May 29, 2020
Quick Links:
COVID-19 Updates: May 29, 2020
This update includes:
  • AHCA/NCAL Unveils System For How to Test and Cohort Residents
  • Assisted Living Communities Fight Coronavirus, Urge Access to Testing, PPE
  • Bureau of Assisted Living – Technology Based Inspections
  • Specimen Acceptance Criteria for Nursing Homes and ICFs/IID Testing
  • AHCA’s Expanded Infection Prevention & Control Training Includes Bonus COVID-19 Material
  • State Agencies Announce $70 Million in Savings
As of today, there are 17,707 confirmed cases of COVID-19 in the state of Wisconsin and 568 deaths caused by the virus. Click HERE to view the latest outbreak information from the Wisconsin Department of Health Services. Click HERE to view COVID-19 projections for Wisconsin and the United States.
AHCA/NCAL Unveils System For How to Test and Cohort Residents
The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said it has created an  algorithm for testing and cohorting nursing home residents that incorporates the latest guidance from the Centers for Disease Control and Prevention (CDC) on the coronavirus (COVID-19).

The algorithm walks through three primary entry points for testing prior to deciding on who and how to cohort individuals. “The entry points include testing residents who develop symptoms, testing all residents simultaneously, and testing new admissions. The algorithm also walks through how to cohort if the person(s) tested are in a single-person room or with roommates,” the group said.

On a separate front, AHCA/NCAL said it now has a  resource to help providers continue to keep residents connected with their loved ones. As visitation restrictions and social distancing continue, the long term care profession needs to find ways to keep people connected in person when possible. Using an infection prevention and control mindset can help generate innovative methods to engage residents, families, and fellow residents, the association said.

“This resource is a starting point and intended to kick off additional ideas each center or community is able to try based on the status of COVID-19 in their building and in their community as well as the availability of necessary resources to support these innovative efforts,” AHCA/NCAL said.

In another area of concern to providers during the pandemic, AHCA/NCAL said in its guidance on  Where to Turn for Help, the association shared information and a customizable template for requesting a facility-level 1135 waiver from the Centers for Medicare & Medicaid Services (CMS). AHCA/NCAL said it has updated the  template due to CMS blanket waivers and guidance provided since the group first shared the template. 

“Remember that while using this check-box format, it is still important that you customize your waiver request to reflect your center’s needs and circumstances, as this will aid in CMS’ review and approval of your requests,” AHCA/NCAL said.

“This is a Word document, so you can make edits to include the items you need and to provide any additional explanation or rationale for your requests.” 

Lastly, AHCA/NCAL said CDC on May 19 updated several of its webpages to be reflective of the CMS updates on reopening guidance. The three webpages that were updated include: 

 
Below is a summary of what was changed. Review your infection prevention and control procedures to ensure they are consistent with the latest guidance. 
 
  • Tiered recommendations to address nursing centers in different phases of COVID-19 response.
  • Added a recommendation to assign an individual to manage the facility’s infection control program (ICP). CDC feels that “facilities should assign at least one individual with training in IPC to provide on-site management of their COVID-19 prevention and response activities,” because of the breadth of activities for which an IPC program is responsible. This includes developing IPC policies and procedures, performing infection surveillance, providing competency-based training of health care personnel, and auditing adherence to recommended IPC practices.
  • Added guidance about new requirements for nursing centers to report to the National Healthcare Safety Network (NHSN).--Added a recommendation to create a plan for testing residents and health care personnel for SARS-CoV-2. Note, AHCA/NCAL provided recent guidance on testing that incorporates the latest from CDC.
  • Additional descriptive information for such areas as universal source control, hand hygiene, optimization of personal protective equipment (PPE), and the COVID unit section based on common questions received, including:
  • Removed language to move residents with symptoms or suspect COVID to an observation unit, if one was available, as this has been a point of confusion and has not been feasible for most facilities.
  • CDC recommends creating a COVID unit for residents with confirmed COVID and, if possible, an observation area for new admissions with no known COVID history (those with known COVID would go to COVID unit), but recommend that if possible, those with symptoms or suspect COVID-19 go to a private room. Testing should be prioritized for these individuals, and, if positive, they would move to a COVID unit. PPE should be worn.
Assisted Living Communities Fight Coronavirus, Urge Access to Testing, PPE
Assisted living communities continue to battle the COVID-19 pandemic by deploying the same limitations on visitors and other screening and infection control practices seen in skilled nursing facilities, but Scott Tittle, executive director of the National Center for Assisted Living (NCAL), says operators need access to testing and supplies to maintain high-quality resident care.

“The story is no different for our providers. There is not adequate access to PPE and testing in assisted living,” he tells Provider.

PPE refers to the personal protective equipment staff inside assisted living communities need to wear to prevent infections during the pandemic, like masks, gowns, and other supplies.

As for the issue of testing, Tittle says new data from the American Health Care Association/NCAL (AHCA/NCAL) said the combined cost for COVID-19 testing of every resident and staff of assisted living communities in addition to nursing facilities would tally $672 million nationwide. For assisted living alone the cost to do such testing would amount to $232 million.

AHCA/NCAL supports testing every resident and staff of skilled nursing facilities and assisted living communities, but ongoing testing carries unsustainable costs without continued support from federal and state governments, he says.

“With seniors among those most susceptible to the virus, the assisted living profession, in particular, is facing historic challenges when it comes to our most sacred charge—the health and safety of our residents,” Tittle says.

“Unfortunately, shortages of testing and PPE continue to be a challenge nationwide, and because assisted living communities are not medical facilities, they have not been prioritized for testing or supplies. We encourage our elected leaders to prioritize our most vulnerable and those who care for them in all long term care settings.”

Moving forward, he says, there is no doubt that fighting the pandemic has been “incredibly challenging” for operators. “The amount of resources that assisted living operators are dedicating to this crisis is immense. They have had to purchase high-priced PPE at unanticipated volume, adapt their operations for more one-on-one care to keep residents protected from spread, and offer ‘hero pay’ to caregivers as well as hire additional staff,” Tittle says.

In addition to the financial strain of operating buildings right now under tight visitation rules and precautions to prevent virus spread, AHCA/NCAL is very concerned about litigation issues.

“You think about the need for seeking immediate protection at the state and federal level from misguided lawsuits,” Tittle adds. “We understand that loved ones are grieving and looking for answers, but this is an unprecedented public health crisis, and caregivers are doing everything they can with limited resources and the information they have. Providers or individual staff members who were following government guidance should not be held responsible for their good faith efforts during this once-in-a-generation pandemic.”

Since the start of the current crisis, Tittle says assisted living has been on the frontlines working to manage, control, and eliminate the virus from buildings all across the country and will remain vigilant even as states gradually loosen lockdown protocols in the coming weeks and months.

“Certainly, even before CDC [Centers for Disease Control and Prevention] and the states acted in early March, we [NCAL] were sending out guidance to our operators on limiting visitors because we knew early on about the way the virus was spreading,” he says.

“I think as we move forward, one thing that needs to be shared is this thought we’re not going back to the same normal that we were before. That’s acutely true in long term care. I know other business lines are very anxious to open up and have customers, but we are uniquely positioned in how this virus attacks and impacts the most vulnerable of our population.”

Tittle says assisted living, from owners to staff in the buildings, are doing everything that they can to persevere over the coronavirus, and “there are incredibly heroic stories about how staff are taking on double shifts or they’re actually moving into facilities and staying there overnight to help fight the battle.”

What about the future? Tittle says people looking at assisted living communities as a place to call home need to look beyond the headlines and explore the options themselves, as best as possible.

“I think the best thing people can do is to evaluate the amount of spread in their surrounding community and contact the facility directly to learn what’s going on inside the building and how they’re adapting to protect residents,” he says.

And, some facts about life inside assisted living communities play to the new normal that has taken hold with the virus, Tittle notes.

“Assisted living by its nature sees most residents in individual rooms, so that can help reduce spread already,” he says. “I know our operators are doing everything they can to be sure they are providing environments that are safe not only for residents and families but for their employees.”
Bureau of Assisted Living – Technology Based Inspections
In order to reduce the footprint in assisted living facilities during the COVID-19 crisis, the Bureau of Assisted Living will conduct remote surveys.

Surveys conducted during this time will include but not limited to:

  • All complaints that constitute imminent danger, immediate threat, and allegations of abuse and neglect
  • Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses
  • Statutorily required probationary licensing visits
  • Verifications visits required due to a No New Admission Order (NNAO) or NNAO
  • Extended Initial licensing/certification surveys

Surveyors will conduct remote surveys using a combination of phone calls, email/fax, and online video conference technology to complete interviews, record reviews, and observations.

Online video conferences will be conducted through Apple FaceTime or Zoom.

The Bureau of Assisted Living encourages you to review the following online video conference guides to prepare for a remote survey: Apple FaceTime
Specimen Acceptance Criteria for Nursing Homes and ICFs/IID Testing
Testing is a key strategy for identifying individuals who have COVID-19 and in limiting the spread to others, which is particularly important for the individuals who live in these settings. To date, approximately 91% of nursing home and ICF/IID providers are testing or have tested their residents and staff. Providers are encouraged to send the specimens back to the lab on a daily basis as testing is conducted; this will ensure the integrity of the specimens and assist in timely processing.

Please follow these best practices for specimen acceptance criteria to help ensure that every specimen gets tested:

Specimen Identification
  • Label every specimen you collect clearly and legibly with the resident information
  • Ensure the label on the tube matches the information on the Test Requisition Form
  • Under “Healthcare Organization Name” enter the account name for your site; if you do not know the account name, reach out to your Exact Sciences account manager or call 844-570-9730 for more information
  • Please identify whether the specimen is for a staff member or resident

Specimen Collection
  • Refrigerate specimens as soon as possible after collection
  • Send specimens the same day you perform collection; you may wish to make arrangements with the courier in advance to ensure same day transport
  • If you need to collect over multiple days, please send specimens at the end of each day you’re collecting
  • Ensure specimens are in an appropriate container; loose specimens in bags are more susceptible to damage, and may break and leak more easily

Specimen Transport
  • Pack specimens securely
  • Pack specimens to avoid excessive movement; avoid open space within containers
  • Make sure caps are secure before transport
  • Ensure specimens are packed with ice or cold packs during transportation; specimens that arrive at room temperature must be rejected

Additional resources will be developed and posted under “Testing Criteria” on the COVID-19: Long-Term Care Facilities and Services webpage

If you have questions about the testing process or suggestions for other publications that would be helpful, please email WI COVID-19 SNF Testing.
AHCA’s Expanded Infection Prevention & Control Training Includes Bonus COVID-19 Material
AHCA/NCAL’s expanded version of its popular  Infection PreventionistSpecialized Training (IPCO Version 2) in now available. The online training is recommended for individuals responsible for infection prevention and control in all long term care settings, including assisted living.

Phase III Requirements of Participation took effect November 28, 2019 and mandate that every nursing facility have a designated and specially trained Infection Preventionist who is running a comprehensive infection prevention and control program. The training is also highly recommended for assisted living communities because they care for a similar population and can face similar infection risks.

AHCA has long recommended that each skilled nursing facility train at least two Infection Preventionists through  AHCA’s IPCO training program should one Infection Preventionist leave the facility or be unavailable. On its May 13 weekly call for nursing homes, CMS also recommended that skilled nursing facilities have two Infection Preventionists for the same reasons.

IPCO Version 2 is designed to train Infection Preventionists and is approved for 25 ANCC contact hours. The online course is also now approved for 22 NAB CEUs for Administrators. AHCA/NCAL recognizes Administrators will not serve as designated Infection Preventionists but recommends that Administrators consider taking the course to gain a deeper understanding of infection prevention and control in the overall operation of a nursing facility as this is a high target area for survey and liability.

IPCO Version 2 includes:

  • Updated regulatory requirements and added course content, including:
  • Multi-drug Resistant Organisms (MDROs) and Enhanced Barrier Precautions (EBP)
  • Candida Auris
  • Water management
  • COVID-19

Bonus Content – All persons who register for IPCO Version 2 receive additional non-CE approved content. Topics include Interim COVID-19 Guidance, and courses on PPE and N-95 mask use.

The registration fee is $450 for AHCA/NCAL members and $650 for non-members. There are no refunds and no transfers.  Registrants have one year to complete the course. Payment and registration are made online at  ahcancalED. Discounted group purchase rates are available for groups of 25 or more by contacting  educate@ahca.org.

Members will need to login with their AHCA/NCAL usernames and passwords to  register for IPCO Version 2. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail  educate@ahca.org with their name and facility
State Agencies Announce $70 Million in Savings
The Department of Administration says $70 million had been identified in cost savings in state operations. The reductions are part of the 5% reduction requested by DOA to balance the remainder of the FY19-20 budget. More than half of the $70 million is coming from a $40 million lapse at the UW System. According to documents provided by DOA, the target lapses are:

  • DATCP: $1,151,600
  • DFI: $898,600
  • OCI: $986,200
  • DPI: $2,747,900
  • UW System: $40,774,400
  • Technical Colleges: $150,800
  • DNR: $1,494,700
  • Tourism: $714,000
  • Corrections: $2,397,300
  • DHS: $7,482,700
  • DCF: $1,910,500
  • DWD: $367,500
  • Justice: $965,200
  • DMA: $510,400
  • DOA: $552,200
  • Governor: $201,360
  • DOR: $5,671,400
WHCA/WiCAL Staff
John Vander Meer, MPA | President & CEO | john@whcawical.org

Jim Stoa, J.D. | Director of Regulatory Affairs and Government Relations | jstoa@whcawical.org

Pat Boyer, MSM, RN, NHA | Director of Quality Advancement and Education | pat@whcawical.org

Kate Dickson, MPA | Director of Reimbursement | kate@whcawical.org

Kate Battiato, MPA | Director of Workforce Development | kbattiato@whcawical.org

Allison Cramer | Communications and Government Relations Specialist | allison@whcawical.org

Jena Jackson | Director of Development | jena@whcawical.org

Jammie Moore | Director of Administrative Services | jammie@whcawical.org

Business Partner Spotlight
Navigator Group Purchasing, Inc.. is the largest and most experienced full-service GPO exclusively focused on senior living. Members gain access to a full range of programs, tools, and services to help them achieve their resident and financial goals.

As a full-service GPO, we have a complete services offering including: Group Purchasing, Data Analytics, Emerging Market Trends, Quality Metrics, Resident Satisfaction, Culinary Consulting Services, Software Solutions, and Advocacy and Legislative.

Operating as part of Managed Health Care Associates, Inc. (MHA), we conduct our business in accordance with the Mission and Vision that unify all MHA companies and solutions:

Mission  
MHA is committed to deliver excellent value and enable the success of our Members, Customers and Business Partners in the alternate site health care setting. Through the use of innovative technology, solutions and services MHA assists in managing health care costs, improving operational efficiencies and supporting business growth.

Vision
To be recognized as the leader in delivering value through innovative technology, solutions and services to our Members, Customers and Business Partners by providing exceptional service through extraordinary people.

CONTACT:
Navigator Group Purchasing
Laurie Jochmann
800-642-3020


For the complete listing of WHCA/WiCAL Gold Business Partners, click   HERE !
WHCA/WiCAL | 608.257.0125 | info@whcawical.org | www.whcawical.org