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COVID-19 Updates: March 23, 2020
ACTION REQUIRED: PPE SUPPLY EFFORT FOR LTC--DUE TODAY at 3:00 p.m.! Click
HERE
for the Survey!
This update includes:
- Governor Evers to Issue "Safer-At-Home" Order
- CMS Issues "Prioritization of Survey Activities" Memo
- COVID-19, Visitation and Long-Term Care Communities
- Beware COVID-19 Scams Selling PPE or Other Supplies
- Interim Guidance on SNFs Accepting Patients from Hospitals
- Recommendations for Active Symptom Monitoring for Employees in Health Care Settings where Community Transmission of COVID-19 is Occurring
- Making Decisions on Essential Staff Entering Your Building
- 1135 Waiver Requests
- CMS is Delaying Implementation of the October 1, 2020 MDS Update
- WisCaregivers Careers Applicants Encouraged to Apply to WCCEAL Member Facilities
- AHCA/NCAL Announces #CareNotCOVID
- DFI Issues Emergency Guidance on Remote Notarization
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As of today, there are 416 confirmed cases of COVID-19 in the state of Wisconsin and four deaths caused by the virus. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services.
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Governor Evers to Issue "Safer-At-Home" Order
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Governor Tony Evers
tweeted earlier today that he is planning to issue a "Safer-At-Home" order on Tuesday, similar to the "Shelter-In-Place" orders that several other states have issued.
Evers said he's acting on the advice of public health experts to protect front-line workers and the most vulnerable in Wisconsin. He said he's talked with business leaders and local elected officials who agree that an "all-hands-on-deck" approach is critical.
Workers providing essential care or service in communities will be allowed to continue to travel to and from work, he said. That includes healthcare professionals, grocers and family caregivers.
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CMS Issues "Prioritization of Survey Activities" Memo
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WHCA/WiCAL will be providing additional guidance on this memo as soon as possible.
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The Centers for Medicare and Medicaid Services (CMS) has issued
blanket waivers of some Federal requirements under Section 1135(b) of the Social Security Act, applicable throughout the nation.
In regards to the specific concerns of your facility, if it appears on the
blanket waivers document, CMS has waived that requirement and no additional action on your or your facility’s behalf is necessary at this time.
If you do not find that CMS has waived the specific requirement, it remains in effect and will require an 1135 waiver. In order to request a waiver of a Federal requirement not covered under the CMS
blanket waivers, you must make the request on an individual basis. Those inquiries can be sent to the CMS mailbox at:
[email protected].
In order for CMS to expedite their review of your individual waiver request, please review this
guide to ensure that requests contain all necessary information and elements.
Any additional questions regarding Section 1135 waivers should be sent to the CMS national email box at:
[email protected].
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COVID-19, Visitation and Long-Term Care Communities
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In order to try to stop or slow the spread of COVID-19 the BOALTC is urging the full cooperation of all residents of long-term care settings, their families and friends. People who live in our nursing homes, assisted living communities and the staff and caregivers are at highest risk. When a COVID-19 case occurs in a long-term care setting, the potential for rapid spread can be extremely high and life-threatening.
The Department of Health Services Division of Quality Assurance today alerted WHCA/WiCAL that they were made aware by a local police representative at the Emergency Operations Center that there continues to be visitation at many assisted living and skilled nursing facilities. These visits appear to violate previous guidance issued by CMS. We encourage all facilities to follow guidance on visitation
Given the public health emergency, the Department of Health Services is asking for the following, effective immediately:
- Please do not visit anyone face to face, either in a long-term care setting or outside in the community.
- If you are a resident, please stay where you are. When you go into the community you run the risk of bringing COVID-19 back into your long-term care home with you, potentially infecting other vulnerable residents and staff.
Residents still have the right to access the Ombudsman Program with the Board on Aging and Long Term Care. Do not hesitate to contact them with questions or concerns.
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Interim Guidance on SNFs Accepting Patients from Hospitals
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On Friday, March 20, 2020, AHCA/NCAL sent information with
Interim Guidance for SNFs accepting Admissions from the Hospitals During the COV-19 Pandemic. It also gives recommendations on what to do if your have a resident test positive in your facility. They included two tables that will be helpful in your decision making. If you have any questions or would like to discuss, please contact
Pat Boyer, WHCA/WiCAL's Director of Quality Advancement and Education.
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Recommendations for Active Symptom Monitoring for Employees in Health Care Settings where Community Transmission of COVID-19 is Occurring
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- DHS recommends that all health care providers, including inpatient, outpatient, and residential care facilities, actively monitor staff for symptoms consistent with COVID-19.
- Employers should ensure that staff involved in patient care are systematically evaluated for symptoms of respiratory infection, including temperature monitoring and query for specific symptoms before every shift.
- Providers who develop fever or respiratory symptom MUST be excluded from work for at least 7 days. If testing for COVID-19 is performed and is negative, staff may return to work after they have been afebrile for 72 hours.
- Health care providers who have been exposed to COVID-19 but are asymptomatic do not need to be excluded from work, but should self-monitor symptoms.
Community Transmission of COVID-19 is Increasing in Wisconsin
As of 3/19/20, 155 cases of COVID-19 have been detected in 14 counties in Wisconsin, including a growing number of cases with no known exposure to confirmed cases or out of state travel. Health care workers have been diagnosed with COVID-19 in multiple areas of the state, raising concern for transmission within health facilities among staff and patients. To minimize the risk of nosocomial transmission of COVID-19 and to protect the health of the health care workforce, aggressive infection control efforts are necessary.
New research suggests that transmission of the virus that causes COVID-19 often occurs from individuals who have mild or no symptoms of the disease. Also concerning is that individuals’
level of infectiousness may be high during the pre-symptomatic phase, or in the presence of mild symptoms such as sore throat and myalgia. This poses a challenge to rapid detection and isolation of cases in health care settings.
Health Care Workers Must Stay Home when They are Sick.
It is critically important at this time that all providers assume personal responsibility for reducing the spread of respiratory viruses by not reporting to work when ill,
including if they only have mild symptoms that would not normally cause them to miss work. Employers should reinforce the message that during the current pandemic, the usual tendency for staff to “push-through” and come to work when mildly ill is not acceptable. To support staffing needs, employers should explore available resources for back-up coverage and discourage vacations during the next 60 days. When possible, employers should re-evaluate existing sick leave policies to ensure they do not pose unnecessary burdens on essential staff who must miss work due to illness.
All Health Care Organizations Should Develop and Implement Procedures for Evaluating Health Care Workers for Symptoms of Respiratory Illness before Every Shift Involving Direct Patient Care
The purpose of self-monitoring is to identify illness early and encourage self-isolation at home to reduce the potential of transmission to co-workers and patients. Monitoring should include temperature monitoring and query for symptoms of COVID-19 like illness which include any of the following:
- measured temperature >100.0F* (37.8C) or subjective fever
- new or worsening cough
- new or worsening shortness of breath
- sore throat
- myalgia
*CDC recommends fever cutoffs are different in its guidance for the healthcare workers. This is done to recognize illness early.
Monitoring may be performed by designated staff at the facility or by employees themselves with allowances for documentation of the symptoms screen to supervisors (e.g. via text, email or other methods). Staff should be evaluated before every shift. Staff who develop symptoms while at work should be instructed to don a face mask, notify their supervisor, and leave work for the day.
When May Staff Return to Work if COVID-19 Testing is Not Available?
According to DHS priorities for COVID-19 testing, health care workers who have a febrile “influenza-like illness” with lower respiratory symptoms should be tested for COVID-19. If the test is negative, then staff may return to work after the illness has resolved, according to usual best practices. Staff confirmed as having COVID-19 disease must be excluded from work for no fewer than 7 days since symptom onset, and 3 days since fever resolved. Staff with mild symptoms who are not tested for COVID-19 should remain home from work until their illness has resolved.
Expanded Use of Personal Protective Equipment to Prevent Asymptomatic Transmission
Some health systems are considering enacting policies for more universal use of face masks to prevent respiratory droplet-based transmission in most or all patient care areas. While scientific evidence for the effectiveness of this strategy is lacking, CDC has advised that health care facilities may consider requiring heath care workers to wear a surgical mask when in the facility as a
community mitigation strategy when substantial community transmission is occurring. Given the limited availability of personal protective equipment, use of surgical masks by all staff is not likely to be feasible in all settings. This strategy may be focused in areas with highest disease burden, or limited to health care workers who have had known high-risk exposures or are involved in care of vulnerable patients (e.g., age ≥60, chronic lung disease (e.g., asthma, COPD), heart disease, diabetes or immunocompromised hosts). CDC has published specific
guidelines for optimizing the supply of facemasks, which should inform decisions about expanded use of masks in routine care.
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Making Decisions on Essential Staff Entering Your Building
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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 is Delaying Implementation of the October 1, 2020 MDS Update
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The Centers for Medicare and Medicaid Services (CMS)
announced that they are delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
This delayed release will eliminate the need for significant SNF MDS training during the upcoming months as well as avoid increased documentation nationwide.
CMS staff continues to be actively engaged in discussions with AHCA and various other stakeholders, regarding the various changes, the impacts of these changes, as well as, the timeline to educate and train facility staff and update software and IT systems.
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WisCaregivers Careers Applicants Encouraged to Apply to WCCEAL Member Facilities
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Earlier today, Kevin Coughlin from the Department of Health Services sent an email to the 4,661 WisCaregivers who registered for WisCaregiver Careers but did not sign up for training or were on a waitlist when funding ran out to encourage them to apply to work in WCCEAL member facilities across the state.
If you receive any inquiries about employment as a result, please be sure to contact
Pat Boyer.
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DFI Issues Emergency Guidance on Remote Notarization
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“Due to the
COVID-19 public health emergency, remote online notarization is now authorized in this state, subject to several safeguards to ensure the integrity of the notarial process,” said DFI Secretary Kathy Blumenfeld.
Remote online notarizations must be performed using technology providers that are regulated under standards that meet or exceed the safeguards set by Wisconsin Act 125. DFI has approved four remote online notarization providers thus far:
Notarize.com and
NotaryCam, which provide remote notary services to the general public, and Pavaso or Nexsys, which provide them for title companies and other real-estate transactions.
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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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