May 12, 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.

TOP STORIES
LeadingAge Issues Press Statement on Testing Activity
LeadingAge issued a press statement yesterday on the White House activity around testing. The statement came after President Trump announced the White House is recommending that all nursing home residents and staff be tested regardless of whether or not the state has reached Phase One of the reopening plans. 
 
In a statement, Katie Smith Sloan, LeadingAge President and CEO, pointed to the failure of government to protect older people and their care workers and the needed solutions.  She also restated the LeadingAge Five Essential Actions, which were announced last week in a LeadingAge Virtual Press Conference. 
 
Press Statement from Katie Smith Sloan, LeadingAge President and CEO:
After months of pleading for help with access to testing and personal protective equipment (PPE), nursing homes and other aging services providers were desperately awaiting word from the White House today that their voices had been heard—and that help would be on the way.
 
Instead, we heard that “we have prevailed” on testing, but wishing does not make it so. Too many nursing homes still don’t have access to any kind of testing. 
 
The President this afternoon (May 11) barely mentioned millions of vulnerable older adults in nursing homes, and made no mention of those in other care settings. An entire generation of adults and care workers have been left to fend for themselves in the face of the worst pandemic in a century. The federal government has a responsibility to coordinate a response.
 
News reports today (May 11) said the White House recommended to governors that all nursing home residents and staff be tested for the virus in the next two weeks and the White House said it will help states that need it.
 
There is no clarity on how this help is coming—two months after the start of the pandemic that requires testing to limit its spread. We need test results in minutes, not days to contain the virus and to ensure that we do not lose staff while waiting for results. We also need ongoing testing, not just a Bandaid—especially since so many carrying the virus are asymptomatic.
 
The time to start leading was months ago—at the beginning of the crisis, when it was clear that millions of vulnerable older adults were in mortal danger. And we still don’t have the leadership we need.
 
In the middle of a massive shortage of testing and PPE in nursing homes, assisted living, and other care settings for older adults, a White House phone call with governors to encourage more testing for nursing homes and an offer of token support is literally the least that can be done.  
 
Two weeks ago, I attended a White House event to hear an announcement from the President that would affect nursing home providers, residents, and front-line workers. I waited eagerly to hear that months into the pandemic, the White House would finally turn its attention to securing desperately needed PPE and testing that could protect lives—and let health care providers focus on helping vulnerable residents instead of scrounging for masks and gowns. I had hoped that moment would come today, but was sorely disappointed.
 
Older Americans have been overlooked from the beginning of this pandemic, with policymakers failing to prioritize PPE and testing for nursing homes, assisted living, and other care providers going without needed PPE and testing. Some have resorted to wearing trash bags and others have had to rely on someone they call “Parking Lot Guy” to supply much needed PPE.
Unanswered Questions
 
Today’s (May 11) announcements also leave behind a cloud of questions that decide whether today’s announcement goes beyond words:
  • What help does this provide to millions of vulnerable adults cared for in non-nursing home settings?

  • Will these be rapid-result tests? If not, how are nursing home residents supposed to cope if care workers have to be quarantined while awaiting test results?

  • Since COVID-19 is affecting uncounted numbers of new people every day, what happens after 2 weeks?

  • What about desperately needed PPE?
 
Last week, LeadingAge released a new plan—Older Americans Lives at Stake: Five Essential Actions—that laid out the fundamental steps that policymakers must take to protect older adults and the people who care for them:
  • Assurance that states will not reopen without first ensuring older Americans are safe and protected.

  • Immediate access to ample PPE for all care providers who serve older Americans, not just nursing homes. Policymakers must act now to get these providers on the same priority tier as hospitals. 

  • On-demand access to rapid-results testing for older adults and their care providers. Aging services providers must also be on the same priority tier as hospitals. Results are needed in minutes, not days or weeks.

  • Recognition for the heroic frontline workers serving older Americans in nursing homes, assisted living, affordable housing, and home and community based settings, including hospice—just as we’ve recognized hospital workers and others who have kept America running.

  • Funding and support for aging services providers across the continuum of care. In its next relief package, Congress must allocate $100 billion to cover COVID-19 needs, and provide critical support for aging services: hazard pay for frontline workers, federal housing assistance, support to deliver telehealth, access to loans, Medicaid increases, and administrative relief.
LeadingAge Illinois gives special thanks to our members for serving others with commitment, compassion and care.
STATE
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.
 
To register, click on dates below:
 
 
 
 
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.
HFS Supportive Living Program Staff Transition
Kara Helton has accepted a position with another state agency and will be leaving the Illinois Department of Healthcare and Family Services (HFS) at the end of this month. She has been the leader of the Supportive Living Program (SLP) for several years and a great speaker at LeadingAge Illinois education sessions. 
 
In a message to providers yesterday, Kara said: “I’ve enjoyed working with you and appreciate the cooperation and support you’ve shown through the years. I couldn’t have done it without you! It’s been incredible to watch the program grow. When I started in 2005 there were only 37 SLP buildings! I loved visiting buildings, meeting our amazing residents and hearing their fabulous stories. It also warmed my heart to see first-hand the relationships staff built with residents. I’m grateful for having the opportunity to work with so many wonderful residents and staff.”
 
The day-to-day operation of the SLP has already began transitioning to Sara Reardon (SLP Coordinator; 217.785.9765) and Janene Brickey (Manager of Policy and Rules; 217.557.0593), although Kara will still be on staff through the end of the month to answer any COVID-19 questions.    
 
LeadingAge Illinois would like to thank Kara for her quality leadership of the Supportive Living Program.                                        
Governor Pritzker Daily Press Conferences
Governor JB Pritzker is conducting daily press 2:30 p.m. conferences on COVID-19. Click here to listen daily.

Yesterday’s briefing was held via webcast from the Governor’s home (Chicago) and IDPH Director, Dr. Ngozi Ezike’s home .  This was due to a member of the Governor’s senior staff testing positive for COVID-19. The staffer was not exhibiting symptoms, but did test positive. The Governor’s team is also working from home at this time. The Governor tested negative for the second time.   
 
Yesterday’s updates included:
 
Cases:
  • 54 new deaths (3,459 total)
  • 1,266 new csases (79,007 total)
 
Hospitalizations:
  • 4,319
  • 1,248 in ICU
  • 730 on ventilators
 
Testing:
442,425 total with 12,441 in last 24 hours
 
Remdesivir:
  • In studies, patients who receive it had statistically significant shorter recovery. 
  • Illinois received their first allocation from HHS on Saturday.
  • 140 cases were sent to 14 hospitals around the state. Each case has enough viles to care for about 5 patients. 
  • Criteria was set on receipt of the cases (transparency, data, etc.). Hospitals with the most critical cases, safety net hospitals and those who serve primarily patients of color received the cases. 
  • More shipments are expected. 
Illinois Department on Aging Update
The Illinois Department on Aging (DoA) has been updating providers and older adults on agency programs and resources throughout the emergency. 
 
As you may know, the Department temporarily suspended adult day services and group activities at the senior centers. Adult Day providers are still receiving funds from the Department during this time. The Department has also increased one-on-one in-home services.
 
The agency implemented guidance and tools from IDPH so that both in-home workers and the older adults they care for are safe when they do their work. The agencies in DoA network use this as part of any protocol where face-to-face contact with an older and more vulnerable adult occurs.
 
The Department has also issued tips for older adults (especially those at-risk) to help reduce exposure to COVID-19. The Department’s webpage titled, Be Socially Engaged While Practicing Social Distancing , offers opportunities for older adults to “connect” during this emergency.
SIREN Notifications
To get the most up-to-date guidance from the State of Illinois, you can register to receive SIREN - State of Illinois Rapid Electronic Notifications .  SIREN provides regional, State and Federal partners with a comprehensive information sharing, collaboration, alerting and notification solution. If you have difficulties registering please contact SIREN .
Source: SIREN
FEDERAL
CMS Administrator Letter to Nursing Homes
CMS Administrator, Seema Verma sent a letter to all nursing home facility management and staff yesterday thanking them for their dedication and commitment and describing all the actions CMS has taken to keep nursing home residents safe and healthy. The accounting includes extensive, ongoing guidance; coordination with CDC; temporary visitor restrictions; blanket waivers of many regulations; and new reporting requirements under the National Healthcare Safety Network. Notably, the letter says that if nursing homes need Personal Protective Equipment (PPE) and/or testing, they should contact their state health department immediately. FEMA began PPE shipments last week to CMS-certified nursing homes. CMS says that homes have received or will receive a 1-week supply of PPE.
New 1135 Waivers
New 1135 waivers were released yesterday. The CMS fact sheet has been updated and is available here . For nursing homes, this means waivers related to paid feeding assistants, fire drills, placement of alcohol-based hand rubs, and temporary construction to create physical barriers for environmental control. More information is to come. 
HHS Issues New Provider Relief FAQ and Says More Relief Coming
The U.S. Department of Health and Human Services (HHS) issued an updated Frequently Asked Questions (FAQ) document late Friday, May 8 which includes two new pages of information and clarifications regarding the Provider Relief Fund and in a meeting with HHS Deputy Secretary Eric Hargan told LeadingAge CEO Katie Smith Sloan that additional relief is coming.
 
Hargan indicated that the next round of relief payments will be going to Indian Health Services facilities and SNFs in COVID-19 hotspots, which is an item LeadingAge requested in a recent letter to HHS Secretary Alex Azar. When asked about relief payments for Medicaid providers, he added, “we are working on it. The delay is not a policy delay but a technical issue.” He went on to explain the process of obtaining provider lists from states then matching them against Medicare files to ensure that the providers are Medicaid-only (no Medicare billing) for this next round of payments.
 
In the FAQ, HHS clarifies:
  • HHS broadly views every patient as a possible case of COVID-19.
  • Funds can be recouped in the future if a provider’s health care related expenses and lost revenues attributable to the coronavirus to not equal or exceed the payment(s) received and those expenses and lost revenues were not reimbursed or required to be reimbursed from other sources. 
  • Hargan also noted that HHS may look at cases where the provider had very small losses (he suggested less than 2% but said it’s not a hard and fast standard), the government might recoup the funds.
  • Funds can also be recouped for failure to comply with the terms and conditions.
  • While there is a prohibition on balance billing for presumptive or actual COVID-19 patients as part of the terms and conditions, this FAQ clarifies that out-of-network providers simply cannot charge cost sharing in excess of what the patient would have paid through an in-network provider. This prohibition applies to presumptive and actual COVID-19 cases not to possible COVID-19 cases.
  • Presumptive cases are those where the patient’s medical record documentation supports a COVID-19 diagnosis even if the patient does not have a positive COVID-19 test result in the record.
  • Not much new news on reporting requirements except to reiterate they will begin for the calendar quarter ending June 30, 2020. The new FAQs also indicate there is more to guidance forthcoming "about the type of documentation we expect recipients to submit.”
 
Returning Payments:
Finally, for providers who received funds erroneously or received more than was expected, the FAQs walks through how providers can return these funds. These providers should still go to the Attestation Portal and reject the entire General Distribution payment. The portal will guide providers through the process for returning the funds. These steps include:
  • The provider contacting their financial institution
  • Asking the financial institution to refuse the ACH credit by initiating an ACH return using the ACH return code of “R23 – Credit Entry Refused by Receiver.”
 
For providers who received a paper check, after rejecting the funds through the Attestation Portal , the provider should destroy the check if not yet deposited or mail a paper check for the amount received to United Health Group indicating they are returning the funds.
 
After returning the funds, providers who returned a payment that was much more than expected should submit the appropriate revenue documents through the General Distribution portal in order to receive the correct payment from HHS. These payments are anticipated to be processed within 10 business days.
 
LeadingAge will update its Provider Relief Fund Background, Considerations and FAQ document to reflect the latest HHS FAQ guidance.
Source: LeadingAge
Next Steps: “Reopening” Considerations for Housing Providers
Throughout the ongoing health crisis, affordable housing providers have had to adapt to the new reality. Many senior housing communities nimbly adjusted to continue housing operations and to keep older adult residents healthy.
 
As the country eyes recovery, senior housing providers have several things to consider, including federal requirements, state or local directives, equitable recovery, workflow limits and opportunities, and the health and housing needs of residents.
 
Responsible Recovery:
During the next phases of the crisis, adapted housing community policies will require cautious adjustment. Here are several items to consider when shifting from crisis-management to recovery in affordable senior housing:
  • Move-Ins and Move-Outs. Out of concern for both residents and staff at affordable senior housing properties, or in response to state or local travel restrictions, many housing providers chose to temporarily suspend, or freeze, new admissions to the community (with exceptions for certain scenarios). Other providers continued move-ins throughout the crisis under modified safety protocols.
 
Adjusting new move-ins limits virus exposure for senior housing communities, but impacts cash flow at properties with extended vacancies, as well as affordable housing needs in the broader community. When considering whether to adjust this policy moving forward, providers across the country are weighing options for controlled adaptations to move-ins – such as electronic processing of applicants or restricted move-in timing and reserved paths into the building – and are evaluating the associated risks for staff and residents.
 
In the meantime, HUD has acknowledged the need to adjust policies based on local needs or directives, and has maintained their policy of reviewing vacancy claims on a case by case basis. In its May 1st COVID-19 FAQs for multifamily housing providers , HUD continued to encourage owners to lease-up units where safely possible; some LeadingAge members have reported flexibility on vacancy claims from their HUD Multifamily Housing regions.
  • Visitor Restrictions. Limiting access to senior housing communities was one of the first – and most important – changes that housing providers put in place at the start of the pandemic. Affordable housing visitation policies are set at the property level by owners, and HUD defers to local or state requirements, or to directives by health officials on what those policies should entail.
 
Despite the logistical and emotional challenges of limiting access to affordable housing communities, providers likely won’t lift access restrictions without deliberate planning. Many properties have had to hire or reassign staff to monitor building entrances, and residents are anxious to visit with family members and friends; however, restricted property access is seen by many housing providers as being a critical effort in slowing the spread of the virus for an at-risk population, especially as surrounding communities loosen restrictions.
 
The White House guidelines for “ Opening Up America Again ” lay out a three-phase approach to adjusting protocols. Throughout the majority of the guidelines, older adults an people with underlying health conditions are advised to continue to avoiding risks, including by limiting exposure. Several state guidelines also continue to take a cautious position on visitation by recommending or requiring senior living facilities to maintain restrictions through both accute and post-accute phases of pandemic response. HUD’s May 1st COVID-19 FAQs encourage multifamily housing providers to adjust visitation policies as they deem necessary, to keep access open for essential services providers, and to be mindful of fair housing and civil rights.
 
As providers evaluate community access policies for the next phases of the crisis, communication with residents and staff remains key. On-site teams at both small and large properties have navigated frustrated or non-compliant residents with increased transparency and by emphasizing common goals.
  • Remote Workforce. Throughout the height of the crisis, many providers adjusted staff and service coordination workflows to off-site where possible. This approach has limited exposure risk for staff and residents and is one of the more flexible arrangements of affordable housing properties.
 
In some cases, work flow at housing communities has been impacted by productivity levels or limitations; for example, school closures may have increased childcare demands on remote staff and limited their output; similarly, the limited remote access to resident files or HIPAA compliant software may have reduced capacity of property management teams. In other cases, remote work systems may have demonstrated opportunities for teams to reduce overhead costs, provide the benefits of flex schedules, or connect colleagues with new platforms. Service Coordinators may have implemented new virtual systems that worked for resident wellness checks – or solidified their belief that in-person connections work best.
 
Regarding management office hours at affordable communities, HUD has said in its May 1st FAQs that multifamily housing providers will not incur penalties for curbing hours as needed for safety reasons during the pandemic. This puts the provider in charge of assessing what works for housing staff and residents, and presents an opportunity for housing properties to innovate for a new reality of increased caution.
 
Preparing for the “New Normal”:
Regardless of what the next phases of the current crisis (or the next crisis) look like, disaster preparedness and response are key for every housing provider. As communities learn from the ongoing emergency, providers can adapt emergency plans and adjust workflows to improve resilience.
 
By examining what resiliency looks for each stakeholder, providers can better meet ongoing challenges. Helpful questions for disaster preparedness include: What does resiliency look like for my operations? What does resiliency look like for my community? What does resiliency look like for my residents? Practical answers to these questions can be reflected in property emergency operations plans to help with future crisis scenarios.
 
To help frame these discussions for housing staff, HUD has encouraged the use of several worksheets . These tools help providers learn best practices for job continuity, assess risks and weaknesses, and survey employee capacity to go to work during an infectious disease outbreak.
Source: LeadingAge
OTHER NEWS
LeadingAge Illinois HUD Member Update Set for Tomorrow at Noon
The LeadingAge Illinois Monthly HUD Member Call is set for tomorrow from 12-1 p.m. The monthly update features 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 as well as have the opportunity to provide feedback and ask questions. RSVP to Jason Speaks. 
Social Security Advisory Board Public Information
The Social Security Advisory Board has created a public information page on its website that links to government resources that may be helpful to your residents. Information on the resource page includes: how to receive delayed economic impact payments in 2021; guidance for representative payees; finding a local field office; and how to protect yourself from fraud.
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.
EDUCATION
Upcoming LeadingAge Illinois Sessions:
 
May 19
10:15 a.m.
Free to LeadingAge Illinois Members

Upcoming LeadingAge Virtual Sessions:
 
Faculty: Michael Gillette
Thursday, May 14
1 p.m.