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COVID-19 Updates: March 22, 2020
This update includes:
- Action Required: PPE Supply Effort for LTC
- Washington Ozaukee Public Health Department Orders Lockdown of all LTC Facilities in Washington and Ozaukee Counties
- Submit State Admin. Code Waiver Requests/Ideas to WHCA/WiCAL
- Communicating After a Confirmed Case of COVID-19
- CMS Provides Medicare Advantage Flexibilities Related to COVID-19
- Medical Review Audits During COVID-19
- Interim Guidance on SNFs Accepting Patients from Hospitals
- Let’s Spread #CareNotCOVID
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WORKER SHORTAGE:
WHCA/WiCAL is working closely with the State Emergency Operations Center to address the way in which facilities can communicate their concerns about staffing if the event of an emergency. WHCA/WiCAL will update members regarding a protocol as soon as we have one. WHCA/WiCAL President & CEO John Vander Meer has asked for a hotline to be established so that in the event of an emergency providers can raise their concerns about staffing.
NOTE ON PPE:
DHS sent out an announcement on Friday to all contacts for facilities who may be receiving a limited shippment of Personal Protective Equipment (PPE) from the Strategic National Stockpile (SNS). The announcement said that if you are receiving equipment, we need your point of contact, as identified in your survey response, to be readily available to be in contact with DHS staff as the PPE is being shipped as soon as possible. Vander Meer has also asked for a hotline to be established so that facilities who have run out of PPE have someone to call.
As of today, there are
382 confirmed cases
of COVID-19 in the state of Wisconsin - up from 281 yesterday. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services.
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ACTION REQUIRED: PPE SUPPLY EFFORT FOR LTC
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WHCA/WiCAL,
LeadingAge Wisconsin, and WALA have been approached by Dr. L. Silvia Munoz-Price, M.D., Ph.D., Froedtert & Medical College of Wisconsin, with a strategy to provide Personal Protective Equipment (PPE) for nursing homes and assisted living facilities. Dr. Munoz-Price is working to secure a PPE grant from Advancing a Healthier Wisconsin to fund the purchase of disposable masks and reusable face shields. Please note that the face shields are re-usable after disinfection with standard disinfectants.
If approved, the grant would allow a “local manufacturing company to manufacture large quantities of visors and face masks.” Dr. Munoz-Price is optimistic the grant will be approved.
If your facility is interested in potentially receiving masks and face shields through this proposed grant (at no cost to the facility),
complete the survey here
.
Multi-facility companies: please coordinate within your organization so either each facility submits its own survey response, or a multi-facility company submits one survey response on behalf of all of its facilities. It is important to avoid duplication of survey responses among organization facilities.
The survey will ask you to give your best estimate of the number of masks and face shields you will need over the next four months (We realize the answer is likely, "It depends," but give us your best guess).
Interested facilities/companies must submit a survey response before 3:00 p.m. on Monday, March 23rd.
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Washington Ozaukee Public Health Dept Orders Lockdown of all LTC Facilities in Washington and Ozaukee Counties
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The Washington Ozaukee Public Health Department ordered an immediate lockdown of all LTC facilities in Washington and Ozaukee Counties on Saturday, March 21.
The order comes after three residents and a worker at a Grafton assisted living center tested positive for COVID-19. A 91-year-old man also tested positive after he passed away.
This is the first public "lockdown" order issued in Wisconsin for LTC facilities.
View the order here.
The order applies to all LTC facilities. Some/most of these restrictions have already been implemented in SNFs and in many ALs. Requirements include:
- PPE requirements for staff providing care of all residents, regardless of presence of symptoms.
- Visitation restrictions
- Posting/notice requirements
- Restricting nonessential personnel/volunteeers
- Staff screening pre-shift
- Record-keeping requirements for staff who also work at other facilities
- Record-keeping requirements for residents who are relocated or leave the facility, submitted to the public health department weekly.
- Cohorting and care bundling requirements
- Daily resident monitoring requirements
See the order in full here. This order only applies to facilities in Washington or Ozaukee counties, but this type of order may also be used by other local public health departments if COVID-19 is detected in LTC facilities. WHCA/WiCAL will continue to monitor this situation and provide members with relevant information.
WHCA/WiCAL has reached out to the public health department to express concern for the PPE requirement included in this order, as supplies are already depleting and this order requires PPE use when it may not be necessary.
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Submit State Admin. Code Waiver Requests/Ideas to WHCA/WiCAL
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Under Wis. Stat. 323.12(4)(d), when a state of emergency is declared, the governor can “suspend the provisions of any administrative rule if the strict compliance with that rule would prevent, hinder, or delay necessary actions to respond to the disaster.”
The governor’s
Executive Order states that by signing the EO, the governor hereby: “Suspend[s] the provisions of any administrative rule, if the Secretary of the Department of Health Services determines that compliance with that rule would prevent, hinder, or delay necessary actions to respond to the emergency and increase the health threat.”
WHCA/WiCAL is in communication with DHS about suspending certain rules in order to allow providers to provide efficient and quality care during this public health emergency.
If there are any current DHS rules that you believe would help facilities across the state be more nimble in delivering quality care amit the COVID-19 pandemic, please send your suggestions/ideas to
[email protected].
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Gov. Evers Requests PPE from FEMA, earmarked for first responders
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Gov. Tony Evers on Sunday announced that he has asked the Federal Emergency Management Agency (FEMA) to help Wisconsin get 50,000 non-surgical masks, 10,000 face shields, 11,000 coveralls, 3,000 N95 face masks and 35,000 pairs of protective gloves.
“We are asking FEMA to help us purchase valuable medical supplies that will be used to protect our first responders as they do the important work of keeping Wisconsin safe,” said Gov. Evers in a statement. “It is our hope that the federal government can identify a source for these supplies as quickly as possible.”
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COMMUNICATING AFTER A CONFIRMED CASE
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It’s important to keep families and staff informed once you have confirmed a case of COVID-19 in your building. To help with communication to all stakeholders, AHCA/NCAL has developed a
sample letter
for families and staff and
talking points
for the media and broader public.
Making Decisions on Essential Staff Entering Your Building
When deciding if a person needs to enter your building (including employees or outside contractors such as
therapy
, pharmacy, lab, portable x-ray, mental health provider, repair technicians, and others), all long term care facilities should consider the intent of the federal and state guidance on visitation and building entry restrictions.
The intent is to restrict entry of as many people as possible to reduce the risk of COVID-19 entering and/or spreading in the building. Anybody entering the building must comply with the most current federal and state COVID-19 guidelines. Entering multiple buildings during the day should be discouraged, or increased attention to infection control processes should be applied in cases when it is essential.
This decision needs to be balanced with meeting the needs of the resident. The risk-benefit trade off needs to be made on a case-by-case basis and should be informed by the high mortality associated with contracting this virus in the elderly. This decision process should also be evaluated and adjusted as necessary as the COVID-19 situation evolves in your local community and building.
Utilizing Non-Direct Care Staff to Support Needs
COVID-19 has interrupted usual daily operations in all long term care facilities. This means some direct or non-direct care staff usual duties are on hold or not urgent during this pandemic. Thus, there is opportunity to engage those staff in supporting activities that must continue despite the pandemic disruptions. Below are some ideas to consider.
Typical Nurse Aide Duties to be Stopped and Shifted to Other Non-Direct Care Staff:
- Deliver water and snacks
- Deliver linen and supplies
- Restocking supplies
- Assisting residents in wheelchairs to/from events (bathing, etc.)
- Take menu/orders from residents
- 1-on-1 with resident who have behavioral challenges or need socialization
- Deliver meals to residents during mealtime
- Applying/removing glasses and hearing aids to residents
- Bed making
- Responding to call lights
- Assisting with feeding non-choking or non-aspiration risk residents
- Doing errands for the resident
- Doing personal care such as combing hair or washing faces/hands
- Stay with resident while in the bathroom to free up NA to do other tasks while waiting to transfer
Nurse and Nurse Aide duties that could be supported by physical and occupational therapy and speech-language pathology staff:
- Restorative and functional ADL and mobility maintenance services
- Perform and document routine vital signs, orthostatic BPs, etc.
- Assisting to feed moderate risk residents (history of some choking issues)
- Any other basic support duties that could also be performed by non-direct-care staff
Typical Nurse (or some medication aide) duties to be shifted, stopped, or requests to reduce/discontinue:
- Request discontinue of non-critical medications (e.g. vitamins, calcium)
- Request discontinue or reduced blood sugar checks (e.g. decrease to daily or weekly)
- Request discharge of sliding scale insulin and standard/set amount of long-acting insulin administered every day
- Request to reduce dressing changes to daily or biweekly (as appropriate)
- Routine vital signs decrease to weekly or monthly (as appropriate)
- Orthostatic B/Ps - reduce to one time daily or weekly (as appropriate)
- Stop routine monthly vital signs
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CMS Provides Medicare Advantage Flexibilities Related to COVID-19
CMS has provided Medicare Advantage (MA) organizations with flexibilities. However, it is up to each individual MA plan to determine what flexibilities they will implement. It also applies to Medicare Medicaid Plans (MMPs).
MA organizations
have the ability to
:
- Waive or reduce enrollee cost-sharing for beneficiaries impacted by the outbreak.
- Provide enrollees access to Medicare Part B services via telehealth in ANY geographic area and from a variety of places, including a beneficiaries’ home.
- Waive plan prior authorization requirements that otherwise would apply to tests or services related to COVID-19.
- Relax “refill too soon” edits and provided maximum extended day supply on drugs.
- Reimburse enrollees for prescriptions obtained from out of network pharmacies.
- Relax plan-imposed policies that may discourage certain methods of delivery such as mail or home delivery, for retail pharmacies that choose to offer these delivery services in these instances.
- Waive prior authorization requirements at any time that would otherwise apply to Part D drugs used to treat or prevent COVID-19 if or when such drugs are identified.
MA organizations
are required to
: During disaster or emergency (declared by the Governor of a state or Protectorate) the following are in effect until the end date identified in the State declaration or for 30 days, if no end date is identified in the declaration.
- Cover benefits furnished at non contracted facilities if the facilities have participation agreements with Medicare.
- Waive, in full, requirements for gatekeeper referrals where applicable.
- Provide the same cost sharing for the enrollee at a non-contracted facility as if it were a contracted facility.
- Changes that benefit the enrollee can be effective immediately without the 30-day notification requirement (examples include reductions in cost sharing and waiving prior authorizations).
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Medical Review Audits During COVID-19
AHCA is aware that several members are receiving additional development review (ADR) medical review documentation requests for Medicare Part A, Part B, and Medicare Advantage (MA) services from Medicare contractors and MA plans. Such requests have a limited response time and often require front-line clinical staff to provide the supporting documentation.
While AHCA is awaiting clarification from CMS about possible audit relief, we recommend that providers receiving any ADRs
immediately contact the contractor or MA plan and request suspension of any pre-pay review and an extension for any post-pay review due to the COVID-19 crisis.
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Interim Guidance on SNFs Accepting Patients from Hospitals
AHCA is issuing
interim guidance
to help skilled nursing facilities (SNFs) make decisions about accepting hospital discharges to SNFs during COVID-19 pandemic. The decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community. This guidance is designed to help reduce the risk of admitting someone with COVID-19 into your building, along with the steps you should take to prevent any spread.
During a COVID-19 epidemic, the elderly will still have other medical problems that require hospitalization and post-acute care (e.g., strokes, CHF exacerbations, surgeries, etc.). The volume of some traditional post-acute admission is decreasing as hospitals are discontinuing most elective surgeries and elective admissions. However, hospitals expect to see a surge in admissions related to COVID-19, who will need post-acute care, especially as COVID-19 becomes more wide-spread in the surrounding community.
CMS has also waived the 3-day stay requirement for all discharges, regardless of COVID-19 status, to allow hospitals to more easily create new beds for the surge in COVID-19 admissions. As such, SNFs will face the challenge as to which hospital discharges, they can accept. The decision-making process will vary depending on if the SNF has COVID-19 positive residents already, the prevalence of COVID-19 in the surrounding community, and the hospital’s capacity, as well as the ability of the SNF to manage residents who are COVID-19 positive or suspected to have COVID-19.
We strongly urge SNFs to begin now creating separate wings, units or floors by moving current residents to handle admissions from the hospital and keep current resident separate, if possible
. It is likely state public health officials may issue state or regional specific guidance that supersedes this guidance.
Transfers from SNFs to the Hospital
A positive test for COVID-19 or a person with fever or respiratory symptoms does NOT need to be hospitalized. They should be put in contact precautions and follow
CDC guidance
for COVID-19 positive or presumptive cases in long term care. If a resident requires IV fluids, oxygen and other treatments due to their respiratory symptoms, Medicare will allow you to switch the person over to Medicare Part A
without a 3-day SNF stay
. Discussion with families and residents should occur about the risks of hospitalization with COVID-19 during this pandemic period.
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Let’s Spread #CareNotCOVID
This has been a challenging time for everyone: staff, residents and their loved ones. We know many of you are going to extraordinary lengths to keep your residents safe from this virus, as well as help keep them engaged while they’re unable to visit with family members, volunteers, and even each other due to social distancing. With many individuals now staying home, we thought this would be a good opportunity for members of the public to send some messages of support to our residents.
So, we’re happy to announce the release of
www.carenotcovid.com
to make it easy for anyone to send a video message to our seniors and individuals with disabilities. We’re also collecting stories from around the internet, so everyone can feel uplifted and inspired to chip in where they can. Whether it’s encouraging donations of hand sanitizer to your local facility, or asking children (who are at home while schools are closed) to create a homemade card, we hope you’ll show your residents
www.carenotcovid.com
every day to let them know that we’re all thinking about them.
Feel free to even take a photo or video of your residents reacting to the messages on this website – we'd be happy to share those too. Send us any messages, inspiring stories or random acts of kindness by:
- Using the hashtag #CareNotCOVID, and/or
- Tagging @WHCA/WiCAL on Facebook
And if you’re looking for ideas on how to keep your residents engaged and adjust some of your activities in light of this pandemic,
check out our new resource
.
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As a reminder, WHCA/WiCAL's staff team is ready to serve your facility. We are committed to providing members with the services you need to succeed in your mission to provide high-quality care to Wisconsin's most vulnerable residents.
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Jim Stoa, J.D.
| Director of Regulatory Affairs and Government Relations |
[email protected]
Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
[email protected]
Allison Cramer
| Communications and Government Relations Specialist |
[email protected]
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