Please keep reading our information because it changes every day. Below is the latest information provided to the association -- please note that we will continue to send updates as soon as we receive any new information.
September 14, 2020
In This Issue:
  • Just to Clarify -- Your Questions Answered
  • Rapid Antigen Tests Available for ALFs
  • Issue Brief: What To Do When Your Resident Goes Off-Site
Just to Clarify . . .

During a call on Friday morning with AHCA Secretary Mary Mayhew, FSLA asked the following questions:

  • Will the mandatory staff testing be continued?
ANSWER: No, according to AHCA's latest guidance, the Emergency Rules requiring biweekly staff testing for nursing homes and assisted living facilities expired September 13, 2020 and will not be renewed; 59AER20-4 and 59AER20-5,FAC. 

Staff testing will end on September 15, 2020. If you still have tests, please go ahead and use them to test your staff and send to Curative as soon as possible. All tests must be postmarked by September 15, 2020 to be completed. If you have tests that you are not planning to use, please return them to Curative by September 15, 2020 or the state will be charged $125 per test.

  • Do staff need to monitor essential caregiver (EC) and compassionate care (CC) resident visits inside their apartments?
ANSWER: No, but staff may want to check in during the visit every so often. Residents and their EC/CC visitors should have a reasonable expectation of privacy.

  • Is there a time limit for EC and CC visits?
ANSWER: At this time, there is not a time limit on EC and CC visits. Facilities must schedule visitor time and be able to manage visitors in a fair manner for all residents.

We just learned from Secretary Mayhew that AHCA is going to send out a clarification that essential caregivers and compassionate caregivers should not be time limited.
  • Can a community resume Church Services if the community observes social distancing?
ANSWER: No, at this time, activities still have not been allowed in a group setting. Please consider using facebook live or other technology to broadcast Church services.
  • Is the community required to provide PPE to the visitors?
ANSWER: No, visitors must wear PPE, but communities are not required to provide it.
  • Is the community required to provide PPE to visitors if they receive supplies from the state’s emergency management office?
ANSWER: No, proper PPE must be purchased by the visitor.

For additional clarification on PPE, please refer to Question #5 of the latest set of AHCA Questions & Answers for more information.

  • Will rapid tests at ALFs require the facility to acquire a Clinical Laboratory Improvement Amendments (CLIA) waiver?
ANSWER: Yes, that was the interpretation that was given by AHCA on the AHCA/FHCA call on Thursday. Deputy Secretary Molly McKinstry tells us that many communities have already applied for CLIA. If you are interested in applying for a CLIA waiver, please CLICK HERE.

  • Who determines the local infection rate, and how will facilities be notified on how often they need to test employees?
ANSWER: CMS testing rule applies to nursing homes, not ALFs.

  • Will a new staff member still be required to have a negative COVID-19 test before starting work?
ANSWER: The AHCA emergency rule requiring staff testing expired on September 13 2020 and not be renewed.

  • Are tours allowed at assisted living communities?
ANSWER: Yes, see question #16 in AHCA’s September 4, 2020 Q&A

  • Can family members take residents off campus for visits or short stays?
ANSWER: Residents are allowed to leave ALFs; however, they may be subject to 14-day isolation upon their return. Please see Issue Brief below for more information.

  • Are the CC and EC visits allowed to be inside the facility?

  • Are ALFs and SNF's requirements for testing both expiring?
ANSWER: The emergency rule expired on September 13 and the Curative contract expires on September15. The contract will not be renewed.

  • What are the cleaning protocols for before and after visitation?
ANSWER: See CDC guidance.

  • Who will set the local requirements for frequency of testing?
ANSWER: The CMS staff testing rule applies to nursing homes, not ALFs. The AHCA staff testing emergency rule expired on September 13.
Assisted Living Communities with CLIA Waivers
Set to Receive Rapid Antigen Tests from Abbott Labs

HHS shared that the federal government intends to prioritize Assisted Living in the distribution of point-of-care COVID-19 antigen tests from Abbott Laboratories, cleared for emergency use by the FDA last week.

To receive these tests, ALFs must have a CLIA waiver certificate. Apply for a CLIA waiver by clicking here and scrolling down to the middle of the page to read the application instructions and download a copy of the application.
Issue Brief: What To Do When Residents Go Off-Site
Jason Hand, Esq., FSLA Vice President of Public Policy and Legal Affairs

Florida Senior Living Association (FSLA) has frequently been asked how communities should respond when a resident wants to go off-site – whether it’s a trip to the doctor or lunch at a local restaurant with their family. Here's some information for you to consider.

Should communities prohibit the resident from leaving? Should all residents automatically be quarantined/isolated for some period of time when they return? What if the resident wears PPE, etc.? The short answer is that it depends.

Allow us to explain . . .

1. Can communities prohibit residents from going off-site?
Generally No. Florida’s resident bill of rights says no resident of a community shall be deprived of any rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a community. See, 429.28(1), F.S.

Further, the CDC’s guidelinesConsiderations for Preventing Spread of COVID-19 in Assisted Living Facilitiesstate communities should “encourage residents to wear a cloth face covering (if tolerated) whenever they are around others, including when they leave their rooms and when they leave the facility (e.g., residents receiving hemodialysis).”

Something similar was addressed in the FAQ from CMS’s QSO 20-28 for nursing homes:

Question: What if a resident wants to leave the nursing home against medical advice?

Answer: It is unlawful for a facility to detain and stop a resident from leaving the facility if the resident wishes to leave. Because of the risks of transmission of COVID-19, facilities should strongly discourage residents from leaving the facility and follow the guidelines released by local or state jurisdictions. If a resident insists on leaving against medical advice, the facility must allow them to leave, encourage them to wear a facemask while out in the community, discuss the importance of handwashing, offer hand sanitizer if available, and document in the resident’s medical record how the facility discouraged leaving and explained the risks of leaving to the resident and/or resident representative.

It is possible for the state to require communities to quarantine/isolate residents. For example, under Governor DeSantis’s Executive Order 20-51, the Florida Department of Health (DOH) must ensure all individuals meeting the CDC’s definition of persons under investigation are isolated or quarantined for 14 days or until the person tests negative for COVID-19. Additionally, DOH is directed to make its own decisions as to quarantine, isolation and any other necessary public health interventions as permitted under Florida law. However, for residents in general, the state has only stated that “residents are discouraged from leaving the facility.” See DEM Emergency Order 20-006, superseded by DEM Emergency Order 20-009.

2. What should a community do when a resident returns from an off-site medical appointment, restaurant or activity?

Per DEM Emergency Order 20-009, all residents must be screened upon their return. Specifically, individuals seeking entry to the community will not be allowed to enter if they meet any of the screening criteria listed below:

  • Any person infected with COVID-19 who does not meet the most recent criteria from the CDC to end quarantine.
  • Any person showing, presenting signs or symptoms of, or disclosing the presence of a respiratory infection, including cough, fever, shortness of breath, sore throat, chills, headache, muscle pain, repeated shaking with chills, new loss of taste or smell, or any other COVID-19 symptoms identified by the CDC.
  • Any person who has been in contact with any person(s) known to be infected with COVID-19, who does not meet the most recent criteria from the CDC to end isolation.

The above screening criteria only applies to prohibit residents from re-entering the community. However, communities should not stop there. For residents who pass the screening, communities should consider additional criteria to determine whether a resident quarantine for any length of time upon their return.

For any resident that leaves the community who cannot (or will not) wear a face mask, communities should consider the risk of transmission and exposure to the resident while they are away from the community and the risk of them exposing others upon return. There are several things a community may want to consider from this perspective:

  • Public Health Advisory: The Surgeon General’s Public Health Advisory (7/20/20) states in part that:
  • All individuals over the age of 65 and all individuals of any age with high-risk health conditions should limit personal interactions outside of the home and take all measures to limit the risk of exposure to COVID-19. These measures include, but are not limited to: distancing any unavoidable personal contact by a minimum of 6 feet; wearing a face covering when social distancing is not possible; washing hands often with soap and water for at least 20 seconds, or using hand sanitizer with at least 60% alcohol; avoiding unnecessary touching of eyes, nose, and mouth, and washing hands prior to doing so; and cleaning and disinfecting high-though surfaces, including entryway door handles.
  • All individuals should refrain from participation in social or recreational gatherings of more than 10 people. For all gatherings of fewer than 10 people, individuals should practice social distancing by maintaining a distance of at least six feet from each other and wear a face covering.
  • Every individual in Florida should wear a face covering over the nose and mouth in any setting where social distancing is not possible, both indoors and outdoors.
  • CC Guidance Deciding to Go Out: In general, the more closely you interact with others and the longer that interaction, the higher the risk of COVID-19 spread. If you decide to engage in public activities, continue to protect yourself by practicing everyday preventive actions. [Note: this guidance is written for the general population, and not specifically written for seniors. As explained by the Surgeon General’s Public Health Advisory, seniors should be even more careful.]
  • CDC Guidance When to Quarantine: People who have been in close contact with someone who has COVID-19 should quarantine. Close contact is: being within 6 feet of someone who has COVID-19 for a total of 15 minutes or more; provided care at home to home who is sick with COVID-19; had direct physical contact with someone who is sick with COVID-19 (e.g., hugged or kissed them); shared eating or drinking utensil with someone who is sick with COVID-19; or someone with COVID-19 sneezed, coughed, or somehow got respiratory droplets on you.
  • DEM Emergency Order 20-009 states in part: Residents leaving the facility temporarily for medical appointments or other activities and residents receiving visits from health care providers, must wear a face mask, if tolerated by the resident’s condition. All residents must be screened upon return to the facility. Eye protection should also be encouraged. Appointments should be scheduled through the facility or group home to ensure proper screening and adherence to infection control measures.
  • Also, the AHCA 9/9/20 LTCF Expectations state: The Order also clarifies that residents may leave the facility for health care services and wear a mask while out of the facility. These residents are not required to be quarantined upon return to the facility solely based on leaving for an appointment.
  • For nursing homes, CMS QSO 20-28 states in part: Q: What if a resident wants to leave the nursing home against medical advice? A: For a resident who leaves and intends to return, the facility should monitor the resident upon return for fever and signs and symptoms of respiratory infection for 14 days (preferably in a space dedicated for observation of asymptomatic residents), and implement the necessary Transmission-Based Precautions if the resident develops fever or signs and symptoms of respiratory infection.
  • For nursing homes, CDC guidance Preparing for COVID-19 in Nursing Homes contains a section titled, “Create a Plan for Managing New Admissions and Readmissions Whose COVID-19 Status is Unknown” and states: “Depending on the prevalence of COVID-19 in the community, this might include placing the resident in a single-person room or in a separate observation area so the resident can be monitored for evidence of COVID-19. HCP should wear an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (i.e., goggles or a face shield that covers the front and sides of the face), gloves, and gown when caring for these residents. Residents can be transferred out of the observation area to the main facility if they remain afebrile and without symptoms for 14 days after their admission. Testing at the end of this period can be considered to increase certainty that the resident is not infected.” Note – although prepared for nursing homes, this guidance is linked in the CDC guidance document Considerations for Preventing Spread of COVID-19 in Assisted Living Facilities.