Coronavirus Update #75
Executive Order Mandating Universal Testing in Nursing Homes, More Healthcare Heroes, CDC Webinars, and Additional Updates
New Executive Order from Governor Hogan

In a press conference today, Governor Larry Hogan announced an executive order to mandate universal testing of all residents and staff in all Maryland nursing homes, regardless of whether they have symptoms.

Nursing homes will be prioritized based on an imminent outbreak or rising threat of an outbreak. It will now be mandatory for all centers to fully comply and cooperate with strike teams deployed by the state. In addition, nursing homes must have a physician, nurse practitioner, physician's assistant, or registered nurse evaluate all residents on a daily basis.

With expanded testing, Governor Hogan acknowledged that it is expected to see a rise in positive cases among residents and staff. Centers are required to develop emergency surge staffing plans to ensure continuity of care in the event of an outbreak. To aid with this, the Governor also announced that strike teams would be supplemented with newly created bridge teams to provide emergency clinical staffing to centers that are experiencing crisis. Bridge teams are composed of a registered nurse and five to seven aides sufficient to care for up to 100 residents per shift. These team members are fully vetted and ready to be immediately deployed statewide; they are capable of providing 24-hour coverage.

The executive order also requires nursing home facilities to provide regular informational updates to residents, resident representatives, and staff.

During the press conference, Governor Hogan announced the appointment of Col. Eric Allely, the State Surgeon of the Maryland National Guard, to serve as an Emergency Safety and Compliance Officer for Maryland nursing homes. He will be charged with directing a multi-agency team to ensure compliance with state law.

Lastly, we applaud Governor Hogan for thanking healthcare heroes and we count nursing home employees among those heroes. We look forward to celebrating your work and sacrifices this Saturday on the newly proclaimed "Healthcare Heroes Day in Maryland."
Healthcare Heroes - Thank You!
The team at Genesis Glade Valley Center! In the midst of a rapidly changing environment, these quality care teams have truly risen to the occasion and deserve to be celebrated! (above)
Heroes have blossomed at CommuniCare’s Marley Neck Health & Rehabilitation. 
Ty McNeal, Staffing Director and Paulette Carroll, GNA Rehab at Lorien Columbia. Both have stepped up and have gone above and beyond during the COVID-19 crisis (above).
Celebrating the Healthcare Heros at Genesis Ballenger Creek! Genesis and the Genesis Ballenger Creek team give their sincere thanks to Fire Medic Derek Hartman and the International Association of Fire Fighters Local 3666 and of course, Munson, Tickle, Cooper and Spike for volunteering their time to visit our residents and teams! (above)

Who are your healthcare heroes?

There are so many amazing stories of dedication, sacrifice, and compassion by long term care professionals who are going above and beyond to ensure the safety, health, and happiness of residents during this unprecedented time. These individuals are saving lives; they are heroes.

We want to hear your stories! Please email    to share a current story and picture of members of your team who are going above beyond to provide quality care during this unprecedented time. 
CDC Webinar Trainings for LTCF COVID-19 Module: New Mandatory Reporting 

CDC’s National Healthcare Safety Network has announced two upcoming webinar trainings for the new LTCF COVID-19 Module , which is expected to be a new requirement by CMS. The final rule from CMS on this requirement is still pending. However, CDC is making the module available to nursing homes now. 

The training webinars will be recorded and posted to the LTCF COVID-19 Module webpage with a PDF of the slide presentation. 
First Topic: COVID-19 Module Overview for Long-term Care Facilities 
Thursday, April 30, 2020
1:30-3:00 PM EDT
Second Topic: COVID-19 Enrollment Guidance for Long-term Care Facilities
Friday, May 1, 2020
1:30-3:00 PM EDT

Learn how to join these webinars on the CDC website .  If you have any questions, please email CDC at and include LTCF COVID-19 in the subject line.
CDC Increases Priority for COVID-19 Testing in Long Term Care Residents

This week, the Centers for Disease Control (CDC) made changes to its priority classifications for COVID-19 testing . The CDC has now modified its priority classifications into two categories: high priority and priority, and both healthcare facility workers with symptoms and residents in long term care facilities with symptoms are classified as high priority. 

In addition, the CDC states that healthcare workers with contact with a person with known or suspected COVID-19 should be considered for testing. Residents and health care workers in long term care facilities without symptoms may also be prioritized by state or local health departments or clinicians, for reasons including public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals.

Previously, the CDC identified three priority levels for testing. Patients in long term care facilities with symptoms were identified as priority two for testing while healthcare workers with symptoms were identified as priority one and healthcare workers without symptoms as priority three. 

This update represents a positive step in continuing the push for better access to testing for both long term care residents and staff. Providers should use this guidance when seeking testing from hospitals, physicians, labs and local officials and advocating for faster turnaround times.

For more information, please see AHCA/NCAL’s recent guidance on testing . Facilities can refer to AHCA/NCAL’s list of vendors who provide testing in nursing home setting and are FDA-approved.
How Can the Ombudsman Program Help?

The Ombudsman program’s primary focus is to protect and promote the health, safety, welfare and rights of long-term care residents. Ombudsman programs are a community resource and their outreach can help to calm fears by providing information and resources to residents, their families and center staff. The following are just a few examples of how the Ombudsman program can assist center staff. 

  • Answering questions from resident’s family, who may have additional concerns because they are not able to visit their loved one in person;
  • Providing information and assistance to staff regarding individual resident and family concerns related to dementia care and ideas on providing individualized activities. 
  • Serving as a resource to facilitate communications between the facility and other agencies, such as public health, the Aging & Disability Resource Center and Centers for Independent Living to facilitate resident transitions to home; 
  • Assisting with virtual resident and family councils, or similar meetings, when possible;
  • Educating the public through the media on the importance of the work of care providers; reminding in a public way to show gratitude and kindness to staff.

Administrators and/or Directors of Nursing should talk with their Ombudsman Program to identify together what is most helpful for the facility needs during this unprecedented pandemic. 

How can I contact the Ombudsman program? 

  • To find a program near you, visit this website.
  • Call the Eldercare Locator: 1-800-677-1116
  • More information about the Ombudsman program is available online.
CDC Launches LTC Frontline Staff Training Webinar

CDC has developed resources for frontline staff in long term care facilities. These short webinars are all published on the Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs) webpage at the bottom under a “Webinar Series” section. These new webinars are intended to be a training tool/resource for frontline long term care staff members. CDC has also listed three “Additional Resources” to this page, which have been updated previously. 

Here are the direct links to each webinar:

And the new additional resources are:

The Centers for Disease Control and Prevention have updated their list of COVID-19 symptoms . The symptoms now include cough and shortness of breath or difficulty breathing or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, vomiting, diarrhea, and new loss of taste or smell. 

With the addition of these symptoms, AHCA/NCAL has updated their relevant resources, including the screening checklist for essential personnel and visitors, as well as our sample daily log for personnel . If you created your own screening tools, you should update to include the additional symptoms.  
Preparing for Future Surveys: Document Your Calls For Help

As noted in previous updates, the AHCA/NCAL has developed brief guidance for facilities facing personal protective equipment and staffing shortages, as well as other challenges in receiving assistance. Most long term care providers do not have access to the adequate supplies or staff to provide the level of care needed to contain the virus. Documenting requests for assistance is a critical part of managing of the long term consequences of the lack of supplies and testing – and preparing for future surveys.

Unfortunately, also due to this crisis, many long term care providers are unable to fulfill requests for help made to regular contacts (e.g., suppliers, morgues, staffing agencies, etc.) and through traditional communication channels. Long term care providers need to regularly call for help and need to document these calls were made. Continue to reach out to these entities:

Be sure to check out the AHCA/NCAL guidance , which also has information on how to properly document calls for help and the importance of requesting a facility level waiver.
FEMA Shipping SNFs a Supply of PPE in Early May and Again in June

The White House Coronavirus Task Force announced yesterday that FEMA will be shipping to every nursing home in the United States a supply of PPE (surgical masks, gowns, face shields and gloves) in early May and again in early June. As we learn more about the arrival dates and amounts, we will let you know.
CMS COVID-19 Stakeholder Engagement Calls

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so you are highly encouraged to join via audio webcast, either on your computer or smartphone web browser. Calls recordings and transcripts are posted on the CMS podcast page HERE .

CMS COVID-19 Office Hours Calls (Tuesdays and Thursdays at 5:00 – 6:00 PM Eastern)
Office Hour Calls provide an opportunity for hospitals, health systems, and 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
Thursday, April 30th at 5:00 – 6:00 PM Eastern
Toll Free Attendee Dial In: 833-614-0820; 
Access Passcode: 7476619

Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM Eastern)
Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.

Friday, May 1st at 12:30 – 2:00 PM Eastern
Toll Free Attendee Dial-In: 877-251-0301; 
Access Code: 9545128

Weekly COVID-19 Care Site-Specific Calls
CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

Dialysis Organizations (Wednesdays at 5:30 PM Eastern)
Wednesday, April 29th at 5:30 – 6:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 6965645
Nurses (Thursdays at 3:00 PM Eastern)
Thursday, April 30th at 3:00 – 3:30 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 4268398
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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.