June 2, 2020
Stay Connected - LeadingAge Illinois COVID-19 Resources
Stay up to date on state and federal COVID-19 information and updates by accessing the LeadingAge Illinois COVID-19 Resources page. You can also engage with other Illinois members through our listservs, connecting you with your peers by provider type. We have now added a COVID-19 listserv . Contact LeadingAge Illinois if you’d like more information about the listservs or would like to join one.

We Have a New Website!
You should have received an e-mail regarding our new website and how to log-in to access members-only materials and register for education. We encourage you to take a look . If you did not receive an e-mail with your password, you can create a new one here and then click on “Lost your password?” Please note that in order to receive member pricing when registering for LeadingAge Illinois education, you will need to be logged in to the website. Click here to submit any questions
Governor Issues Emergency Rule on Testing and Response Strategy for Long Term Care
Last week, the Governor and the Illinois Department of Public Health (IDPH) made a couple announcements impacting long term care regarding testing and COVID-19 response. 
Nurse Response Teams:
Response Teams have evolved since this pandemic began in Illinois. There are now two types. 
  • IDPH Nurse Teams. 200 IDPH nurses focused on infection control surveys to monitoring compliance and doing swab tests to reviewing PPE use and hygiene practices. 
  • IDPH Contracted Nurse Teams. 100 nurses that also monitor infection control and provide added testing assistance.
These 10 teams average 2 home visits per day each. As many as 140 per week across the state and are responsible for ensuring that best practices are followed to keep residents safe. The Governor said that some facilities opt out of free assistance from the teams and choose to take their own specimens or work with their local health department. Others work with hospital and health centers for testing.
The Governor and IDPH want to ensure testing is being completed in nursing homes for all residents and staff. As a result, the Department has issued a new emergency rule effective immediately amending the Skilled Nursing and Intermediate Care Facilities Code , requiring each facility to develop their own testing plan and document an established relationship with a testing lab. Emergency rules are in effect for 150 days. 
Here are some of the key parts of this rule:
  • IDPH will provide training and assistance with testing if needed (likely with the nurse teams
  • Each facility is required to report to public health officials the number of residents and staff tested, and the number of positive, negative and indeterminate test results.
  • You have to make available, a copy of the your infection control policies and procedures by providing them to residents, the resident’s family or representative, IDPH and the local health departments, upon request.
  • Nursing homes who decline, will be found in violation of the rule.
See current IDPH guidance here . LeadingAge Illinois staff will be seeking additional guidance from IDPH and resources as it relates to this sudden emergency rule and providing any additional updates as they are warranted.
Testing Resources
LeadingAge Illinois and Value First continue to track resources for testing to provide to our members. We will keep you updated on legitimate information we receive. Here is a look at some of the information and resources we have gathered to date (we will keep a running list updated in the newsletter):
Contact: Brent Branneman
Provides testing, packaging and results ($100 each test)
Does not include lab processing.
Testing as a Condition of Employment
LeadingAge received the following question about testing as a condition of employment and thought the answer might be helpful to others:
Question: Individual residents and staff members can refuse testing. However, if a resident wants a test, a facility can’t deny them. Providers want to know if they can make participation in testing a condition of employment.
Answer:  We think that providers can make testing a condition of employment based on the information available. We believe that they can terminate an employee or withdraw an offer of employment if they refuse testing as laid out in the EEOC guidance below.
According to current EEOC guidance, the population we serve is very vulnerable to COVID-19, therefore, testing of employees is a reasonable practice similar to other screens like TB testing, drug screens, background checks, etc., that are common conditions of employment. Ongoing testing can be communicated though the policies and procedures so that employees are made aware of the requirements.
Below are links to an EEOC technical assistance document and a couple articles with some additional insight:
Source: LeadingAge
New CMS Enforcement Memo 
Yesterday, CMS put out a memo that includes survey activities, enhanced infection control related enforcement and quality improvement activities in nursing homes. 
LeadingAge’s statement was released almost immediately, with Katie Smith Sloan, President and CEO, saying “today’s data are a grim reminder of a slow motion tragedy that could have been averted if our federal and state governments had stepped up to provide leadership, coordination and funds that nursing homes need to save lives.” 
CMS cited 60,000 infections and 26,000 deaths in nursing homes to justify increased civil monetary penalties for nursing homes with pattern of infection control deficiencies. CMS will begin posting the still incomplete data to Nursing Home Compare this Thursday and update it monthly.
Sources: CMS/LeadingAge
LeadingAge Illinois Congressional Meetings Recap
As we reported last edition, LeadingAge Illinois along with LeadingAge, have set a series of meetings with members and U.S. Senate and House offices to discuss COVID-19 issues and request relief. Last week, we had a round of five meetings with congressional offices. 
U.S. Rep. Jan Schakowsky (D-9 th District; Glenview):
After meeting with her a couple weeks ago, staff had a follow up meeting with her Senior Health Policy Advisor, Osaremen Okolo. Among items discussed were COVID-19 reporting, Personal Protective Equipment (PPE) and the representative’s bill, the Quality Care for Nursing Home Residents and Workers During COVID-19 Act ( H.R. 6698 ).
U.S. Senator Tammy Duckworth (D-Chicago) and U.S. Representative Michael Quigley (D-5th District; Chicago):
The focus of the meetings with the offices of the senator and representative was LeadingAge’s $1.2 billion affordable senior housing ask ( H.R. 6873 ) . Members detailed the items in the Ask and how critical the funds are for providers and residents at this time:
$845 million for COVID-19 costs for services, staffing, disinfecting, PPE, etc:
Funds from the March 27 CARES Act will begin to make up for lost tenant rent revenue, but not help pay for other related costs. Vida Wojewski, Asset Director, Catholic Charities of Chicago , explained the costs housing providers are faced with, which included things like meal delivery, disinfecting apartments, added staff and hours and the high costs of PPE. 
$300 million for Service Coordinators:
These funds would be for both to support existing Service Coordinators and to get new ones for the senior housing communities that do not have one. I started in 1993 as one and now am the affordable housing executive director.  Our service coordinators are so important to our residents. They do so much to help our seniors. At one moment, they are explaining benefits for Medicare and costs and the next thing they will be organizing a birthday party. Yeah, it’s a party, but it is breaking isolation for many seniors and they feel special,” said Lisa Ingalls, Executive Director of Affordable Housing, Lutheran Social Services of Illinois.
$50 million for wireless internet installation and service fees in resident units and in community common spaces:
The lack of internet access has slowed efforts to combat social isolation, engage residents with telehealth, and connect residents to needed supports. “Research has linked social isolation and illnesses to higher risk of blood press, heart disease and obesity,” said David Guthridge, Director of Affordable Housing CJE SeniorLife . “WiFi is long lasting and enriching for our residents.” 
$7 million for a one-year extension of HUD’s Integrated Wellness in Supportive Housing demonstration:
This program’s funding for wellness nurses and service coordinators is set to end on September 30 without congressional action. Dave Opitz, Senior Director of Mission Services, Embrace Living Communities , gave a full background on the program and examples of the program’s success in requesting for the program to be extended. 
U.S. Senator Richard Durbin (D-Springfield) / U.S. Representative Lauren Underwood (D-14th District; West Chicago):
Meetings with these offices focused on several issues impacting member settings, while also urging relief for members. In addition to providing their stories, members had a number of asks:
$100 billion fund specifically for aging services providers to cover additional costs:
Stephen Yenchek, CEO/President of Friendship Senior Options, Inc. and Tony Madl, Executive Director at GreenFields of Geneva discussed the COVID-related costs providers are facing such as PPE, cleaning supplies, staffing and other needs.  Matt Riehle, Chief Operating Officer, Westminster Village, Bloomington , also provided an in-depth look at his community’s response the pandemic and how costs have now presented an insurmountable issue for providers.   
A charter and funding for a post-COVID Bipartisan Congressional Commission:
Colleen Bottens, Executive Director of Meridian Village, Glen Carbon said a commission is needed to develop a legislative strategy that establishes an infrastructure of aging services that is adequately financed, promotes quality of care and quality of life and enables all Americans to grow old with dignity.

Rep. Underwood was asked for support of H.R. 6935 which would provide for the establishment of a National COVID-19 Resource Center for Older Adults and authorize a Healthy Aging Program. She was asked to become a co-sponsor and after the meeting her staff reported that she informed the sponsor of her support and co-sponsorship.

Special thanks to the following members for taking part in the congressional meetings:
  • Colleen Bottens, Executive Director, Meridian Village, Glen Carbon
  • Ralph Gaines, CEO, Embrace Living Communities
  • David Guthridge, Director of Affordable Housing CJE SeniorLife
  • Lisa Ingalls, Executive Director of Affordable Housing, Lutheran Social Services of Illinois
  • John Larson, CEO, Cantata Adult Life Services
  • Dave Opitz, Senior Director of Mission Services, Embrace Living Communities
  • Matt Riehle, Chief Operating Officer, Westminster Village, Bloomington
  • Vida Wojewski, Asset Director, Catholic Charities of Chicago
  • Stephen Yenchek, CEO/President, Friendship Senior Options, Inc.

These issues and several others will be the focus of upcoming congressional meetings. We will keep you updated on these issues as meetings transpire.
We Need Your PPE Stories for National Media
The Wall Street Journal and Kaiser Health News both are writing stories about the challenge of nursing homes finding adequate and appropriate Personal Protective Equipment (PPE) – and that FEMA PPE shipments have been spotty and shoddy.

We need you to tell the stories of your FEMA shipments. Things such as:
  • Do you have diagnosed cases?
  • What did you get (or not get)?
  • How much was it?
  • Is it usable? 

Recently received PPE  packages are best;  videos and photos  will add important elements to the story. You can share your stories on or off the record.

This is such an important opportunity to back up our proactive media outreach with real stories of real needs.

Please share your stories with Lisa Sanders at LeadingAge.  
Experience the RESIDE Dashboard
The admissions process is messy, complicated, and requires heavy manual oversight due to legacy systems and physical paperwork. Facilities can lose up to 20% of revenue due to missing or inaccurate admissions documentation. But with RESIDE, admissions staff, regionals, and owners can oversee the entire admissions process. Our centralized dashboard ensures accountability at each stage, full transparency into every admission, and the necessary reports to maintain compliance. Experience the RESIDE dashboard with our  demo video .

Holly Kasnetz is the VP of Strategy and Implementation at RESIDE Admissions.
Supportive Living Case Reporting
As we reported previously, Kara Helton, who has been with the Supportive Living Program (SLP) at the Illinois Department of Healthcare and Family Services (HFS) for several years, has moved on to another state agency. Assuming tasks related to the COVID-19 emergency will be Janene Brickey . She now takes all COVID-19 related questions and reports of all positive COVID-19 tests. She can be reached at 217.557.0593.
COVID-19 Updates and Q&A Webinars for Long-Term Care and Congregate Residential Settings
The Illinois Department of Public Health (IDPH) is hosting webinars to provide COVID-19 updates and answer questions from long-term care and congregate residential settings.

Webinar attendance is limited. If you cannot register or get in, email Michael Moore .
IDPH will be recording the webinars and sending out the links of the recordings.
IDPH Emergency Rules Recap
With all the rapid rulemaking and orders in recent weeks, we wanted to remind you of the recent rulemakings adopted by the Illinois Department of Public Health (IDPH) for the assisted living, skilled nursing and sheltered care codes. All went into effect May 5 for 150 days. These are in addition to the rules that came last week from IDPH (see top story). 
  • Suspension of Onsite Surveys. IDPH indicated that all emergency rules suspend, the duration of the Gubernatorial Disaster Proclamations related to the COVID-19 public health emergency routine inspections and surveys and require IDPH to perform on-site investigations in a manner that minimizes impact on facility activities while insuring the health and safety of residents and staff. (On-site visits to investigate alleged resident abuse/neglect or conditions threatening resident health and safety will continue.)
  • Licenses. Also suspended are automatic expiration of probationary licenses.
  • Discharges/Transfers. Further suspensions are for involuntary discharge or transfer of residents for non-payment or late payment.
  • Nurse Aides. An emergency amendment to the skilled nursing code suspends the 120-day deadline after initial employment for Certified Nursing Assistants (CNAs) to complete a Basic Nursing Assistant Training Program (BNATP) and submit documentation needed for inclusion in the Nurse Aide Registry. CNAs are still obligated to perform these actions; only the 120-day deadline is suspended. Individuals working as CNAs shall demonstrate their competency in the principles, techniques and procedures of the BNATP under observation and documentation by a registered professional nurse.
  Department on Aging Adopts CCP Rule Change
The Illinois Department on Aging (DoA) recent adopted rule changes for the Community Care Program (CCP). They went into effect May 13 and they clarify requirements for certification as providers of in-home services, adult day services, emergency home response services or automated medication dispensing services.
Agencies seeking certification as adult day service providers must have at least two years experience providing direct social services programming (formerly, two years experience in “business operations” providing adult day service). Provider agencies for any service that have not previously been certified, or are not in operation at the time they apply for certification, may receive provisional certification for up to two years, during which they will be subject to additional DoA oversight. This provisional certification will replace current rule provisions that allow experience exceptions for providers that are accredited by recognized national organizations. Newly established entities may, in lieu of submitting audited financial reports for the last complete fiscal year, submit bank approved business plans with approved financial backing, along with proof that employee tax accounts have been established with the State and with the U.S. Treasury.
New for-profit entities backed entirely by individuals may, as an alternative to the bank-approved business plan, submit the most recent two years of tax returns and documentation of bank-approved financial backing for these individuals. An applying entity must show that it has sufficient assets to cover 90 days of operating expenses for the service it will provide, and no more than 30 of those days should be based on a line of credit.
This is regular rulemaking for the Department and not a result of COVD-19 emergency rule needs.
Governor Pritzker’s Daily Press Conference Updates
Governor JB Pritzker is conducting 2:30 p.m. press conferences on COVID-19. Click here to listen. LeadingAge Illinois monitors the briefings daily for information coming directly from the Governor and Dr. Ngozi Ezike, Director of the Illinois Department of Public Health (IDPH). After about 70 days of conferences (except some weekends), the Governor announced last week these would move to once per week.
Provider Relief Funds Update
Although the latest HHS FAQs published on June 1 does not shed additional light on the question of whether providers must attest to the General Distribution Funds they have received by June 3 or 90 days after receiving the payment, HHS did slightly change the language on the website related to the June 3 deadline. This language now implies that those providers who did not receive a second payment from the $50 billion General Distribution must submit their attestation to HHS through the Attestation Portal AND financial information through the General Distribution portal by June 3 to remain eligible for the 2 nd payment.  So, without further clarification, we advise all Medicare providers who did NOT receive a second payment from the $50 billion General Distribution tranche to submit their attestation and financial information by Wednesday, June 3 .
It should be noted that all the Provider Relief Fund terms and conditions documents have been updated to say providers have 90 days to attest to the terms and conditions or reject the funds. LeadingAge believes this continues to apply to all other circumstances except the situation outlined above where the provider did not receive a second General Distribution payment.
LeadingAge continues to seek additional clarification from HHS on this matter and will let you and members know if they receive any information that is contrary to this advice.
LeadingAge Comments on CMS Interim Final Rule on Medicare and Medicaid programs
LeadingAge submitted comments on the hospice and home health provisions of the April 6 CMS Interim Final Rule (IFR). The comments support telehealth expansions during the public health emergency and recommend making some of the provisions permanent. They further recommend making advance care planning audio-only communication permanent and that CMS permanently allow flexibility for routine home care hospice to be delivered via telecommunication during any future emergency. LeadingAge also made several recommendations and suggestions regarding home health flexibilities, noting that we encourage CMS to work with Congress to allow home health agencies to be reimbursed for telehealth – as LeadingAge is advocating with Congress.
LeadingAge Illinois Monthly HUD Member Call Set for June 16
Please join us for the next monthly LeadingAge Illinois HUD Member Update on June 16 at Noon. These calls feature Linda Couch, Vice President of Housing Policy and Juliana Bilowich, Director, Housing Operations and Policy at LeadingAge, Washington, D.C.  You will receive important updates on HUD and COVID-19 issues. There is also time for sharing best practices, asking questions and discussion. RSVP to Jason Speaks
LeadingAge Live Online Coronavirus Daily Member Update
LeadingAge is hosting daily live online updates each weekday afternoon. Subscribe to "LeadingAge Need to Know" via communications preferences in your MyLeadingAge account to receive email updates. Register for live online updates 5 days/week at 2:30 p.m. through May. You can find an archive of all member updates here

Also, if you’re a member of both LeadingAge Illinois and LeadingAge National, stay connected with other LeadingAge National Members and share information and resources through the MyLeadingAge Member Community: COVID-19 . This is a place to connect with your peers to share and discuss everyday practices related to the coronavirus. Take a moment now to log into your my.leadingage.org account and join the group to stay connected. LeadingAge also has a COVID-19 webpage with the latest updates, information and resources for members.
LeadingAge Illinois Requests Your Feedback
As your provider association, LeadingAge Illinois wants to offer the most relevant and up-to-date education offerings in the best format possible all while being respectful of provider time constraints and staffing considerations. We’d like your feedback regarding your education needs and readiness to participate in virtual events. 
Please complete this short survey Friday, June 5.  It should take less than 2 minutes to complete.
LeadingAge Illinois staff will use your responses to plan education for the remainder of the year. Thank you in advance for responding to this request and for your dedication to serving your residents.
Leadership and the LGBTQ Senior in the Age of COVID-19 (Webinar)
June 23
1:30-2:30 p.m.
1.0 CEs will be offered.
1.0 hours of general CLE credit pending in Illinois, New York and California

  • Donna Sue Johnson, Licensed Social Worker, St. Mary's Center, Inc. / Adult Day Health Center
  • Dan Churchill, Chief Financial Officer, The Admiral at the Lake; Board Member, Project Q, Boston, Massachusetts
  • David Alfini, Esq., Partner, Hinshaw & Culbertson, LLP; Board Member, One Roof Chicago

As a leader, it is important to understand the unique needs of the LGBTQ community and how COVID-19 has impacted them from a clinical and emotional perspective. The presenters will discuss who the LGBTQ population is and why understanding this will help you better serve the population. Additionally, learn how to avoid the risk management pitfalls and take advantage of opportunities with the LGBTQ resident to better understand needs. Registration information will be available soon.

Sponsored by:
Reopening Considerations for Nursing Homes
In this 18-minute QuickCast , LeadingAge's Jodi Eyigor and Janine Finck-Boyle review guidance from CMS on reopening and the important factors nursing home providers should consider.
Source: LeadingAge