs, agencies and services, such as for
medically fragile children, persons with traumatic brain injury, persons with AIDS/HIV, persons with intellectual or
physical disabilities, and other.
1
Primer on Home Care and Hospice
Emergency Preparedness in New York State
Emergency Preparedness Plans
New York State Department of Health
regulations require home care agencies and
hospices to develop and maintain emergency
plans.
The regulations specifically require home care
and hospice agencies governing authority to
“ensure the development of a written emergency
plan which is current and includes procedures to
be followed to assure health care needs of
patients continue to be met in emergencies
which interfere with delivery of services and
orientation of all employees to their
responsibilities in carrying out such a plan.”
In addition, home care agency emergency
response requirements are further specified in a
May 10, 2005 “Dear Administrator Letter” (DAL),
succeeded by December 1, 2016 DAL DHCBS 16-
11.
The DAL specifies that the following critical
elements must be included in the provider’s
emergency preparedness plan:
• Identification of a 24/7 emergency contact
telephone number and e-mail address of the
emergency contact person and alternate
which must also be indicated on the
Communications Directory of the Health
Commerce System (HCS);
• A call down list of agency staff and a procedure
which addresses how the information will be
kept current;
• A contact list of community partners,
including the local health department, local
emergency management, emergency
medical services and law enforcement and a
policy that addresses how this information
will be kept current. The HCS
Communications Directory is a source for
most of this information;
• Collaboration with the local emergency
manager, local health department and other
community partners in planning efforts,
including a clear understanding of the
agency’s role and responsibilities in the
county’s comprehensive emergency
management plan.
• Policies that require the provider to maintain
a current HCS account with a designated HCS
coordinator(s) responsible for securing staff,
HCS accounts and completing and
maintaining current roles based on contact
information in the Communications
Directory;
• A current patient roster that is capable of
facilitating rapid identification and location of
patients at risk. It should contain, at a
minimum:
o Patient name, address and
telephone number;
o Patient classification Level (see
sidebar);
o Transportation assistance level;
o Identification of patients dependent
on electricity to sustain life;
o Emergency contact telephone
numbers of family/caregivers;
o Other specific information that may
be critical to first responders
• Procedures to respond to requests for
information by community partners in an
emergency.
• Policies addressing the annual review and
update of the emergency plan and the
orientation of staff to the plan.
• Participation in agency specific or
community-wide disaster drills and exercises.
• A procedure staff should employ when a
patient refuses to evacuate in an ordered
evacuation.
• An emergency communications procedure if
the telephone/computer network becomes
disabled.
Additional DAL’s include DAL DHCBS 15-06 and
DHCBS 16-02 (see page 3 “TALs”).
2
New York State Department of Health Regulations on
Home Care and Hospice Emergency Preparedness
Primer on Home Care and Hospice
Emergency Preparedness in New York State
Patient Priority Levels in
Emergency Response
The May 2005 and December
2016 DALs require that home
care and hospice agencies
adopt the following priority
levels for patients in
emergency response.
LEVEL 1 - High Priority
Patients in this priority level need
uninterrupted services. The
patient must have care. In case of a
disaster or emergency, every
possible effort must be made to
see this patient. The patient's
condition is highly unstable and
deterioration or inpatient
admission is highly probable if the
patient is not seen. Examples
include patients requiring life
sustaining equipment or
medication, those needing highly
skilled wound care, and unstable
patients with no caregiver or
informal support to provide care.
LEVEL 2 - Moderate Priority
Services for patients at this priority
level may be postponed with
telephone contact. A caregiver can
provide basic care until the
emergency situation improves.
The patient's condition is
somewhat unstable and requires
care that should be provided that
day but could be postponed
without harm to the patient.
LEVEL 3 - Low Priority
The patient may be stable and has
access to informal resources for
assistance. The patient can safely
miss a scheduled visit with basic
care provided safely by family or
other informal support or by the
patient personally.
Federal Emergency Preparedness Regulations
(see page 3)
3
New Federal Emergency Preparedness Regulations
Since November 2017, all Medicare and Medicaid participating providers have been required to meet new emergency
preparedness rules promulgated by the U.S. Centers for Medicare and Medicaid Services (CMS).
These new rules add to the current state regulations. Much time and attention continue to be devoted by NYS DOH, our
associations and agencies across the state to analyzing, educating, training and implementing these new rules.
The new rules focus on four core elements of emergency preparedness for providers:
• Risk Assessment and Planning: Providers are required to conduct a comprehensive risk assessment utilizing an “all
hazards” approach. Providers are also required to develop an emergency preparedness plan that addresses the
emergency events identified in the risk assessment, to be reviewed and updated annually.
• Policies and Procedures: Providers are required to implement policies and procedures based on the emergency
plan and risk assessment, to be reviewed and updated annually.
• Communication Plan: Providers are required to develop and maintain an emergency communication plan
(reviewed and updated annually) to ensure coordination of patient care within and across health care providers,
health departments, and emergency management agencies; and establish HIPAA-compliant methods of sharing
patient information and keeping medical records readily available during an emergency.
• Training and Testing: Providers are required to develop and maintain an emergency preparedness training and
testing program that includes initial training on all emergency preparedness policies and procedures developed as a
result of this rule. Providers are required to conduct drills and exercises to test emergency plans annually.
Primer on Home Care and Hospice
Emergency Preparedness in New York State
Transportation Assistance Levels (TALs)
DHCBS 16-02 addresses the requirement that home care agencies and hospices adopt and use DOH standard categories
for “Transportation Assistance Levels” (TALs), for planned patient evacuations in emergencies. TALs are used by facilities
as well as home care and hospice to categorize and align patient evacuation transport and assistance needs to patient
functional needs and conditions.
These needs and conditions were further refined from DHCBS 16-02 by a DOH TALs informational notification (Sept 1,
2017) to specifically include the categorizations of:
• Non-ambulatory patients (further categorized by stretcher, vent, or bariatric);
• Wheelchair need; or
• Ambulatory.
Patient TALs categories are required to be indicated on agency patient rosters.
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Home Care and Hospice Challenges in Emergency Preparedness
Home care and hospice agencies and patients face particular and unique challenges in emergency preparedness
and response. Some key challenges are outlined below.
The home care setting itself – The home care setting itself provides for unique and especially challenging
aspects of emergency response, particularly when compared to facility-based care.
Home care and hospice providers are handling large numbers of extremely medically needy and vulnerable
individuals at home and in the community; many individuals reside in remote rural or difficult to access settings
(like high rise buildings).
Instead of a facility-based venue where patients and staff are consolidated into a single, congregate setting,
home care and hospice patients are nearly always in their own individual homes or apartments, and are spread
throughout their communities. Agency personnel must therefore “bring the care to the patient,” traversing
to-and-from each patient’s home and neighborhood.
Home care personnel must also manage, direct and administer services across a geographic expanse that can
be impacted in many varied ways during an emergency.
In home care, every patient, home, neighborhood and community is a potential, distinct emergency in itself to
be navigated and managed.
Home care and hospice providers assist across settings during emergencies – In addition to conducting
emergency response for patients in their homes, home care and hospice also reach beyond to assist other
settings and the community at large. Agencies conduct or assist with patient evacuation, provision of care in
shelters, hospital transfers, and many other system supports.
Navigation across affected community areas – Providers must martial resources, services and patient
management needs across broken communications, severed service networks, extreme environmental dangers
and an entire community in simultaneous need to reach, provide and manage care for patients.
Structural Obstacles – Home care and hospice providers are also challenged with major structural obstacles in
the response system, including:
1. Necessity for access to patients in restricted zones
2. Need for priority access to fuel
3. Need for regulatory flexibility for care and management in emergency conditions
4. Need for supportive financing for preparedness and response
5. Dearth of education/comprehension of home care and hospice
6. Wider dependency on communications and utilities
7. Transportation for home health personnel and patients
8. Coordination with managed care plans
9. Need for transport or evacuation of patients requiring power for treatments such as oxygen
concentrators, ventilators or pain pumps
Primer on Home Care and Hospice
Emergency Preparedness in New York State
5
State Home Care and Hospice Associations’ Roles in Emergency
Preparedness & Response
The Home Care Association of New York State (HCA), the New York State Association of Health Care Providers (HCP) and
the Hospice and Palliative Care Association of NYS (HPCANYS) are statewide associations representing the home and
community-based services sector of the health care continuum in New York State.
HCA, HCP and HPCANYS members reflect the array of provider and program types described in the ”Overview” section of
this document.
HCA, HCP and HPCANYS are all headquartered in Albany and have providers and organizational members statewide. The
associations have administrative, education, policy and communications staff which collaborate on daily functions –
including program/policy development, technical assistance to providers, engagement with state and federal agencies on
home care and hospice-related issues, education, advocacy and more.
HCA, HCP and HPCANYS are deeply engaged in activities related to strengthening home care and hospice emergency
preparedness and response, and better integrating home care and hospice into related State and local efforts. The
associations are collaborative partners to the State Department of Health’s Office of Health Emergency Preparedness
(OHEP) in the implementation of broad based and priority initiatives aimed at developing and supporting home care and
hospice emergency preparedness and response.
The following is a summary of our associations’ organizational roles in emergency preparedness and response.
We serve as:
Principal sources of information, education, training
and technical assistance for home and community
based providers for emergency preparedness and
response (and all other program areas).
Principal communication points for home care and
hospice in emergency conditions, circulating and
exchanging essential information, guidance and
updates pertaining to any and all facets of the
emergency in question.
Communication point to and from state and local
agencies, organizations, and incident command in
advance of, during and following emergency
situations.
Collaborating partners with the State Department of
Health’s Office of Health Emergency Preparedness
under a statewide initiative, which includes multi-
tiered planning and structural improvement for
emergency response in health care, including planning
and response interface with Regional Health
Emergency Preparedness Coalitions and Regional
Training Centers.
Collaborating partners with the Health Department’s
Office of Primary Care and Health Systems
Management (OPCHSM), and Office of Health
Insurance Programs in their regulatory roles for
providers and health plans, as well as in their
jurisdictional roles in declared emergencies.
Collaborating partners with health associations and
organizations representing other sectors (hospitals,
nursing homes, clinics, etc.) in the continuum of care.
Interface with federal agencies on emergency
response policy.
Advocates for policy development and/or revision to
ensure the most effective emergency management
system.
Primer on Home Care and Hospice
Emergency Preparedness in New York State
6
Collaborative Initiatives of Home Care and Hospice & New York State
Department of Health Office of Health Emergency Preparedness
Planning and Initiative Areas of HCA, HCP, HPCANYS and DOH-OHEP include:
Work with Coalitions/Regional Integration and Collaboration – Participate with regional Health Emergency
Preparedness Coalitions and coalition partners – including other provider sectors, local health departments,
emergency managers, regional training centers, and other – in planning, education/training, coordinating and
integrating emergency preparedness efforts. Enhance maturation of emergency preparedness and capabilities
integration of homebased care into regional emergency preparedness and response.
Provider - Local Emergency Manager Engagement – Promote and facilitate local engagement and relationship
development between individual home care/hospice providers and local emergency managers for emergency
preparedness and response.
Regulatory Flexibility Needs - Addressing regulatory barriers; collaborating on the development and circulation of a
provider guide for regulatory relief during emergencies.
Incident Command - Promoting Incident Command System awareness, education, and use.
Transportation Assistance Levels - Facilitating education and implementation of Transportation Assistance Levels
in home care - assist with education, webinars, technical assistance; work with local response partners and Office of
Emergency Management for transportation allocation in an emergency.
Exercises and Drills – Participate in OHEP, regional HEPC and Regional Training Center exercise tabletops and
workgroups, and provide input for exercise design and objectives and provide agencies with information on
upcoming exercises and drills.
Promote Situational Awareness – Collaborate with OHEP, OPCHSM, HEPCs and health sector partners on
development of Situational Awareness processes, roles and activities.
Survey and Reporting - Collaborate to assist with home care provider follow-up to ensure completion of relevant
Health Commerce System (HCS) HERDS surveys conducted during emergencies, including redistribution of
NYSDOH messages and notifications as requested/required.
Toolkit to Assist with Home Care Patient/Family Preparedness – Develop and promote availability and use of a
home care provider toolkit to be used to assist home care and hospice patients and families with overall emergency
preparedness, including transport for relocation in emergencies.
Coastal Storm/Flood Zone Planning – Assist providers with identification and use of coastal storm/flood zone
planning and evacuation resources.
Primer on Home Care and Hospice
Emergency Preparedness in New York State
Contact Information
Home Care Association of New York State
388 Broadway, 4
th
Floor
Albany, New York 12207
(518) 426-8764
www.hca-nys.org
New York State Association of Health Care Providers
20 Corporate Woods Blvd., 2nd Floor
Albany, New York 12211
(518) 463-1118
www.hcp.org
Principal Contacts for Emergency Preparedness
This primer is prepared with grant funding support from the
New York State Department of Health.
Primer on Home Care and Hospice
Emergency Preparedness in New York State
Alyssa Lovelace
Director for Policy and Advocacy
Home Care Association of NYS
(518) 810-0658
Al Cardillo
President and CEO
Home Care Association of NYS
(518) 810-0663
Andrew Koski
Vice President for Program Policy
and Services
Home Care Association of NYS
(518) 810-0062
Kevin Kerwin
Vice President of Public Policy
NYS Association of Health Care Providers
(518) 463-1118
Jeanne Chirico
President and CEO
Hospice and Palliative Care Association of NYS
(518) 446-1483
119 Washington Avenue
Suite 302
Albany, New York 12210
(518) 446-1483
www.hpcanys.org
Updated December 2020
