Thank you for your leadership as we continue to navigate the evolving COVID-19 pandemic. We appreciate all that you do to serve Marylanders and to advocate for your constituents.
Given the recent increasing cases of COVID-19 in communities, we wanted to share the latest update on skilled nursing and rehibition centers and assisted living campuses in Maryland. As we have shared before, community spread is a top factor in the likelihood of outbreaks in long-term and post-acute care centers. As cases continue to rise, it’s important that members of the public do their part to contain the virus.
We have been warning the long-term and post-acute care sector about the fall 2020 COVID-19 surge for several weeks. While we hoped it would not come, we have helped prepare leaders and teams in our sector.
We have shared updates with the sector on issues relative to testing, government expectations, staffing, and PPE. This update includes critical information on testing, personal protective equipment, staffing, and healthcare heroes.
Testing
- Based on lower community positive rates in recent months, random mandatory weekly testing requirements have been relaxed according to federal guidelines and state orders. Some more cautious nursing homes have voluntarily continued with weekly resident and patient PCR commercial lab testing despite the reduced frequency requirements of CMS and state orders.
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According to research from Brown, Harvard, and the University of Chicago, a higher positivity rate in the community often results in higher positivity rates in nursing homes and assisted living campuses.
- As we warned earlier, community positivity rates are spiking and we are seeing more isolated positive cases in nursing homes and assisted living centers. And when testing is triggered or more frequent because of a known positive case, we will see positivity rates go up because testing is done with known possible exposure.
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The difficult task for our centers and their healthcare heroes remains: follow infectious disease protocols, stop the spread, reduce the mortality. No small task when you consider that nursing homes care for people who by definition are more sick with pre-existing chronic conditions, and as a result are highly vulnerable to COVID-19. We all have COVID fatigue. All teams must be vigilant in mask-wearing and social distancing outside of work, and diligent with PPE use and donning/doffing at work.
NOTE: We remain very concerned about the critical need for the testing of ambulance personnel, dialysis employees, and state health inspectors, which has not been ordered.
Personal Protective Equipment
As required by Maryland State Government order, Maryland nursing homes are required to have a 30 day supply of PPE on hand by the end of November, and a 60 day supply by the end of January.
Spot shortages of some PPE (currently gloves) and increased prices (due to production supply and demand) remain. We at HFAM have promoted PPE resources through both Medline and a joint association buying collective with LeadingAge Maryland and LifeSpan.
Staffing and Bridging
Staffing in all healthcare and in our sector was challenging before the pandemic. Our teams are on the front lines against this virus, and staffing has become even more challenging. It is hard, but healthcare leaders continue to encourage their teams to keep up the good work, offer praise and support, and remind them that HFAM has had their back since the beginning of this pandemic and will continue to do so.
As we advised the HFAM Board on October 14, the State of Maryland’s expectation is that our sector will self-bridge during this fall and winter COVID-19 surge. Unlike the first surge in March and April, state bridge teams of RNs, nurses’ aides, and physicians will be VERY limited.
The support of State and National Guard Technical Assistance Teams that have been in all 227 centers in recent weeks to review infectious disease protocols, staffing, and PPE, has been helpful. Even now, those teams are doing a second round of review and instructional visits. But again, the State’s expectation is that our sector will self-bridge during this fall and winter COVID-19 surge.
In the earlier March/April surge, HFAM was proactive in coordination with the Maryland Hospital Association, UMMS, Johns Hopkins Medicine, and Lifebridge on issues of emergency RN staff supervision/training support, and in general coordination. We will continue on this front.
NOTE: A new advantage on the infectious disease, acute and post-acute collaboration, and workforce fronts are the federally supported AHRQ Echo National Nursing Home COVID-19 Action Network being stood-up by Johns Hopkins and MedStar Health. In speaking again today with Michele F. Bellantoni, M.D., C.M.D. from Johns Hopkins Medicine and Bryan O. Buckley, DrPH, MPH from MedStar, I know that all of us are 100 percent dedicated to connecting and collaborating during this long battle against COVOD-19 for the benefit of Marylanders in need and to ensure quality care.
