Coronavirus Update #38
BENHA Approval of Out of State Administrators, Mitigating Risk,
Compassionate Care, PPE Resources, Medline Webinar
BENHA Approval of Out of State Administrators

As of this morning, BENHA's legal counsel has determined that the official definition of "healthcare practitioner" has been redetermined to include Maryland LNHA's, as it relates to Governor Hogan's Public Order "Relating to Various Health Care Matters" which was issued by the Governor on 3/16/2020.

Therefore, out-of-state LNHA's are permitted to work as the administrators of Maryland nursing home facilities, provided they submit a provisional license application within 10 days after first working at a Maryland nursing home as the administrator of record.
Every Interaction is a Risk  

COVID-19 spreads principally person-to-person. Every interaction between people increases the risk of spread, particularly now that the virus is in most areas of the United States.  

The goal is to minimize the number of interactions with residents. This AHCA/NCAL guidance provides some ideas on how to achieve this goal. It includes:

  1. Reducing the number of various (non-essential) people entering the building;  
  2. Targeting the number of interactions with residents by: 
  • Reducing the number of different staff entering a resident’s room 
  • Increasing efficiency of tasks when entering in a resident’s room to decrease the number of times staff enter 

It’s a simple formula for how spread happens – the more interactions that happen with a variety of people, the greater the chance of spread. So, continue to creatively reduce the number of interactions between people and stop the spread of this deadly virus. 
CMS Reports Frequent Incorrect Use of PPE   

AHCA/NCAL has heard from CMS that a common theme they are finding during COVID-19 infection control focused surveys are PPE not being used correctly, including donning and doffing procedures. Surveyors are having staff demonstrate handwashing and donning and doffing of PPE. 

We encourage you to review with your teams the appropriate way to apply and remove all PPE, including gloves, gowns, masks, and eye protection. Performing observations yourself can be helpful to prepare staff for surveyor observation and to quickly correct any practices needing improvement.  

  • These documents can be printed and posted in your center to ensure your staff are aware of how to appropriately don PPE

  • These documents can be printed off and posted in your center to ensure your staff are aware of how to appropriately doff PPE.  

  • The following video explains how to do hand hygiene and donning/doffing PPE appropriately.  
PPE & Supplies Resources


Please see this  supply chain update letter from Medline.  If you have a COVID-19 case, Medline will send you a special augmented shipment of PPE, as long as supplies last. Please contact your sales representative.

Medline also recently shared that this  microporous coverall is available on a first come, first serve basis. This product is recommended to be worn to protect against penetration by airborne solid particulates and infective agents, limited light sprays and aerosols, and liquids. Product features include: taped seams, attached hood, elastic wrists/ankles, zipper front with storm flap cover, and elasticated waist.

For additional information, questions, or product assistance, contact your Medline sales representative or call 1-800-Medline.


In an effort to support the thousands of healthcare, medical staff and essential business workers in protecting themselves in this critical time, Ironmark has leveraged their existing manufacturer relationships to source and make available PPE supplies and gear. Ironmark is committed to making these much needed supplies available to you, to protect the teams of heroes on, and supporting, the front line at the lowest possible cost.

Below are some of the PPE supplies they’re able to obtain.
  • Face Shields
  • Surgical Masks
  • Gowns
  • Protective Safety Gown Body Suits
  • Infrared Thermometers
  • Protective Eyewear
  • Sanitizer

Please contact Jeff Ostenso  for additional information.


PharmScript has access to hand santizer and masks. Please contact Jamie Billings at or 717-645-1172 for additional information.

Therapy Systems

Please see  this communication from Therapy Systems regarding deliveries or pickups of equipment which includes an outline of the protocols and safeguards being taken to prevent cross contamination between facilities. 
Compassionate Care Amidst the COVID-19 Crisis 

Ensuring compassionate care in the midst of this pandemic, when human, equipment and financial resources are significantly strained, when we are balancing professional and personal struggles, can be a challenge. Advance care planning or end-of-life conversations can be difficult in the best of circumstances, let alone the current environment with restrictions, heightened emotions, and scarce resources.  

Medline Webinar: Friday, April 3 at 2:00 PM EST

Join healthcare workers on the frontlines of the COVID-19 pandemic in some of the hardest hit regions across the country. Learn from those who have experienced an outbreak as they share practical tips on how they’re responding on this webinar .

COVID-19 Response: Best Practices and Hope from Healthcare
Providers Experiencing an Outbreak

Friday, April 3, 1 PM CST/2 PM EST
MDH Transmittals

The Maryland Department of Health (MDH) released yesterday two important transmittals regarding COVID-19.

  • The first transmittal from OHCQ shares reminders about infection control, readmissions, testing, and more for both nursing homes and assisted living communities.

  • The second transmittal shares information about the readmission of patients returning from hospitals when transported by ambulance for both nursing homes and assisted living communities.

Providers are also reminded to review residents' advance directives and Maryland MOLST orders to ensure these documents are up-to-date.
Updated COVID-19 Resource Request Process

This afternoon, the Maryland Department of Health (MDH) shared important clarifying information regarding the current process that hospitals and other healthcare entities should use to request PPE and other health related equipment or supplies, except for ventilators. Requests for ventilators will be routed differently and as soon as the Hospital Surge Team completes their process, it will be shared.

The process for requesting health and hospital related materials should be routed from the requester to their respective local health department using THIS FORM.

The local health department (LHD) will provide the requested items if available. If the LHD is unable to fulfill the request, the form should be forwarded to the local office of emergency management (OEM). Prior to sending to the OEM, the LHD should ensure that all required information is completed and that the request is appropriate.  For example, requesting N-95 respirators when CDC and state guidelines indicate that only surgical masks are to be used. The OEM should enter the request into WebEOC and attach the request form.

The ordering form assists the local OEMS to input the requests and provides data needed for MEMA and MDH to respond to numerous federal requests for data and certifies that the requesting agency is conforming to CDC’s PPE conservation guidance.

Here is the detailed explanation of the ordering process, the order form and a contact list for local OEMS for your convenience. 

MDH acknowledges that the changing requesting processes present lots of challenges we must, in this instance, comply with the guidelines of the various federal agencies. MDH is trying to best comply with minimal impacts on providers and is trying to make each request serve as many purposes as possible.

The data that providers supply with request helps to inform the required PPE burn rate that must be submitted daily as well as assuring that MDH is doing their best to comply with conservation guidelines. Both are required for continued eligibility to receive federal assets.

As this crisis evolves, be prepared for the system to change again.

Thank you for all that you are doing and for you continued flexibility to ever-changing federal guidance.

IMPORTANT NOTE : Please do not use previously provided request form or contact sheet. If your request is not documented on the updated sheets and contact emails, it will NOT be processed.
Special Thank You Audio Message

HFAM has recorded a  special thank you  to those of you working in Maryland skilled nursing and rehabilitation centers and on assisted living campuses. Please distribute broadly to your teams.

We are all navigating together in these uncharted waters of the COVID-19 pandemic.  Now more than ever, it is important that we recognize we are in this together, and that we are stronger together.
Temporary Nurse Aide Training & Competency Checklist 

As AHCA/NCAL shared in Update #26 recently, the Centers for Medicare and Medicaid Services (CMS) issued a blanket waiver that includes an allowance for nursing centers to temporarily employ individuals who have completed alternative training paths, as long as they are competent to provide relevant nursing and nursing related services. 

Along with AHCA/NCAL, we have have been advocating for CMS to issue such a waiver to assist in addressing staffing shortages due to the COVID-19 pandemic. This is now allowed on the federal level. State approvals, such as state occupational licensing and state regulatory requirements, may also need to be granted. 

AHCA/NCAL has a training program ready to use as state occupational and licensing agencies approve these waivers. This 8-hour online Temporary Nurse Aide training course is free to all participants.
AHCA/NCAL has also developed a skills competency checklist  for facilities to use on-site when they hire individuals to work as Temporary Nurse Aides. It is important to know the federal requirement at §483.35(c) is still in effect , which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care. 
COVID-19 Case Study (Not Maryland)

Please see this  Case Study that HFAM wrote after being contacted by a SNF provider in another part of the country.

Please review this case study and share with your teams -- it includes critical insight and real time experience.
Child Care for Essential Personnel

Maryland Family Network (MFN) is partnering with the Maryland State Department of Education (MSDE) to make it fast and easy for essential personnel to find safe quality child care during the State of Emergency.

Maryland’s child care providers are essential to stemming the spread of and finding a cure for the COVID-19 pandemic. Our region is teeming with the Nation’s top researchers, doctors, and policy makers. As the Coronavirus continues to spread and demands on these and other essential personnel grows, they need to know their children are safe in order to stay focused on keeping the rest of us safe and healthy.

Visit this  site  to learn more or call 877-261-0060 to locate child care.

While all child care is closed for the general public, child care is  not closed for essential personnel. In addition to new programs being developed by the State, MSDE recently launched a program to allow child care providers that would otherwise be closed to open to serve children of essential personnel exclusively. There will be additional child care providers approved under this new provision and available to provide child care.   LOCATE will have the listing of approved sites for these services for your stakeholder's staff to identify child care services.

Please urge your staff to visit: for more information on these child care options.
Did you miss HFAM's previous alerts?

Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
Please email for additional questions, and visit for additional information and resources.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.