Coronavirus Update #54
CMS Guidance and Updates, New OSHA Resources, NETEC Webinar Series
Together, we’ve been preparing for the days we are currently facing. We are in the middle of these toughest times. Minute-by-minute, day-by-day, we will get beyond this time. Yesterday was a very hard day for many. Today is a new day. A day to continue the fight, and to do all you can for the people in your care and for your teams proving the care.

“Stand up straight and realize who you are, that you tower over your circumstances. You are a child of God. Stand up straight.”  Maya Angelou

Update:  We are reviewing the recent CMS Guidance regarding Long-Term Care Facility Transfer Scenarios (more on that below) and consulting again with OHCQ on the creation of COVID-19 only centers in Maryland. 

Some Great News:  

  • The generosity of Vita Healthcare has resulted in a $10,000 donation to the HFAM Foundation, which we will distribute to Maryland hospitals to assist their workers.

  • The Horizon Foundation has made a $125,000 grant to the HFAM Foundation to provide personal protective equipment, food and temporary housing for front line health care workers at assisted living, skilled nursing and other alternative living facilities in Howard County, and to provide technology so that patients can better engage with loved ones who cannot visit during the state of emergency. 

Important Step Forward:  We connected leaders at CRISP with the Maryland Hospital Association (MHA) and hospital partners earlier, and later this week we all expect to rollout an automated SNF bed capacity reporting function.  Stay tuned, that will be a critical step.
These reminders are obvious, but so very important:

  • Appreciate, support, and over communicate with your care teams.
  • Over communicate with families, residents, patients and staff.
  • Operate DRIVEN by your infectious disease protocol.
  • Execute your observation and isolation beds.
  • Work closely with your acute-care hospital partners and home health partners.
  • Stay in contact with local health offices and the Office of Health Care Quality (OHCQ).
CMS Guidance and Updates

CMS released detailed guidance on long term care facility transfers . This matches the cohorting guidance that AHCA/NCAL shared previously. 

All nursing homes and assisted living communities should make plans for cohorting residents even before COVID-19 enters the building. Cohorting is imperative to help control the spread of the virus. If possible, nursing homes and assisted living communities should also begin preparing wings, units or floors as “isolation units”. Isolation unit should be a separate, well-ventilated area, ideally with a separate entrance.

CMS is hosting a call today for providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to: 

  • Increase Hospital Capacity – CMS Hospitals Without Walls; 

  • Rapidly Expand the Healthcare Workforce; 

  • Put Patients Over Paperwork; and 

  • Further Promote Telehealth in Medicare 

Conference lines are limited, so they highly encourage you to join via audio webcast, either on your computer or smartphone web browser. 
CMS Office Hours
Tuesday, April 14th
5:00 – 6:00 PM EDT 
Toll-Free Attendee Dial In: 833-614-0820 
Event Plus Passcode: 2395745 
CMS Call with Home Health and Hospice Organizations Today

Please join the Centers for Medicare and Medicaid Services (CMS) for a call on COVID-19 with Home Health and Hospice Organizations Tuesday, April 14th at 3:00 PM EST. CMS leadership will provide updates on the agency’s latest guidance and we will be joined by leaders in the field interested in sharing best practices with their peers. The call will be recorded if you are unable to join.

Dial-in details below. Conference lines are limited, so they highly encourage you to join via audio webcast, either on your computer or smartphone web browser.

Home Health & Hospice Call
Tuesday, April 14th
3:00 – 3:30 PM EST
Attendee Dial-In: 833-614-0820
Conference ID: 9466917

CMS posted an updated version of their COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing document .  A change date is provided below each answer to indicate new and updated answers. The document is largely a repackaging of existing CMS guidance

Our partners at AHCA/NCAL released four new resources on guidance from the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) on critically low or unavailable Personal Protective Equipment (PPE). These new resources are applicable to all long term care providers. 

  • A form letter providers can fill in when responding to OSHA inquiries due to complaints regarding limited or unavailable PPE. 

  • A document on OSHA guidance when PPE is critically low or unavailable including steps providers can follow. 

  • An explanation of OSHA and CDC guidance on N95 respirators that are critically low or unavailable. This resource provides five options with guidance on what to do for a limited supply of N95 or other respirators to no N95 or other respirators available. 

  • A document with updated guidance from OSHA on employer recording and reporting requirements for COVID-19.  

In this webinar series, NETEC is providing facilities with the tools to educate health care workers and share preparedness best practices. NETEC will highlight subject matter experts who have been immersed in the many challenges and topics around COVID-19. 
Healthcare Workers and Masks
Friday, April 17, 2020 | 11:00 AM CDT 
The what, how and why of masks for healthcare workers caring for
patients during the COVID-19 outbreak.

All previous recordings and upcoming events can be found here .
Reminder: Ethics Consultations Available

Our partners at the Maryland Health Care Ethics Committee Network (MHECN) are available for a webinar or call to discuss the ethical issues that are coming up as the COVID-19 pandemic continues to play out in Maryland. As you know, it is important to:

  • Have conversations with residents and families about their end-of-life wishes now before someone becomes ill. 

  • Ensure residents’ advance directives, MOLST, and other documents are all up to date with current documented wishes, and physician orders are consistent with these wishes.

It is expected that hospital surges across the country will exceed the capacity to transfer nursing homes and assisted living communities' residents with suspected or confirmed COVID-19. Discussing with residents and families now as to how they want to be cared for in place in the nursing home or assisted living community will be helpful to inform how to best meet their wishes, in advance of the anticipated continued spread of COVID-19, and its increased strain on the health care system.

Should you have questions or concerns about these difficult but important topics, or would like to share what you are doing, please contact Anita J. Tarzian, PhD, RN via email at or by phone at (410) 706-1126.

In the meantime, please see these additional
resources to help you and your teams:

  • This blog post by Joanne Lynne about what long term care and assisted living facilities should be doing now to prepare for a surge of COVID-19 deaths.

  • Healthcare professionals can learn more about the Maryland MOLST form HERE.

Reminder: Artificial Life Support During the COVID-19 Pandemic

These are hard times for of us. While we are well prepared to meet the challenge, we want to share a few important reminders about critical issues for those with COVID-19. Most people will do well, but some are getting so sick that they need a breathing machine/ventilator.

It is important to start talking with residents, patients, and families now about what to do should a resident or patient get sick with COVID-19. This is important because hospitals and skilled nursing facilities are not allowing visitors.  

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.
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.