Update from the Health Facilities Association of Maryland
Please watch the above video as it celebrates the dedication, sacrifice, and compassion of
long-term and post-acute care employees. They are truly healthcare heroes who have gone above
and beyond to continue providing quality care to Marylanders in need and to save lives.

As we head into a traditional holiday week, we are thankful for your leadership and dedicated government service on behalf of all Marylanders. We truly appreciate your support as we continue to navigate the ongoing COVID-19 pandemic together.

We also remain thankful for our healthcare heroes working to provide quality care and to save lives across all healthcare settings, including skilled nursing and rehabilitation centers.

From January through September of 2020, the caring professional teams in Maryland nursing homes provided 5.8 million days of quality care and have proven themselves to be true healthcare heroes in our ongoing fight against COVID-19.

As shared in our previous update, COVID-19 cases are surging throughout the country and here in Maryland. Every indication shows that this coming winter could be even worse than the spring.

As of today, we have COVID-19 outbreaks of at least one case in 149 nursing homes and on 100 assisted living campuses. Last week those numbers were 109 and 73, respectively.

As COVID cases rise in communities, they also rise in nursing homes and assisted living centers in those communities. Independent research shows that community spread is the primary factor in the likelihood of outbreaks in long-term care facilities. 

When community spread is high, it is very difficult to prevent the entry of COVID-19 into a nursing home, hospital, school, or another setting. After entry in to a healthcare setting, the goal is to limit the spread and reduce mortality.

Containing community spread is key to keeping residents, patients, and staff in long-term care centers and all healthcare settings protected from COVID-19.

As you know, nursing homes have been on the front lines fighting COVID-19 since the beginning of the pandemic. We have long known that older individuals and those with pre-existing conditions are most at risk of severe illness for death from COVID-19. Nursing homes took early, proactive steps to protect those in their care and have continued to get better at fighting this virus.

However, healthcare heroes in long-term and post-acute care and across all settings cannot do it alone. Everyone must do their part to help protect themselves, their families, and our most vulnerable populations.

Orders from the Maryland Department of Health (MDH) in October rightfully allowed reduced testing and also linked future increases in testing to the community positivity rate. Announced earlier this week, new orders rightfully mandate twice a week testing for employees with one point of care (POC) and one PCR (commercial lab) test. This order also requires residents to be tested once per week with a PCR test.

Our sector is 100 percent committed to clinically-driven and more frequent testing to protect residents, patients, and staff in our centers. We appreciate that MDH is providing all nursing homes with BinaxNow tests: 90,000 tests (approximately 2 weeks supply) with expected delivery no later than Monday. MDH is also selling other POC testing supplies to nursing homes as they have them available.

There is no doubt Governor Hogan’s testing initiatives and coordination provides critical support as we all fight COVID-19. His purchase and distribution of emergency personal protective equipment (PPE) and deployment of emergency State staff and National Guard teams have also been critical. However, even though enhanced federal FMAP and CARES Act funding was provided directly to the State Government, Maryland is one of about 20 states that has not augmented nursing home Medicaid rates during this pandemic.

In Maryland and across the nation, the COVID-19 pandemic has shone a bright light on the chronic underfunding of Medicaid rates to nursing homes and workforce shortages throughout healthcare.

During a press conference this week, the Governor expressed confidence in Maryland’s public-private commercial testing capacity and we hope that he is right. There have been spot delays in PCR commercial testing from CIAN and others are reporting PCR delays from urgent care clinics. While testing is just one tool that we have to fight COVID, it is a very important tool.

The latest MDH orders also make some changes on visitation. All visitors to nursing homes must have a negative COVID-19 test within 72 hours of their visit. If the facility is currently in outbreak status (meaning at least one case), then indoor visitation is suspended except for cases of compassionate care.

Given the link between community rates and nursing home rates, visitation is also linked to community positivity. If a local jurisdiction is below 5% positivity, nursing homes must continue to follow guidance from the Centers for Medicare and Medicaid Services (CMS) on visitation. If the local jurisdiction is within 5-10% positivity, nursing homes must restrict the number of visitors, and if the local jurisdiction is greater than 10% positivity or if the facility is in a current outbreak status, indoor visitation is prohibited.

CMS also released an alert regarding holiday visitation. CMS recommends that everyone continue to follow guidelines for visitation and strongly recommends against residents leaving the nursing home because it increases risk of exposure to COVID-19. While the restrictions on visitation are heartbreaking, it is the right thing to do and will save lives.

With families and friends gathering for the holidays, and also the co-occurring flu season, it is more important than ever that we all do our part to keep everyone safe. Taking simple steps, such as wearing a mask, washing hands, and practicing social distancing will protect not only the individual, but our most vulnerable citizens and the people that care for them.

We at HFAM have continued to remind the long-term and post-acute care sector that they are not alone. We have reminded teams to remain vigilant in mask-wearing and social distancing outside of work, and to remain diligent with PPE use and infection disease control and prevention practices at work. We have shared important mental health resources so employees can also take care of themselves.

Those working in long-term care, and across all settings, are truly healthcare heroes. We must continue to show our support and gratitude for all that they do, especially with the coming holidays. Like everyone else, healthcare workers are facing fatigue and fear, yet they continue the fight.

Again, thank you for all that you do. We appreciate your leadership in guiding Maryland through these unprecedented times. We look forward to our continued work together to protect quality care. Please continue to count on HFAM as a resource and be on the lookout for future updates. 
Joe DeMattos
President and CEO
On September 3, 2020 HFAM honored the contributions and sacrifices made by healthcare teams at skilled nursing and rehabilitation centers and assisted living campuses across Maryland during the COVID-19 pandemic. "Celebrating Healthcare Heroes" recognized 20 individuals who were nominated by their employers and chosen for their heroic performance during this crisis, including their demonstrated commitment to compassionate quality care, tireless work ethic, dedication to teamwork, and enthusiasm for leadership.
HFAM COVID-19 Center

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