NHPCO Advocates for Consistent COVID Vaccine and Testing Requirements for Health Workers
The National Hospice and Palliative Care Organization (NHPCO), today issued the following statement from NHPCO President and CEO, Edo Banach:
“The health and safety of our frontline workers and the patients, families, and communities they serve have always been and always will be the highest priority for NHPCO and hospice and palliative care providers across the nation.
“Throughout the COVID-19 pandemic, NHPCO has worked with the government to advance COVID vaccines and testing for hospice and palliative care staff and volunteers, to ensure that care for patients and their families can continue safely. Last week, the Centers for Medicare & Medicaid Services (CMS) announced it will require staff working in Medicare and Medicaid-participating nursing homes to be vaccinated against COVID-19. While the move to mandatory vaccinations for these frontline health workers will help protect patients, the current policy does not go far enough. To protect all Americans and give everyone the confidence to seek the healthcare they need, all health workers and volunteers in all settings—including home health, home hospice, and home palliative care workers—should be required to be vaccinated against and regularly tested for COVID-19, with exemptions for medical and religious reasons.
“Today, the Food and Drug Administration (FDA) granted full approval for the Pfizer-BioNTEch coronavirus vaccine, providing greater certainty around vaccines for all Americans. Similarly, announcing a national requirement for healthcare workers to be vaccinated would provide greater certainty for the healthcare sector. The requirement should include a clear timeline and implementation should be supported with financial resources, including but not limited to additional support under the Provider Relief Fund and sufficient home-based rapid testing supplies.
“In addition to optimizing public health and safety, uniform, mandatory vaccinations for health workers would help improve public confidence in the healthcare system and help to address staffing challenges. We recognize that shortages of healthcare workers have created intense competition between employers, which has led to further shortages in some communities and healthcare settings. At the same time, employer vaccine requirements have frustrated some health workers. We realize that a national vaccine mandate may cause further frustration in the short term, and we are concerned about that. However, taking the long view, it’s clear that consistent requirements will strengthen public trust in the healthcare system and help stabilize staffing. A clear, nationwide approach, appropriately resourced, would provide the structure and certainty healthcare providers need in order to continue making progress on getting staff vaccinated.
“NHPCO looks forward to working with its colleagues and CMS to support the development and appropriate implementation of consistent requirements for healthcare providers, workers, and volunteers across the country to ensure the safety of the American people—particularly our most vulnerable populations—and to help stabilize the healthcare workforce.”
NAHC Statement on COVID-19 Vaccine Mandates
Washington, D.C. – It has been reported in some news outlets that the National Association for Home Care & Hospice (NAHC) has joined in calling for mandatory vaccination against the novel coronavirus COVID-19 for all front-line health care workers. This is not accurate. While NAHC continues to urge all medically eligible Americans to get vaccinated against COVID-19 as soon as possible, we believe every health care provider must decide for itself how best to serve the interests of its patients, while respecting the sensitivities of its employees.
From the beginning of this public health emergency, NAHC and its members have been at the forefront of providing the latest and best education about the dangers of COVID-19 and the value and efficacy of the vaccines. This important work will continue. The NAHC Board of Directors took a public pledge to take the vaccine as soon as it became available to them and all have fulfilled that pledge. NAHC and its members will continue to work toward full vaccination of every person in-home care, home health, and hospice through education, persuasion, and incentivization. The COVID-19 vaccines available to Americans are safe and effective and we urge everyone to get vaccinated as soon as possible.
Deprescribing: Proton Pump Inhibitors (PPIs)
As providers, we generally think that the use of proton pump inhibitors (PPIs) are fairly safe and well-tolerated. While the occurrence of side effects, such as diarrhea, impaired B12 absorption, hypomagnesemia, Clostridium difficile infection, hip fractures, and pneumonia might be small, the frail elderly might be at a higher risk of experiencing these conditions. This is especially true for situations with chronic use of PPIs.
The PPIs (omeprazole, esomeprazole, lansoprazole, pantoprazole, etc) were designed to be used for 4 to 6 weeks to resolve heartburn, mild to moderate gastroesophageal reflux, or esophagitis. The recommendations to deprescribe do not apply to those who have or have had Barrett’s esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers.
When PPIs are inappropriately prescribed or used for too long, they can contribute to polypharmacy with their attendant risks of nonadherence, prescribing cascades, adverse reactions, medication errors, drug interactions, emergency department visits, and hospitalizations. When an ongoing indication is unclear, the risk of side effects may outweigh the chance of benefit. PPIs are associated with a higher risk of fractures, C. difficile infections and diarrhea, community-acquired pneumonia, vitamin B12 deficiency, and hypomagnesemia. The most common side effects include headache, nausea, diarrhea, and rash.
The approach to deprescribing PPIs.
Patients and caregivers may be more likely to engage if they understand the rationale for deprescribing (risks of continued PPI use; long-term therapy may not be necessary) and the deprescribing process. There is no evidence that one tapering approach is better than another. You can lower the PPI dose (for example, from twice daily to once daily, or halving the dose, or taking every second day) OR stopping the PPI and using it on-demand. These are equally recommended strong options. Choose what is most convenient and acceptable to the patient.
Deprescribing.org 2018
https://deprescribing.org/wp-content/uploads/2018/08/ppi-deprescribing-algorithm_2018_En.pdf
drug shortage list
These shortages are due either to manufacturing delays or shortage of raw ingredients. This is not an inclusive list, but the listed drugs may be used for hospice patients, especially in the inpatient setting.
For a complete list of drugs on shortage follow this link:
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About the author
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David Bougher
Senior VP of
Regulatory Affairs
David is a seasoned veteran of the hospice world and an essential member of the Wise Hospice Options clinical team.
Education:
RN, BSN
Experience:
- Former hospice COO
- 20 Years of education & training experience
- 10 Years of experience at Wise Hospice Options
Connect
- (800) 856-9757 Ext: 203
- dbougher@wiseop.com
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Tino Vilches
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vice president of clinical services
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