Today's COVID-19 Report: Friday, September 18, 2020
Friday, September 18, 2020
Here are the latest need-to-know updates for Friday, September 18, 2020 regarding the COVID-19 pandemic. FOR MEMBERS WITH BD VERITOR DEVICES, PLEASE NOTE THIS AFTERNOON’S BD TESTING WEBINAR.
Governor DeWine incorrectly points blame at nursing homes for visitation frustrations
During a press briefing (1 hour 02 minute mark) yesterday, Governor DeWine stated: “If you have a loved one, and you cannot get into a nursing home, that is the nursing home that is stopping you from going in. It is not the Health Department." This is incorrect. LeadingAge Ohio has advocated for months for the reopening of safe indoor visitation, and is currently working with association partners and the DeWine Administration on guidance for that reopening. Neither the Governor nor the Ohio Department of Health have given providers guidance or permission to resume indoor visitation, and the Administration later clarified that indoor visitation has not yet been reopened by the state.
Kathryn Brod stated the following in response to the statement:
"When the Governor stated that nursing homes were to blame for ongoing visitation restrictions, we heard an immediate outcry from providers around the state. Our members continue to follow state and federal regulations pertaining to visitation, and at no point have Ohio providers been given guidance or permission to offer indoor visitation from the Administration."
LeadingAge Ohio is aware that many members have received calls regarding visitation from families and loved ones who tuned in to the press conference. LeadingAge Ohio is distributing the statement above and a descriptive infographic citing the ongoing Director’s Orders on visitation to state leaders and the media to ensure that this inaccurate statement is rectified.
Assisted living testing program restarting; Adult Day testing to launch
This morning Director McElroy hosted a webinar on the re-start of bi-weekly Assisted Living testing in Ohio on September 28. The Ohio August 24 Order on testing in residential care facilities directs facilities to comply with testing as outlined by the State. Immediately following, ODA held a similar webinar for Ohio adult day services and senior centers, following up on an August 31 order allowing these settings to reopen, but with testing requirements for staff and participants. Ohio will be using the same lab, MAKO Medical, to meet needs of assisted living, adult day and senior centers, and the roll-out process will follow similar procedures.
Key changes from the assisted living testing process in place before include: the lab performing the testing is the North Carolina-based lab MAKO Medical; testing will use an anterior nares swab process; the specimen collection process does NOT require a licensed personnel to complete; specimen collection will occur Monday – Friday only (i.e. no weekend collections will be scheduled); and, finally, employees will be able to access their own testing results through the MAKO website. Both assisted living and adult day providers will be required to conduct testing for staff every other week; assisted living will only test residents strategically, while adult day will test all participants every other week.
Providers are able to opt-in or opt-out of this state supported plan. A survey monkey to confirm the assisted living facility’s desire to opt-in or opt-out is required to be completed by September 21. Based on the results of this survey, ODA will schedule all assisted living facilities who have indicated they would like to opt-in; facilities will NOT have the option to change their testing date. Adult day providers are also provided the option to opt-in or opt-out. These providers must complete the survey to receive scheduling support directly from MAKO.
For both assisted living and adult day providers who opt-in, MAKO will send a welcome email; this welcome email will include directions for a facility contact person to set up a login to the MAKO website for two different accounts – an employee testing portal and a resident/participant testing portal; additional users may be added. Facilities will be able to login to retrieve results, and, as noted above, employees will also be able to access their own results. NOTE: MAKO recommends use of Google Chrome when accessing its website. Supplies will be automatically sent to the facility based on the survey monkey responses. MAKO noted that to date, it has processed over one million COVID-19 tests, with 98% of those tests having results provided within 48 hours of MAKO receiving the specimen.
As before, All providers are to notify the local health department of positive results. In addition, all testing results should be reported through a reporting tool; this reporting tool link has not yet been posted, but Director McElroy indicated that it would be posted shortly.
Abbott BinaxNOW (cards) distribution and webinar TODAY
LeadingAge learned on Thursday that Abbott BinaxNOW (cards) tests are already in the mail from Abbott. They have reportedly shipped about 1 million of them to SNF operators and 540,000 to assisted living providers with CLIA waivers (there are about 5,400 of them). Home health providers will be on a future distribution list. HHS has not issued a distribution plan in writing.
LeadingAge Ohio received notice from the HHS Binax Team that they would offer a webinar today, September 18, from Noon – 1:00 Eastern, for assisted living facilities receiving Abbott BinaxNOW tests from HHS. Presumably this will help nursing homes as well. The webinar will “walk through the manufacturer’s training, introduce the product, and discuss use in assisted living facilities. During the webinar, Abbott will demonstrate the training tools available and representatives from the U.S. government will be online to speak about the program. Use this link to register for the training.” The webinar will accommodate 10,000 registrants but we know this information is reaching LeadingAge Ohio members too late to participate. We’ve learned, however, that the session will be recorded and available for review and shared. Access the Abbott BinaxNOW training portal here.
Long-term care facility reporting requirements webinar on Monday, September 21
The Ohio Department of Health (ODH) will be providing a webinar on Monday, September 21 at 3:00 pm, with a purpose of explaining the reporting requirements that must be followed by long-term care facilities once facilities start performing COVID-19 testing on the point of care (POC) antigen testing devices, including BD Veritor Ag, Quidel Sofia Ag, and Abbott BinaxNOW Ag Card.
The agenda will include a brief discussion on case/line level reporting and aggregate count reporting and a demo on creation of the CSV file for electronically submitting POC device results at the line level. LeadingAge Ohio strongly encourages all members who have received or are planning to purchase point of care (POC) devices or Abbott cards to attend the webinar.
CMS releases new indoor visitation guidance; Ohio order allowing only outdoor visitation remains in effect
While Ohio’s consideration of indoor visitation is still underway through the Administration’s work with ODH and the provider associations, on September 17, the Centers for Medicare & Medicaid Services (CMS) released memo QSO 20-39-NH which provides new indoor visitation guidance. The QSO 20-39-NH memo outlines guidance for indoor/outdoor visitation, communal dining and activities, compassionate care visits, and access to the Ombudsman or protection representatives. CMS announced CMP funds up to $3,000 will be offered to support visitation.
CMS notes that visitation should be person-centered, consider the residents’ physical, mental, and psychosocial well-being, and support their quality of life. The risk of transmission can be further reduced using physical barriers (e.g., clear Plexiglas dividers, curtains). Also, nursing homes should enable visits to be conducted with an adequate degree of privacy. Outdoor visitation is still the preferred option and should be routinely offered. CMS states that facilities may not restrict visitation without a reasonable clinical or safety cause, consistent with §483.10(f)(4)(v).
Support for indoor visitation is outlined in the new memo, including visits for reasons beyond compassionate care situations, based on the following guidelines:
- There has been no new onset of COVID-19 cases in the last 14 days and the facility is not currently conducting outbreak testing;
- Visitors should be able to adhere to the core principles and staff should provide monitoring for those who may have difficulty adhering to core principles, such as children;
- Facilities should limit the number of visitors per resident at one time and limit the total number of visitors in the facility at one time (based on the size of the building and physical space). Facilities should consider scheduling visits for a specified length of time to help ensure all residents are able to receive visitors; and
- Facilities should limit movement in the facility. For example, visitors should not walk around different halls of the facility. Rather, they should go directly to the resident’s room or designated visitation area. Visits for residents who share a room should not be conducted in the resident’s room.
Facilities should use the CMS COVID-19 county positivity rate to determine how to facilitate indoor visitation as follows:
- Low (<5%) = Visitation should only occur for compassionate care situations according to the core principles of COVID-19 infection prevention and facility policies (beyond compassionate care visits)
- Medium (5% – 10%) = Visitation should occur according to the core principles of COVID-19 infection prevention and facility policies (beyond compassionate care visits)
- High (>10%) = Visitation should only occur for compassionate care situations according to the core principles of COVID-19 infection prevention and facility policies
Having a person-centered approach prevents CMS from having to distinguish different categories of visitors such as essential caregivers.
While not required, CMS encourages facilities in medium or high-positivity counties to test visitors, if feasible. If so, facilities should prioritize visitors that visit regularly (e.g., weekly), although any visitor can be tested. Facilities may also encourage visitors to be tested on their own prior to coming to the facility (e.g., within 2–3 days) with proof of negative test results and date of test.
CMS further supports and clarifies compassionate care visits including visits conducted by any individual that can meet the resident’s needs, such as clergy or lay persons offering religious and spiritual support. Examples of other types of compassionate care situations include, but are not limited to:
- A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
- A resident who is grieving after a friend or family member recently passed away.
- A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
- A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).
Residents who are on transmission-based precautions for COVID-19 should only receive visits that are virtual, through windows, or in-person for compassionate care situations, with adherence to transmission-based precautions.
During this public health emergency, in-person access to an Ombudsman may be limited due to infection control concerns and/or transmission of COVID-19; however, in-person access may not be limited without reasonable cause.
Section 483.10(f)(4)(i)(E) and (F) requires the facility to allow immediate access to a resident by any representative of the protection and advocacy systems, as designated by the state, and as established under the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (DD Act), and of the agency responsible for the protection and advocacy system for individuals with a mental disorder (established under the Protection and Advocacy for Mentally Ill Individuals Act of 2000).
Health care workers who are not employees of the facility but provide direct care to the facility’s residents, such as hospice workers, Emergency Medical Services (EMS) personnel, dialysis technicians, laboratory technicians, radiology technicians, social workers, clergy etc., must be permitted to come into the facility if they are not subject to a work exclusion due to an exposure to COVID-19 or show signs or symptoms of COVID-19 after being screened.
While adhering to the core principles of COVID-19 infection prevention, communal activities and dining may occur.
Surveyor guidance on compliance with the QSO are as follows:
- For concerns related to resident communication with and access to persons and services inside and outside the facility, surveyors should investigate for non-compliance at 42 CFR 483.10(b), F550.
- For concerns related to a facility limiting visitors without a reasonable clinical and safety cause, surveyors should investigate for non-compliance at 42 CFR 483.10(f)(4), F563.
- For concerns related to ombudsman access to the resident and the resident’s medical record, surveyors should investigate for non-compliance at 42 CFR 483.10(f)(4)(i)(C), F562 and 483.10(h)(3)(ii), F583.
- For concerns related to lack of adherence to infection control practices, surveyors should investigate for non-compliance at 42 CFR 483.80(a), F880.
CMS will now approve the use of CMP funds to purchase tents for outdoor visitation and/or clear dividers (e.g., Plexiglas or similar product) to create a physical barrier to reduce the risk of transmission during in person visits. Funding for tents and clear dividers is also limited to a maximum of $3,000 per facility. NOTE: When installing tents, facilities need to ensure appropriate life safety code requirements found at 42 CFR 483.90 are met, unless waived under the PHE declaration. To apply to receive CMP funds for communicative devices, tents, or clear dividers, please contact your state agency’s CMP contact.
Training with BD experts on Veritor Plus COVID-19 testing TODAY 3:00 PM
LeadingAge is partnering with BD to host an exclusive training on the BD Veritor System. This free training will provide key info on:
- Rapid antigen testing for COVID-19
- How the BD Veritor Plus System works
- Key information on how to get support from BD on test results and accuracy.
There will be a demonstration from BD staff and then a live Q and A session for members. The second part of the training will be with LeadingAge staff and cover Infection Control and other key topics. Please register for the training here.
LeadingAge Coronavirus update call on Monday, September 21
Admiral Brett Giroir, MD, Administration testing lead will speak directly to LeadingAge members on the LeadingAge Coronavirus Update Call at 3:30 Eastern on Monday, September 21.
Should we be using antigen testing for surveillance? What’s your PCR testing experience lately, looking for shorter turnaround times? How long will you have to wait for BD test kits? If you offer assisted living services and do not have a CLIA waiver, how can you get Abbot BinaxNOW tests? Will home health providers or hospice providers receive Abbott cards?
Join the LeadingAge Coronavirus Update Call at 3:30 Eastern on Monday, September 21 to hear answers to these and other questions related to testing. (Note: this is not a session on the CMS Interim Final Rule.) If you aren’t already registered for these calls, you can register here.
Training with Quidel Experts on Sofia COVID-19 Testing on Thursday, September 24
LeadingAge will partner with Quidel to offer an exclusive training on the Quidel Sofia analyzers on Thursday, September 24 at 3:00 PM Eastern. As with the BD Veritor training, Quidel trainers will demonstrate how to use the machine, provide details on batch testing, and answer member questions. LeadingAge’s Jodi Eyigor and Janine Finck-Boyle will be on hand to answer member questions about the CMS Interim Final Rule and other topics. You can register for the training here.
Independent Nursing Home COVID-19 Commission Findings Validate Unprecedented Federal Response; call on Monday, September 21
On September 16, CMS received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE. CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the Coronavirus Disease 2019 (COVID-19) in nursing homes. The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. This announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.
“The Trump Administration’s effort to protect the uniquely vulnerable residents of nursing homes from COVID-19 is nothing short of unprecedented,” said CMS Administrator Seema Verma. “In tasking a contractor to convene this independent Commission comprised of a broad range of experts and stakeholders, President Trump sought to refine our approach still further as we continue to battle the virus in the months to come. Its findings represent both an invaluable action plan for the future and a resounding vindication of our overall approach to date. We are grateful for the Commission’s important contribution.”
As outlined in the overview released on September 16, the Trump Administration has already taken significant steps to implement many of the Commission’s findings. The Administration has worked to support nursing homes financially during this challenging time, distributing over $21 billion to America’s nursing homes – more than $1.5 million each on average. To ensure nursing homes had access to supplies, the Trump Administration shipped a 14-day supply of personal protective equipment to more than 15,000 nursing homes across the Nation in May.
The Administration has also required facilities to report data about COVID-19 cases, deaths, and supply levels, with 99.3 percent of facilities currently reporting. CMS took action to keep COVID-19 out of nursing homes by requiring them to test staff, a requirement that was paired with the Administration’s distribution of 13,850 point-of-care testing devices to America’s nursing homes. The Administration has also deployed federal Task Force Strike Teams in six waves, in 18 states so far, to 61 facilities particularly affected by COVID-19 to share best practices and gain a deeper understanding of how the virus spreads. CMS also required states to conduct focused infection control inspections at their nursing homes; between June and July, states completed these inspections at 99.8 percent of Medicare and Medicaid certified nursing homes.
Additionally, since March, CMS has conducted weekly calls with nursing homes, issued over 22 guidance documents and established a National Nursing Home COVID-19 Training program focused on infection control and best practices. CMS is also using COVID-19 data to target support to the highest risk nursing homes. In May, CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to nursing homes. The toolkit is a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19. CMS updates the toolkit on a biweekly basis.
For More Information:
- Coronavirus Commission for Safety and Quality in Nursing Homes Report
- Trump Administration Response to Commission findings
- COVID-19 Guidance and Updates for Nursing Homes during COVID-19
See the full text of this excerpted CMS Press Release (issued September 16), including a list of CMS public health actions for nursing homes on COVID-19 to date.
There will be a call on Monday for nursing home stakeholders per the announcement below. Here are details:
The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. This announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.
Join CMS Chief Medical Officer Lee Fleisher, MD and agency officials for a National Stakeholder Call with Nursing Homes to discuss the announcement, Monday, September 21 from 2:00 – 2:30 PM Eastern.
Toll Free Dial-In Number: (833) 614-0820
Conference ID: 7883929
Conference lines are limited, so participants are encouraged to join via webcast with this link.
HB606 signed, health care workers now have additional protections
On Monday, Governor Mike DeWine signed HB606, Ohio’s bill that would extend civil immunity to providers and employers acting during the coronavirus public health emergency. The bill will take effect in 90 days and lasts through September 2021. LeadingAge Ohio heavily advocated for the quick passage of this legislation, which will protect long-term care staff from frivolous lawsuits during the ongoing crisis.
The bill applies to “acts, omissions, conduct, decisions, or compliance from the date of the Governor’s Executive Order 2020-01D, issued on March 9, 2020 declaring a state of emergency due to COVID-19 through September 30, 2021.” The two chambers of the General Assembly worked together to iron out the differences that were needed to move the bill through each chamber, and the Governor’s virtual bill signing marks a major victory for LeadingAge Ohio members, who have been seeking this protection since the early days of the pandemic.
Activity professionals discuss plan development for visitation shift and holiday season activities
Activity professionals within the LeadingAge Ohio membership are continuing to come together to offer support, share ideas, and discuss resources in the midst of current COVID-19 restrictions. On yesterday’s call, Stephanie DeWees, LeadingAge Ohio’s Quality and Regulatory Specialist for Long-Term Care, shared LeadingAge Ohio’s efforts in working with the Administration to develop the guidance for indoor visitation as colder weather is fast approaching. Members were encouraged to start exploring with their staff additional areas within their communities that could be used as potential indoor visitation areas. Activity staff shared some creative ideas for upcoming holiday celebrations for Halloween and preparing for the Thanksgiving and Christmas season.
Please contact Jen Taylor at firstname.lastname@example.org to ensure activities staff are receiving information on LeadingAge Ohio activities events.
LeadingAge Need to Know: COVID-19 – September 18, 2020
LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured news on two COVID-19 webinars taking place today and reminder about National Day of Action next Wednesday.
Check out the full report here.
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.