COVID-19 Update #292
HFAM Update

First, I want to congratulate Levindale/LifeBridge and Charles E. Smith Life Communities for mandating employee vaccination, joining Genesis Healthcare, Sava Senior Care, and Sunrise Senior Living. Click here for the previously released HFAM statement on mandatory vaccination.  As we thought would be the case, more and more organizations in our setting are likely to mandate vaccination over time. But, of course, in the absence of a state vaccination mandate, the danger is that employees simply quit one setting when a mandate is in place and go to work in another setting that does not require vaccination.
An additional operational and financial burden in the absence of a state vaccination mandate is a possible state requirement for increased testing of non-vaccinated employees or specifically requiring fit tested N95 masks for all unvaccinated employees. That testing policy was included in Governor Hogan’s order last week for Maryland State employees and the two state-run health facilities. That policy is also required in both the Massachusetts and California Governors’ vaccination mandate orders. The first value of medical care is to do no harm, and during this pandemic the number one step a direct care professional across all settings can take is to be vaccinated. 
Antibody Testing:
  • In the coming days and weeks, the Maryland Department of Health (MDH) is looking into sampling about 500 individual patients/residents in our settings for COVID-19 antibodies. These samples could be new draws with MDH staff or taken from remnant samples. Obviously, this goal will be to determine the effectiveness of initial vaccination after all these months. Just a real-time heads-up; stay tuned for details, this is fast developing.
  • We’ve been messaging for weeks now about the coming need for seasonal flu and COVID-19 booster vaccination. It is expected that skilled nursing centers will directly administer boosters, especially to residents and patients. That time will come sooner rather than later; likely in the coming weeks at this point. This is why the ImmuNet registration we have been promoting for several months is so vital. Click here for a previous HFAM update with detailed information about registering for ImmuNet.
We have also shared previously that we are entering a troubling and challenging time in the current surge. These cases seem to be driven by the Delta variant, and we see a small but increasing percentage of breakthrough cases. Recent data released by the CDC indicates that vaccinated individuals can spread the Delta variant. Given the virus trend over the last year, we are worried about future COVID-19 variants this fall. In this surge going forward, I am very concerned about staffing in Maryland hospitals and our sector—there are fewer healthcare workers across all settings right now, and often a necessary reliance on agency staff (and even agency staffing is running low).
As Always:
  • Focus on what is in your control and not what is out of your control.
  • Overcommunicate.
  • Adapt and innovate.
  • Rely on your partnerships.
  • Speak up when you need help.
  • Double efforts on infectious disease protocols, training, and operations.
  • Take and document your action; keep a timeline.
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing

Be well,
Joe DeMattos
President and CEO
Webinar Tomorrow! How to Boost Your Staff Vaccination Rates

AHCA/NCAL will host a webinar on August 11 at 3 PM Eastern focused on the recent report, Invest in Trust: A Guide for Building COVID-19 Vaccine Trust Among Certified Nursing Assistants (CNAs). The report’s lead researcher will share key findings from the report that was commissioned by the AHRQ ECHO National Nursing Home COVID-19 Action Network. You will also hear from two long term care (LTC) providers who have worked hard to improve vaccination rates among their staff.

This webinar will also involve a Q&A session to allow attendees to share their challenges and seek insight from the speakers. Through both evidence-based research and real-world stories of success, this webinar will provide you with helpful tools and knowledge to improve your staff vaccination rates.

LTC communities have been working tirelessly to build COVID-19 vaccine confidence among their staff, but data from the CDC show that approximately only 59% are fully vaccinated. With the new delta variant quickly spreading in the United States, it is more important than ever to increase staff vaccination rates.​
Facilitating Safe Visitation in LTC Communities

As COVID-19 cases rise in communities across the country, nursing home and assisted living communities must pay close attention to CMS and CDC visitation guidance to ensure they are facilitating safe visitation for residents and families. 

For skilled nursing facilities, CMS’ visitation guidance outlines core principles of infection control which all visitors, residents, and staff should adhere to. It also outlines scenarios where indoor visitation should be limited due to a high risk of COVID-19 transmission. The CDC’s guidance includes practical strategies to facilitate safe visitation and preserve residents’ quality of life.
Other COVID-19 Updates

NHSN Announces Changes to COVID-19 Vaccination Summary: The NHSN has announced new changes coming this fall to the Health Care Personnel COVID-19 Vaccination Cumulative Summary. Read More

IRS Updates FAQs on Tax Credits Under American Rescue Plan Act: Last week, the IRS updated its FAQs on the paid sick and family leave tax credits under the American Rescue Plan Act of 2021. Read More
AHCA/NCAL Letter to HHS Requests Funds Be Released Immediately

With the Delta variant causing surges in positive COVID cases across the country, the pandemic is far from over. Nursing homes and assisted living communities have been doing everything in their power to protect their residents from this deadly virus, but with increased costs to fight the pandemic, coupled with long-standing financial challenges, providers are struggling to stay afloat.

This week, long term care providers sent a letter to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra with a request that remaining resources in the Provider Relief Fund (PRF) be released immediately to health care providers, including long term care facilities.

In 2020, nursing homes received $13 billion of the $178 billion of the PRF, which for many providers, made the difference between keeping their doors open or shutting them for good. Currently, approximately $44 billion remains in the fund; however, nothing has been distributed in 2021. In the face of mounting new cases due to Delta, the Administration should aid our frontline health care heroes before the situation gets worse. Public health officials must heed the lessons from last year and prioritize long term care residents and staff.

During the pandemic, nursing homes have faced increased expenses for personal protective equipment (PPE), testing and additional staffing to ensure residents and caregivers remain protected from COVID-19. In 2020, providers spent $30 billion on PPE and staffing alone. But as the pandemic continues, these costs will remain constant. By the end of 2021, providers are projected to spend $60 billion on pandemic-related costs in the span of two years.

These additional costs are causing a major strain on facilities that have long struggled to break even. Medicaid – the primary payer for nursing homes residents – has been historically underfunded. The amount that providers are reimbursed only covers between 70 and 80 percent of the total cost of care. This chronic gap in funding has left many providers operating on shoestring budgets year after year. 

Medicaid underfunding is contributing to workforce challenges that have been exacerbated by COVID. Providers across the country are seeking to hire more staff, but many lack the financial resources to offer competitive wages. Eighty-one percent of nursing home providers and 75 percent of assisted living communities stated that higher Medicaid reimbursement to offer better staff pay and benefits would help improve the facility’s ability to recruit and retain staff members.

In addition to bolstering the long term care workforce, proper financial support will help prevent widespread closures. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) estimates that nearly 2,000 nursing homes could permanently close their doors over a two-year period (2020-2021). Closures are detrimental not only to vulnerable seniors who rely on long term care for their health care needs but also to the dedicated caregivers who would be out of a job.

In the letter to HHS, AHCA/NCAL President and CEO Mark Parkinson said, “The staff and residents in skilled nursing facilities around the country desperately need ongoing support in facilities most affected by the virus. Ensuring that this funding is delivered to long term care providers immediately is critical to our primary role of caring for and protecting our nation’s seniors and most vulnerable.”

Lawmakers must support the long term care industry and ensure economic stability for the sake of its vulnerable residents and dedicated caregivers. In the short term, providers can continue to protect their residents and staff from COVID-19. In the long term, they can continue providing the high-quality care that our seniors deserve for years to come.
Additional Updates and Reminders
Updates from the Maryland Department of Health

Ending Flexibilities re PASRR: Please see this memo from MDH regarding the termination of COVID-19 #10 Non-Enforcement of Preadmissions Screening and Resident Review (PASRR) Requirements and the termination of the temporary deferment for MDS validations. Per the memo, termination of the non-enforcement of PASRR requirements and the temporary deferment for MDS validations will terminate on August 15, 2021.

Medicaid Rates: Please see this Medicaid update memo regarding July 1, 2021 rates. Per this memo, the final calculation for the rates, effective July 1, 2021, is delayed. In the interim, the Department's FY 2021 fourth quarter rates for nursing facility services will remain in effect until final rates are available. As soon as rates are available, the Department will adjust payments as appropriate.

Medicaid Redeterminations: Please see this memo announcing that MDH has extended Medicaid redeterminations to December 31, 2021. Keep in mind that families, facilities, and representatives of participants are encouraged to complete their renewals as close to the scheduled redetermination as possible. The sooner the renewal is completed, the sooner staff can update the case. This extension gives more time but does not extend past December 31, 2021.
Nursing Home Media Toolkit

Check out the new Nursing Home Media Toolkit from the Maryland Department of Health. The password to access the materials is Vaccine2021.

Please use the materials in this media toolkit to spread the word about vaccination with staff.

You'll find flyers, ads, social media posts, videos, and posters. 
The 2021 HFAM Conference “Together We Re-Imagine” will be held in person October 4 – 7, 2021 at the Maryland Live Hotel and Casino in Hanover, Maryland. Hundreds of long-term care leaders will connect, share best practices and discuss actionable insights on how we can reflect, reform, rebuild, and revolutionize quality care. You and your teams will not want to miss this opportunity as we come together again.

Visit the conference website to learn more and register.
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