Critical Update for Skilled Nursing and Rehabilitation Centers, Assisted Living Centers, and Other Senior Settings
Boosters and Omicron Variant
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Friends:
We are at a critical point in our fight against COVID-19. I know all of our frontline healthcare heroes are tired, and they are frustrated for any number of reasons. Trust me, we all are. In the moment it is important to remember what is in our control, and what is not. Dating back to the start of this pandemic we’ve all been driven by a commitment to quality care and our passion for caring for Marylanders in need. The number one thing in our control right now is to get vaccines and boosters into the arms of residents, patients, and employees in our settings as fast as we possibly can. Together we must double and triple our efforts on this front in the coming days.
Providers should work with their long term care pharmacies and hospital partners to gain access to the booster dose and schedule booster clinics. If you are having trouble scheduling a clinic at your center, please contact mdh.congregate@maryland.gov for assistance.
While this short battle has now become a long war, together we must persevere. It is in our unity that we will overcome this latest challenge of a dual Delta and Omicron Surge – all while everyone is tired, staff across all settings are stretched thin, and our acute care hospitals are nearing capacity.
We agree with our state colleagues that we want to avoid mass COVID-19 admissions from hospitals to skilled nursing and rehabilitation centers. That is our joint goal. Last night, I spoke with Maryland Health Secretary Dennis Schrader and we agreed on that. None of us want to repeat the clinical outcomes that occurred in New York last year when there was a mass transfer of COVID-19 patients from hospitals to nursing homes. This morning, we conferenced with Secretary Schrader, Dr. Jeff Woolford, and other state leaders regarding standing up our offensive against this COVID-19 surge. Again, we agreed again on that point while also acknowledging that some of our skilled nursing and rehabilitation centers are taking and are prepared to take COVID-19 referrals from hospitals. In our communication with state leaders, especially this week, we also agreed that we are in desperate circumstances in our sector. In all healthcare settings in Maryland, we are fighting for the same limited number of licensed healthcare professionals. We have empty beds in our skilled nursing and rehabilitation centers, yet we are struggling to find the staff to make those beds available.
The current situation is this:
- Skilled nursing and rehabilitation centers have been fighting COVID-19 for nearly two years and have received some deeply appreciated direct financial support from the State of Maryland—but frankly, more is needed.
- Direct payments to skilled nursing and rehabilitation centers from the federal government in 2020 has long been spent on staffing, PPE, infectious disease protocols, and testing.
- There have been two direct payments to skilled nursing and rehabilitation centers from the federal government in recent weeks. These have been grossly inadequate – early data indicates the disbursements for each center averaged about $33k and $55k, respectively.
- Our base Medicaid rates during the pandemic have not increased relative to our fight against COVID-19.
- The surge we are now entering is different and dramatically impacting us all:
- The Omicron variant is spreading faster than earlier variants, while Delta is still in play.
- There is some early doubt on the effectiveness of the vaccines and even the booster with this variant.
- Unlike previous surges when hospitals where essentially empty, in this surge hospitals are still filled with majority non-COVID patients while COVID patients are increasing exponentially.
- Emergency rooms are full with traditional patients and COVID patients; there has also been a major increase in behavioral patients in mental health crisis.
- Finally, hospital lengths of stay for non-COVID patients have increased, not decreased, in Maryland hospitals during this recent surge.
Booster Clinics and the Omicron Variant
As we have been sharing, in Maryland and across the nation, COVID-19 vaccination and booster shots are more important as ever with the rise of the Omicron variant. Today, we are reaching out to strongly encourage you to conduct COVID-19 vaccine booster clinics in your center. Booster shots increase the protection that an individual has against COVID-19 infection and severe outcomes resulting from infection. With the emergence of a new variant, Omicron, it is imperative to get as many residents and staff their booster shot as soon as possible. Nationally, 50.9% of residents and 21.8% of staff in nursing facilities have received a booster dose.
The Omicron variant is spreading incredibly rapidly. A recent report from the state of Washington suggests the prevalence in the community is doubling every 2-3 days, which mirrors the data from Africa and Europe. Vaccination without the booster provides about 30% protection, while protection after receiving the booster (after ten days) increases to about 75%. The speed in which this virus is likely to spread across America and the 10-day delay in booster protection would suggest that it is extremely important to get residents and staff vaccinated with the booster in the next few weeks.
Even though it appears to be less virulent it still can cause serious illness and deaths, especially in our fragile population. Again, it is imperative that we get residents and staff boosters over the next two to three weeks. Data released yesterday from CDC shows how effective the vaccination and the booster is among nursing home residents. The addition of the booster dramatically reduces the number of cases (see figure below).
Figure. CDC comparison of nursing home residents COVID cases by vaccination status.
- Redline is unvaccinated
- Blue line is fully vaccinated
- Green line is fully vaccinated PLUS booster.
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Again, providers should work with their long term care pharmacies and hospital partners to gain access to the booster dose and schedule booster clinics. If you are having trouble scheduling a clinic at your center, please contact mdh.congregate@maryland.gov for assistance.
Please know that we in Maryland and AHCA/NCAL nationally are engaging in our advocacy efforts to raise the alarm and identify the needed supports to make sure those in our sector get vaccinated and get the booster. Yesterday, AHCA/NCAL sent a message to the White House vaccine team, CDC, National Governor’s Association (NGA) and Public Health Directors Association. Here is the letter to the NGA , along with resources (one and two) shared by the Illinois Health Care Association.
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Monoclonal Antibody EUA:
As Always:
- Focus on what is in your control and not what is out of your control.
- Let’s get those boosters and the flu vaccine in the arms of people.
- Overcommunicate – with residents, patients, families, staff, and government partners.
- Adapt and innovate.
- Rely on your partnerships.
- Speak up when you need help.
- Double efforts on infectious disease protocols, training, and operations.
- Take and document your action; keep a timeline.
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CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing.
Be well,
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Joe DeMattos
President and CEO
HFAM
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Kevin Heffner
President and CEO
LifeSpan Network
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Allison Ciborowski
President and CEO
LeadingAge Maryland
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