Additional Q&A Information on COVID-19
Yesterday, FSLA staff spent most of the day answering questions regarding the latest COVID-19 guidance published by the
Governor’s 3/14/20 Press Conference; the DEM Order No. 20-006; and a CMS 3/15/20 Revised Memo to Surveyors (specific to Nursing Homes and State Survey Agency focus).
Some of the information that we have previously published has either changed or been updated based on your questions and concerns, for example allowing home healthcare providers into your buildings and admitting new residents. We are in constant contact with the Agency for Health Care Administration (AHCA), Department of Health, (DOH) and the Emergency Management Office (EOC) and as information changes, we will provide you with the most up-to-date guidelines and restrictions.
Please continue to send us your questions and concerns by email at:
We will get every question answered for you as soon as possible.
AHCA addressed the following questions yesterday on a conference call.
- Will ALFs and NHs be cited for failing to meet staffing ratios during the COVID-19 outbreak?
AHCA will not penalize a facility for not meeting staffing requirements [in rule, statute]; however, facilities must have sufficient staff to take care of their residents. That includes providing the same level of care that you are providing now.
- Physical Plant/Operation workers were not mentioned in the Executive Order’s list of persons exempted from the visitor ban. Can they be admitted to perform maintenance or repairs to essential equipment?
Admit repairmen as needed to keep operations running.
However, apply the screening standards and PPE as indicated and limit exposure and close contact to residents and staff. (Principle: everyone is subject to the screening standards and the PPE policies at your facility.)
This should be handled on a case by case basis. Look for alternative ways to meet the need.
We don't need to remind you but this virus is highly contagious so please be cognizant of anyone entering your building.
DOCUMENT, DOCUMENT, DOCUMENT.
- If a family member is the one providing health care, can they be admitted?
If you have a care plan and are charging the family for care, then the community is the primary caregiver.
Emergency Status System
- An event, "COVID-19 Monitoring” was opened in the Emergency Status System on 3/15/20. Does the Emergency Status System have to be completed every day?
AHCA sent an email to all ALFs and nursing homes asking them to complete the following sections of the ESS by 10:00 a.m. every day. Those sections include:
1) Facility Contacts;
2) Current Resident Census; and
3) Available beds.
- Does a staff member returning from a domestic flight trip have to be tested for COVID-19 before returning to work?
According to the
Governor's Emergency Order
, anyone who traveled through any airport within the past 14 days will not be allowed to enter a community.
- Should a nursing home or ALF be expected to admit a patient from a hospital?
Hospitals should be testing for COVID-19 before they transfer a patient to a nursing home or ALF. The Florida Health Care Association and the Florida Hospital Association developed a
Voluntary Transfer Form
that was designed to be used for hospital-nursing home transfers; It should be suitable for hospital-ALF transfers as well.
COVID-Positive Cases in a NH or ALF
- What actions should a NH or ALF take if a resident tests positive for COVID-19 recognizing that the capabilities are significantly different?
Isolate in place to the extent possible (utilizing the COVID-19 infection control guidelines). If PPE is inadequate to prevent contagion, work to transfer to a hospital or to another facility that is better equipped.
If one or more of your residents are being tested as a person under investigation, call your local County Health Department and contact AHCA. Both should be aware so they can immediately reach out to the facility.
AHCA representatives continue to work closely with other local and state agencies to monitor any persons under investigation in a nursing home or ALF.
An AHCA visit will not be regulatory in nature but to make sure adequate PPEs and supplies are in place and being utilized.
Personal Protective Equipment and Supplies
- If a nursing home or ALF is running out of PPE and their regular supplier/vendor has indicated that they can’t make deliveries as needed, what should the provider do?
Contact your County Health Department (which will likely be activated into the local emergency management office).
Please fill out the
Providers may be charged for the supplies later.
- We’re a small community and get our supplies from WalMart; they have suspended deliveries of food. Is there anything we can do besides sending staff to the store to get needed provisions?
Contact your County Health Department; they may be able to help with a pathway.
- Is the Agency conducting recertification surveys?
At this time, AHCA is only conducting surveys for 1) recent infection control deficiencies; 2) complaints that could be Immediate Jeopardy; and 3) complaints that are related to abuse or neglect.
- Are residents to be screened for COVID-19 every day? Yes.
- Is there a form for screening staff for a respiratory illness?
A form for staff screening is not specified by the Emergency Order; there are some authoritative resources that can be used on the DOH site.
Resident Care and Services
- Is it okay to restrict residents to their rooms (an ALF in Broward County)?
For now, the provider will and/or the County Health Department/Emergency Management Office will decide on this policy; and it will likely be a case by case basis depending on resident population and contagion risk.
- We have two symptomatic residents; do we need to isolate them?
Call the doctor and tell them the resident(s) is symptomatic and the doctor will order the tests as needed and give you further instructions about getting a test. If you have to transport the resident for testing alert the transportation provider that they are transporting a resident that is being tested. Hospitals are doing most of the testing right now.
- Is communal dining okay especially if distance is maintained?
Background: The Center for Medicare and Medicaid Services provides regulatory mandates to skilled nursing facilities and survey requirements to the state survey agency directors.
CMS’s latest Guidance (
QSO-20-14 NH Revised 3/13/20
) indicated that nursing homes should cancel communal dining. However, it was pointed out that the document is nursing guidance and that AHCA will consider whether to restrict communal dining in ALFs.
- Rehabilitative services are provided in a small group setting. Is this alright to continue?
AHCA will obtain further clarification and are focused on supportive measures.
- Activities such as games are provided in a small group setting. Are these alright to provide for residents?
The 3/13/20 CMS Memo is guidance and the facility may need to make an executive decision based on the guidelines. Educate residents on the facility’s process.
State of Florida Interactive DOH Data and Survellance Map
for the latest COVID-19 data and surveillance dashboard report.