10/09/2020

Today's COVID-19 Report: Friday, October 9, 2020

Friday, October 9, 2020

Here are the latest need-to-know updates for Friday, October 9 regarding the COVID-19 pandemic. 

DeWine Administration releases visitation order

Yesterday evening, the DeWine Administration posted the revised Director’s Order allowing nursing homes and assisted living to facilitate visitation indoors. The guidance comes just four days before the order takes effect on October 12, leaving providers little time to prepare.

Changes in the order include:

• Requirements for providers to report to ODH information to be included in an online dashboard. This information includes: facility name, facility type, facility contact information, facility county, visitation status, visitation hours, total outdoor visitations, total indoor visitations, total visitations, maximum visitation time, visitation hours and total visitors. This morning ODH shared registration instructions for data entry for the visitation dashboard.
• Specific requirements related indoor visitation, which includes requirements for ingress and egress routes, escort, and restroom use.
• An expanded section speaking to compassionate care visitation, with specific examples of compassionate care including family members who previously assisted with feeding duties.
• Recommendations for testing visitors.

LeadingAge Ohio is continuing to evaluate the impact of the new order, and encourages members to send questions and concerns to COVID19@leadingageohio.org.

Focused infection control survey tip sheet

The Focused Infection Control Surveys (FIC) are continuing, and surveyors are increasing time spent reviewing documents and being onsite. These surveys are happening frequently based on the QSO-20-35-All survey prioritization memo. LeadingAge Ohio has developed this Focused Infection Control (FIC) Survey tip sheet to support you in preparing for the ongoing FIC surveys.

The Centers for Medicare & Medicaid Services (CMS) provides the focused infection control survey tools on the CMS Nursing Home webpage. These tools were developed to assess how a provider is applying standards of practice. Facilities should use these same tools to assess their own compliance and identify opportunities for improvement. The survey summary lists the actions conducted offsite, onsite, and evaluation of the facility self-assessment.

LeadingAge Ohio recommends its nursing facility members make the following preparations, taken from the COVID 19 Focused Surveyor resources found in the surveyor resources zip file found under the download section of the CMS Nursing Home webpage:

• Develop an electronic file of the entrance conference worksheet document request. Check the date modified to ensure you have the most current version. This worksheet includes the 14 items and EHR information they will request at the beginning of the survey. Recent additions include:
   
  • Update floor plan to include the different COVID units
  • The working schedule request now includes all staff and their departments
  • Procedures to address resident and staff who refuse testing or are unable to be tested
  • Documentation related to COVID-19 testing, which may include the facility’s testing plan, logs of county level positivity rates, testing schedules, list of staff who have confirmed or suspected cases of COVID-19, and if there were testing issues, contact with state and local health departments.
  • Location of resident COVID test results in the EHR
    
    
• Utilize the COVID Focused Survey for Nursing Homes pathway to conduct your own observations, interviews, and record reviews.
  
  
• The pathway covers the staff interview questions. Interviewing staff will identify knowledge and additional training needs. Some of the staff interview questions include:
  
  
  • Do you have enough PPE and training on donning and doffing?
  • Who is your infection preventionist?
  • Are you aware of transmission-based precautions and how staff are monitored for compliance?
  • How do you know who is in isolation?
  • What is the protocol for new admissions?
  • Do you have any dialysis residents? What are your protocols?
  • What PPE do you wear and for which residents? Do you have enough and do all staff wear it? Who do you go to if you need PPE?
  • When did you last receive training on hand hygiene and PPE?
  • How often does the facility test residents and staff?
  • When do you do hand washing, use ABHR, and when do residents?
  • How are you screened when you come to work?
  • Does the facility allow sick people to work?
    
    
• Resident interviews are so important and can identify additional education needed for staff as well as the resident. A few of these questions include:
  
  
  • Have you received education and information on COVID?
  • Do they keep you updated on cases?
  • Have you had any symptoms, and did they test you?
  • Are you aware of anyone else with symptoms such as a cough?
  • How often do they take your vital signs?
  • How are you reminded to wash your hands and how often?
  • Is staff wearing PPE and washing their hands?
  • Are you encouraged to wear a mask if you come out of your room?
  • Do you eat in your room or common area, attend group activities, or have visitors and if so are you socially distanced?
  • How often do they clean your room, and do you have concerns with cleaning?
    
    
• Doing observations of residents, visitors, and staff will identify compliance with infection control practices. The following areas most frequently found to be out of compliance:
  
  
  • Hand washing time, supplies available, turning off faucet with clean hands, not performing after glove use
  • ABHR dispensers outside of at least every four rooms, common areas, and access points
  • Lack of using ABHR when hand washing not required, entering/exiting resident rooms, and when delivering meal trays.
  • PPE donning and doffing
  • Lack of resident hand hygiene
  • Environmental cleaning practices and contact time compliance
  • Equipment cleaning and individual use practices
  • Universal source control measures including eye protection and respirator practices
  • Signage as indicated are readily visible, outside resident rooms, and entrances
  • Residents wearing face covering when out of room or when staff are providing care
  • Compliance with social distancing
    
    
• The surveyor will interview the infection preventionist and other administrative staff. Utilize the survey tools to evaluate all areas of infection control practices as well as the QSO-20-38-NH-revised memo. Some of the item’s surveyors will review include:
  
  
  • Infection prevention and control policies & protocols, COVID emergency preparedness plan including 1135 waiver policy and E-24 staffing plan.
  • Infection Preventionist responsibilities
  • Tracking tools for testing and COVID+
  • Reporting requirements include NHSN data entry
  • County positivity rate
  • Notifications to residents, families, and staff

Doing a comprehensive review of all of these documents will assist a facility in preparing for the survey and reducing time spent collecting information on the day the surveyor initiates the survey.

CMP-funded technology payments

ODM has approved 751 applications for the CMP-funded technology grants offered earlier this summer in response to the pandemic. While each of these 751 facilities should have received an email from ODM with directions for submitting documentation, hundreds have either not yet submitted the required documentation OR have submitted the documentation but have done so in a way that causes the submission to be returned to the facility for additional follow-up. To ensure that a facility’s submission is as complete as possible, facilities should carefully follow the details on the attached.

In yesterday’s monthly meeting with the provider associations, ODM noted that three errors tend to cause delays:

1. Failing to provide the facility’s Medicaid number – this should be in BOTH the subject line of the email AND the body of the email;
2. Failing to include the name and full facility address to which ODM should send the check; and
3. Sending a screen shot of receipts rather than a pdf --  only a pdf of the receipts is acceptable.

ODM update on NF post-payment review audits

In a meeting with nursing facility policy and program integrity staff of the Ohio Department of Medicaid (ODM) this week, ODM staff shared progress on the post-payment review audits for FY 2017 and FY2018. Of roughly 1430 reports scheduled, ODM has already sent out over 700. The rest will be sent by October 30. In addition, all providers who will not receive a report will receive an emailed notification indicating this by October 30.

Unlike previous years, this year’s reports are being sent by email only. While most providers are providing positive feedback on this method of distribution, it has created some challenges for ODM as it finds invalid emails or bouncebacks. As in previous years, nursing faciliites should be sure to send in their resolution form within 30 days of receiving the report. Questions related to this process may be directed to Susan Wallace at swallace@leadingageohio.org.

Updates on project ECHO 

The team at the University of New Mexico working on project ECHO has made some changes to accommodate nursing homes that are interested in participating but raised questions. Changes include:

• Teams do NOT have to include the most senior staff or a medical director or director of nursing.
• Teams may consist of three members, rather than being held to four.  Participants from a facility can take turns, as long as they bring information back to the full team.  For example, a nursing home might have seven people participating in the learning collaborative. They could alternate weeks, with one three person team attending one week and a four person team attending the next week.
• Minimum attendance to qualify for the $6,000 stipend from Provider Relief Funds is now 13 sessions.

A reminder that interested nursing homes may sign up at this link. ECHO staff are aware that some hubs are already reaching out to nursing homes. It is still recommended to sign up through this link.

LeadingAge Need to Know: COVID-19 – October 9, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured a reminder that today is the deadline to fill out the Home Health and Hospice survey!

Check out the full report here.

                                        

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Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.