How U.S. Policies Aid in the Spread of Virulent Diseases within the Healthcare Setting

Pandemic Sick Leave:

How U.S. Policies Aid in the Spread of Virulent Diseases within the Healthcare Setting

J. Hunter Martinsky

Saint Joseph’s College of Maine

Introduction

            Currently, the U.S. does not guarantee paid sick leave for short or long-term illness.  It is one, of only three, modern economies where it is not nationally mandated (Kim, 2017).  This benefit has commonly been an agreement between employees and their company, along with serving as an incentive to attract new workers.  As most Americans continue sheltering in place because of COVID-19, there are others who continue to work due to the necessity of employment.  This can be a dangerous combination, especially with the ability of the virus to take multiple days to incubate and can initially present as mild symptoms (Klompas, 2020).  If these workers are unable to take the needed time off to slow the spread of a virus due to fears of losing a paycheck, then quarantines serve no purpose.  This is most important within the U.S. healthcare systems as workers are on the frontlines of the epidemic and have daily contact with those patients most susceptible to the virus.

Implications

            The issue at the present time is whether COVID-19 efforts would be improved if all Americans had access to paid sick leave.  As the U.S. has quickly begun to take the lead in global cases and deaths due to the virus, one outstanding conclusion to be made is whether it has to do with this near global benefit for workers (Renken & Wood, 2020).  Legislation entitled, Families First Coronavirus Response Act was created to help those employers offer paid sick leave to their employees but this response may be too little too late as it took effect on April 1^st of 2020, well after the virus had taken a foothold within the country (Department of Labor, 2020).  Special efforts need to be made within healthcare systems to ensure that paid sick leave is always available not only during pandemics but to prevent spread of illnesses overall.  National attempts also must be made to guarantee this benefit for all workers in order to alleviate the U.S.’ overcrowded emergency rooms and lessen the costs of healthcare.  Without these endeavors, America will only continue its struggle with the spread of COVID-19 and similar respiratory illnesses.

Conclusion

            Overall, the research has shown that access to paid sick leave allows workers to take the time off needed during courses of influenza-like illnesses.  This can result in fewer workers getting sick as it mitigates the spread of the viruses (Kumar et al., 2013).  It also could prevent employees from practicing presenteeism as they work during their illness which results in inadequate productivity and potential financial loss (Allen et al., 2018).  While there is an upfront cost to this benefit being offered, the incentives provided are fully realized during courses of pandemics and even the seasonal epidemics (Gianino et al., 2019).  All of this translates into the healthcare systems as healthcare workers are often the guiltiest of presenteeism and increase the potential spread of these viruses to not only fellow employees but also potentially patients (Mitchell, & Vayalumkal, 2017).

            As this pandemic continues to run its course globally, the research and information collected will continue to be deciphered and explored to identify ways in which governments could have prevented its spread.  One aspect that will need to be investigated is the effect of the pandemic and its relation to paid sick leave.  This will include the rate of infections within specific organizations such as those with paid sick leave and those without.  Additionally, there will be a need to examine reinfection rates in countries with paid sick leave along with their ability to reduce the spread of the virus.  One positive aspect of this virus in this modern age is the treasure trove of research being collected which allows for countless research opportunities to decipher and explore for years to come.

The benefits of paid sick leave go beyond the workplace as its absence effects workers, their families, and impacts the healthcare system.  While initially paid sick leave was created as an added benefit to working for an employer, this research has shown that its availability makes it a necessity.  Previous research indicated that the U.S. healthcare system would be most prepared during a pandemic, but it has become quickly overwhelmed due to its spread (Nuclear Threat Initiative, 2019).  This may be the result of workers’ inability to stay home as they develop symptoms and continue passing the virus to more bystanders. The lack of guaranteed paid sick leave has been noted as a contributing factor in past pandemics.  (Zhai, Santibanez, Kahn, Black, & de Perio, 2018).   Other countries have already proven its usefulness in everyday life.  Furthermore, the impact of COVID-19 upon American society has demonstrated an urgent need to change our old standards and guarantee this benefit to all workers.  While this virus continues to ransack everyday life and impede normal businesses, it is clear that the world will never be the same after the virus has run its course.

About the Author

J. Hunter Martinsky, MT (AMT), is a Lead Laboratory Scientist at Parkview Randallia Hospital in Fort Wayne, Indiana.  He is also a 2020 Graduate of the M.H.A. program of Saint Joseph’s College of Maine and a baccalaureate graduate in Human Biology from Indiana University.     

References

Allen, D., Hines, E. W., Pazdernik, V., Konecny, L. T., & Breitenbach, E. (2018). Four-year review of presenteeism data among employees of a large United States health care system: a retrospective prevalence study. Human resources for health, 16(1), 59. https://doi.org/10.1186/s12960-018-0321-9

Department of Labor. (2020). Families First Coronavirus Response Act: Questions and Answers. Wage and Hour Division. Retrieved from https://www.dol.gov/agencies/whd/pandemic/ffcra-questions

Gianino, M. M., Politano, G., Scarmozzino, A., Stillo, M., Amprino, V., Di Carlo, S., Benso, A., & Zotti, C. M. (2019). Cost of Sickness Absenteeism during Seasonal Influenza Outbreaks of Medium Intensity among Health Care Workers. International journal of environmental research and public health, 16(5), 747. https://doi.org/10.3390/ijerph16050747

Kim, D. (2017). Paid Sick Leave and Risks of All-Cause and Cause-Specific Mortality among Adult Workers in the USA. International journal of environmental research and public health, 14(10), 1247. https://doi.org/10.3390/ijerph14101247

Klompas, M. (2020). Coronavirus Disease 2019 (COVID-19): Protecting Hospitals From the Invisible. Ann Intern Med. 2020; [Epub ahead of print 11 March 2020]. doi: https://doi.org/10.7326/M20-0751

Kumar, S., Grefenstette, J. J., Galloway, D., Albert, S. M., & Burke, D. S. (2013). Policies to reduce influenza in the workplace: impact assessments using an agent-based model. American journal of public health, 103(8), 1406–1411. https://doi.org/10.2105/AJPH.2013.301269

Mitchell, K. J., & Vayalumkal, J. V. (2017). Sickness presenteeism: The prevalence of coming to work while ill among paediatric resident physicians in Canada. Paediatrics & child health, 22(2), 84–88. https://doi.org/10.1093/pch/pxx026

Nuclear Threat Initiative. (2019). GHS Index – Global Health Security Index – Building Collective Action and Accountability. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiR4NnE_-_oAhVXg3IEHeBxBVUQFjAAegQIARAB&url=https%3A%2F%2Fwww.ghsindex.org%2Fwp-content%2Fuploads%2F2019%2F10%2F2019-Global-Health-Security-Index.pdf&usg=AOvVaw1UEVvYg9Bybto0jTTs8-y3

Renken, E. & Wood, D. (2020). Tracking the Pandemic: How Quickly is the Coronavirus Spreading State by State?. NPR.Org. Retrieved from https://www.npr.org/sections/health-shots/2020/03/16/816707182/map-tracking-the-spread-of-the-coronavirus-in-the-u-s

Zhai, Y., Santibanez, T. A., Kahn, K. E., Black, C. L., & de Perio, M. A. (2018). Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among U.S. workers. Vaccine, 36(48), 7316–7323. https://doi.org/10.1016/j.vaccine.2018.10.039

Thinking about Health Literacy to Improve Outcomes

Brandie N. Elizaitis, MS, CDP, CDS

Health literacy, per the Institute of Medicine, refers to the degree to which an individual possesses the capacity to obtain, process and comprehend basic health information and services in order to make appropriate health decisions (Committee on Health Literacy, 2004). This literacy is not limited to reading written materials that contain healthcare-related information, nor is health literacy determined only by measuring an individual’s ability to read, comprehend and process health-related information (Andrulis & Brach, 2007). Instead, as Andrulis and Brach note, health literacy is dynamic and changes based on both an individual’s level of capacity to understand information as well as the demands that information provided puts on an individual’s ability to interpret and understand it. This means that while an individual may be able to comprehend basic health information, such as understanding that his or her fever may be a symptom of an infection, that same individual may not understand what it means to have cancer of the lymph nodes. Comprehension may become even more problematic when a diagnosis is first revealed or when stress levels are higher.

Why Health Literacy Matters

Compared to those with proficient health literacy, individuals with low health literacy have lower use of preventative healthcare services, higher rates of hospitalization, worse self-management skills and lower levels of health knowledge (Wolf, Gazmararian, & Baker, 2005). This emphasizes the need for healthcare practitioner recognition that limited health literacy can impact health outcomes, and as such, health literacy is considered one of the social determinants of health. Overall, health literacy has been found to be a stronger predictor of an individual’s health status than racial or ethnic group, employment status, income level or education level (Güner & Ekmekci, 2019). Health literacy is also considered to be distinct from general literacy and is not based on education level, since someone may have a college degree, but may not necessarily have proficient health literacy.

 In the United States, the incidence of poor levels of health literacy is staggering. The first National Assessment of Adult Literacy (NAAL) that included health literacy-related assessment items was first administered in 2003, and found that only 12% of adults ages 18 and older had proficient health literacy (Office of Disease Prevention and Health Promotion, 2008). When the statistics are broken out by race, the numbers are even more concerning. For instance, compared to approximately one-quarter of Caucasian adults, more than half of African Americans, nearly half of Alaskan Native/First Nations, and two-thirds of Hispanic Americans were found to have limited health literacy (Andrulis & Brach, 2007), indicating that racial and ethnic factors can contribute to lower health literacy.

Panagioti et. al note that focusing on improving health literacy is important because unlike other socio-demographic characteristics, it appears that health literacy can be improved, which can lead to better outcomes (Panagioti et al., 2018). Healthcare practitioners who understand the variable levels of health literacy that their patients may have will be able to alter their interactions with individuals who have limited health literacy by recognizing that this group will be less likely than others to understand basic health information, such as medication names, dosages and administration frequencies (Jiang, Sereika, Lingler, Tamres, & Erlen, 2018; Pacleb, Randall, Neubeck, Lowres, & Gallagher, 2018).

Who is at Risk for Limited Health Literacy?

Since health literacy levels can be impacted by social and other circumstances, it is essential to recognize that health literacy issues can potentially impact most adults at some point in their lives. However, there are certain groups who are more likely than others to have limited health literacy. Per the United States Department of Health and Human Services, these groups include:

·       Adults age 65 and older

·       Members of non-white racial and ethnic groups

·       Non-native English speakers

·       Individuals living at or below the poverty level

·       Individuals with education levels of less than a high school degree

·       Refugees and immigrants (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2008)

Healthcare providers who are aware of potential comprehension limitations are better equipped to recognize the need to provide more “user-friendly” information to care recipient. Information should be presented in plain, non-medical jargon when possible, and follow-up to ask if the individual has understood the information should be conducted (Güner & Ekmekci, 2019). Essential information should be provided before other information, and efforts should be made to ensure that other distracting information is minimized. It is important to recognize that individuals undergo several steps during a health care encounter, including trying to remember the instructions that they have been provided, understand information related to health insurance and then remember and implement the healthy behaviors that their practitioner has recommended (Serper et al., 2014).

About the Author

Brandie N. Elizaitis, MS, CDP, CDS, is a graduate student at Saint Joseph’s College of Maine. She is Director of Operations for CMS Compliance Group, Inc., a regulatory compliance and quality improvement consulting firm working with post-acute and long-term care providers. She holds a Master of Science in Dementia and Aging Studies with a concentration in Long-Term Care Administration from Texas State University. Brandie is a Certified Dementia Practitioner and a CARES Dementia Specialist.

References

Andrulis, D. P., & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Health Behavior, 31 Suppl 1, S122–33. doi:10.5555/ajhb.2007.31.supp.S122

Committee on Health Literacy. (2004). Health literacy: A prescription to end confusion. (L. Nielsen-Bohlman, A. M. Panzer, & D. A. Kindig, Eds.). Washington, D.C.: National Academies Press. doi:10.17226/10883

Güner, M. D., & Ekmekci, P. E. (2019). A survey study evaluating and comparing the health literacy knowledge and communication skills used by nurses and physicians. Inquiry : a Journal of Medical Care Organization, Provision and Financing, 56, 46958019865831. doi:10.1177/0046958019865831

Jiang, Y., Sereika, S. M., Lingler, J. H., Tamres, L. K., & Erlen, J. A. (2018). Health literacy and its correlates in informal caregivers of adults with memory loss. Geriatric Nursing (New York, N.Y.), 39(3), 285–291. doi:10.1016/j.gerinurse.2017.10.008

Office of Disease Prevention and Health Promotion. (2008). America’s Health Literacy: Why We Need Accessible Health Information. Retrieved December 16, 2019, from https://health.gov/communication/literacy/issuebrief/

Pacleb, A., Randall, S., Neubeck, L., Lowres, N., & Gallagher, R. (2018). Health literacy and medication adherence in cardiac disease. British Journal of Cardiac Nursing, 13(11), 545–554. doi:10.12968/bjca.2018.13.11.545

Panagioti, M., Skevington, S. M., Hann, M., Howells, K., Blakemore, A., Reeves, D., & Bower, P. (2018). Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice. Quality of Life Research, 27(5), 1257–1268. doi:10.1007/s11136-017-1775-2

Serper, M., Patzer, R. E., Curtis, L. M., Smith, S. G., O’Conor, R., Baker, D. W., & Wolf, M. S. (2014). Health literacy, cognitive ability, and functional health status among older adults. Health Services Research, 49(4), 1249–1267. doi:10.1111/1475-6773.12154

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2008). National Action Plan to Improve Health Literacy. Washington, DC: U.S. Department of Health and Human Services.

Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165(17), 1946–1952. doi:10.1001/archinte.165.17.1946