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By Rose Hoban
In response to the coronavirus pandemic, North Carolina lawmakers are rushing to hear presentations and line up priorities for how the state legislature can augment the federal funding flowing from the $2 trillion CARES Act, which passed late last month.
In the third meeting of the health care working group of the House Select Committee on COVID-19, lawmakers heard from representatives of the child care industry that is providing such critical services for essential workers at this time. They also heard from leaders in the state Coalition on the Aging and representatives of the state’s Emergency Medical Services on the challenges they’re facing in protecting their constituents.
“Our child care facilities in our state have not hesitated in deciding to remain open to provide for this crisis,” said Tara Fish, director of the Harnett County Partnership for Children. “But unfortunately their hearts are bigger in their bank account balances, and many of them are recording cash flow issues.”
Each of the groups had messages such as this for lawmakers. They described overtaxed social service agencies, workers who fear bringing COVID-19 home to families from their workplaces, struggles to reach constituents who may be vulnerable and at risk, and just not enough revenue to keep agencies’ doors open through and/or after the pandemic subsides.
“On the 23rd we anticipate having a draft bill to the committee, two bills, we’ll be looking at,” said Rep. Donny Lambeth (R-Winston-Salem).
He said that of the two bills, one will deal with needed policy changes that will allow federal policies to align with state policies, such as the changes to telehealth regulations and billing allowed by the federal Centers for Medicare and Medicaid Services. The other bill will have line-item appropriations to supplement federal funding that came from the federal CARES Act, and in some instances, make up for what federal lawmakers did not provide for.
“We want to make sure those are as comprehensive as we can get,” he said.
Lambeth said that speed is of the essence as there will be one more meeting, next Tuesday, to present to lawmakers. The working group meeting next Thursday will then consist of a discussion session to mark up potential bills in advance of the legislative session which is supposed to convene on April 28.
“For those … who have asked to present to this committee we’ll continue to receive your requests but make those requests known as soon as possible,” he said.
Child care cash flow woes
As essential workers grapple with how to care for their children, this past week, the state Department of Health and Human Services moved to roll out more help for cash strapped agencies.
Fish said that DHHS has moved in a positive direction in providing continued funding through the extension of child care subsidy payments for April, May and June and also providing NC Pre-K providers payment for those months as well.
“However, those payments, along with the emergency care payments, are essential personnel are all based on reimbursement,” she said. “That means they have to meet the demands of payroll, increased sanitation standards, lower staff-to-child ratios, and then wait 30 to 45 days for payment.”
She said that usually the delay in payment would not be such an issue, because those centers caring for children whose families get the child care subsidy get additional funding from private paying parents. But those paying parents are no longer in the mix.
“Most of our private-pay parents in our community find themselves either furloughed, unemployed, or working from home, and they are not paying for their children to be in child care,” Fish said. “I’d say about 30 to 35 percent of our children in our county are private pay, and so that is a significant loss for those child care facilities.”
Jennifer Simpson from the Blue Ridge Partnership for Children described some of the ways her organization has facilitated new child care services: buying thermometers for taking temperatures, providing services for night shift hospital workers, corrections officers and emergency workers.
“They too have essential employees who are covering shifts over 24 hours,” she said.
Lambeth said he was sympathetic to the needs of child care centers, saying that the number floated to legislators was about $125 million.
“But we’re going to need some details behind that in terms of what that number is and how that would be spent and how we best can help you,” he said. “And I don’t know that I have a good feel right now what your request actually is.”
The women said that cost estimates to cover these new needs varied, but it was hard to pin down because the situation remained fluid.
Emergency medical services
EMS responders are often the first people outside of a family that a patient with COVID-19 encounters once they realize that they’ve gotten sick from the COVID.
That’s something EMS workers are keenly aware of, said William Kehler, who heads the McDowell County EMS. He told lawmakers that for his employees, too, access to personal protective equipment is a major concern.
“We are sourcing here in our local community from the private sector as much as possible as we know the state and the federal supply has dwindled,” Kehler said. “That’s something that really concerns us on a daily basis.”
He said they’ve gotten a boost on PPE from at least one local manufacturer.
“We have one industry here that has begun manufacturing face shields and we received delivery on those earlier this week,” Kehler said. “We’re exploring every avenue and not leaving any rock unturned.”
EMS systems throughout the state have worked with the state Office of Emergency Medical Services to waive regulations about how many licensed paramedics can ride in a given ambulance, Kehler explained to the working group. He said that instead of having two paramedics, they’re instead allowed to staff with one in the back to do patient care and another person up front to drive.
“We’re going to look for non-traditional personnel such as potentially school bus drivers or those who are adequately trained to operate a large vehicle to serve as a driver for our EMS ambulances, and have that one paramedic in back,” he said.
And having only one paramedic on an ambulance will give his department some cushion in the event his workers test positive for the virus.
“Personal safety is a big concern and making sure that our employees if they become sick that they do not expose additional family members,” he said. “Through cooperation with local foundations and other agencies, we’ve come up with a plan to be able to shelter those employees at an off-site facility were they to test positive to COVID-19 to prevent them from taking it home.”
Seniors at risk
One of the most vulnerable groups during the COVID-19 pandemic are seniors, who die at higher rates than younger patients. So far in North Carolina, while people over 65 make up only 22 percent of those with the disease, they comprise 82 percent of those who have died as a result. These people also are more likely to have chronic health conditions that put them at higher risk of death from COVID.
“There’s a great fear of this virus,” said Mary Bethel, a board member of the NC Coalition on Aging. “And there’s a great fear of the virus by kids of older people.”
That’s a big concern for Bethel and COA board chair Tracy Colvard who detailed for lawmakers how seniors are now holed up in their homes, afraid to leave, often unable to get food. Many of the supports available to low-income seniors have been profoundly altered: in many places Meals-on-Wheels now delivers frozen meals only several times a week instead of daily and congregate meal sites are now making meals to drop off.
She said the state’s 211 information number had received more than 17,000 calls since the crisis began.
“They said the number one thing they’re receiving calls about not only from older adults but also from the disability population is about food pantries and delivery of meals,” Bethel said. “The whole issue of food is top of mind.”
The other worry Bethel expressed was the lack of socialization for seniors, more than a third of whom live alone, with communication via electronic devices that many seniors are uncomfortable with.
Getting to physicians is a problem too. Many seniors are unable to use telehealth services because of their unfamiliarity with iPhones and tablets, but federal rules prohibit providers from billing for services delivered by audio calls only.
Colvard asked legislators for help advocating with federal regulators to allow for telephonic visits.
The two had a laundry list of needs, from asking legislators to consider the issue of the 1,200 aging inmates in the prison system to the increased pressure on long-term care facilities to the narrow margins at agencies that provide services.
“It’s possible that we may have … we will have limited resources for this first wave of responding to the COVID-19 cost issues,” Lambeth said, asking Bethel and Colvard to prioritize their long list of needs for seniors. “Because we will be looking at this for more than just the next few weeks.”
“You had a number of things that might be longer term discussions,” he said. “In our world, longer term might be three to six months.”