Volume 12 | September 2020
LeadingAge Ohio is pleased to share with you our legislative newsletter - The Aging Advocate. This monthly publication is designed to communicate what's going on in the world of aging and give you a peek at LeadingAge Ohio's 400+ members around the state. 

Please continue to support frontline healthcare workers during this time as they work to keep everyone safe.
What's Inside?
  • 'Essential caregiver' action proposed by LeadingAge Ohio to Ohio Department of Aging;
  • Indoor visitation returning to Ohio's long-term care facilities, state seeks alignment in testing/visitation guidance;
  • State legislators check in with local providers;
  • Workforce crisis in long-term care takes spotlight during COVID pandemic;
  • And more!
Aging Happenings
'Essential caregiver' action proposed by LeadingAge Ohio to Ohio Department of Aging
Visitation restrictions in response to the pandemic have been ongoing in Ohio since March, and there is no doubt that the effects of social isolation have taken a toll on Ohioans served in long-term services and supports. To counteract these negative effects, creative solutions to ensure adequate social opportunities and care are critical. In the interest of better serving residents and fighting social isolation in facilities, LeadingAge Ohio submitted an "essential caregiver" pilot program to the Ohio Department of Aging.

The essential caregiver program would allow individuals in long-term care to designate an 'essential caregiver' and an alternate who would be allowed expanded visitation to facilities to help care for and assist their loved ones. To help visualize this need, imagine the following example, based on numerous real reports in Ohio facilities:

A frail elder who always responded to her daughter’s urging to get out of bed from her afternoon nap prior to COVID now shows no interest in getting out of bed and signs of worsening frailty amid ongoing visitation restrictions. Outdoor visitation has become difficult due to her multiple conditions. If the daughter became an essential care giver, the daughter could still arrive at her mother’s bed side to assist in getting her up to socialize in her room. 

Moving forward with a pilot program will offer providers and families a chance to try this kind of program and monitor the effects before any type of statewide mandate is issued. Essential caregiver programs have been utilized in Texas and other states around the country to support residents during the pandemic. LeadingAge Ohio looks forward to working with state leaders on making this proposal a reality.
Indoor visitation returning to Ohio's long-term care facilities, state seeks alignment in testing/visitation guidance
During last Thursday's press conference, Director of Aging Ursel McElroy announced that the DeWine Administration will allow indoor visitation for residents of Ohio’s nursing homes and assisted living beginning October 12. This comes after months of LeadingAge Ohio-led advocacy efforts to resume indoor visitation with winter fast approaching.

“The prolonged loss of connection is critical,” said the Director, noting that they had consulted with aging advocates, including LeadingAge Ohio, to develop the guidelines for indoor visitation.

LeadingAge Ohio and other provider associations worked hand-in-hand with the Administration to craft considerations for indoor visitation. Similar to outdoor visitation, providers should consider the following before opening indoor visitation:

• Case status in the surrounding community;
• Case status in the facility;
• Staffing level;
• Access to adequate testing for residents and staff;
• Personal protective equipment supplies; and
• Local hospital capacity.

Director McElroy noted that nursing homes cannot limit access to the building to other healthcare providers, including hospice staff. The Director of the Ohio Department of Developmental Disabilities noted that visitation will begin for intermediate care facilities (ICF-IDD) on September 28, setting up a space in each home that would allow visitation to occur in a space isolated from other residents.

CMS Guidance

The state has recently sought to align Ohio's testing and visitation guidance with federal guidance from the Centers for Medicare & Medicaid Services (CMS) to streamline the process. CMS, the federal body which regulates nursing homes, recently released QSO-20-38-NH and QSO-20-39-NH, which provides new guidance for testing and visitation in nursing homes during the COVID-19 pandemic.

For months, state and federal guidance surrounding visitation and testing have been at odds with one another, with providers having to follow two distinct and contradicting county color coding systems and sets of requirements. The state has recently sought to align Ohio's guidance with federal guidance to streamline the process. Confusion still exists, however, particularly around the county positivity color designation. LeadingAge Ohio continues to work with association partners and the Administration on this issue.

The CMS guidance relies on core principles of COVID-19 infection prevention, which include:

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred)
  • Face covering or mask (covering mouth and nose)
  • Social distancing at least six feet between persons
  • Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit
  • Appropriate staff use of Personal Protective Equipment (PPE)
  • Effective cohorting of residents (e.g., separate areas dedicated to COVID-19 care)
  • Resident and staff testing conducted as required at 42 CFR 483.80(h) (see QSO-20-38-NH)

CMS will also only permit indoor visitation for a facility if there has been no new onset of COVID-19 cases in the past 14 days and the facility is not conducting outbreak testing. “Outbreak” is defined as any new case within a facility. 
State legislators check in with local providers
As daily changes and challenges continue to affect long-term care providers across the state, LeadingAge Ohio has taken the lead in arranging outdoor visits and virtual meetings to ensure that state leaders are well briefed on the needs of this sector and those they serve.
Representative Bill Roemer recently made stops at Regina Health Center in Richfield and Chapel Hill Community in Canal Fulton to donate personal protective equipment (PPE) from JobsOhio. Providers continue to struggle to stock certain types of PPE.
Representative Phil Plummer visited Grace Brethren Village in Englewood to talk with long-term care workers on their experience during the pandemic. Despite the physical and emotional demands of the job, these workers continue to be underpaid.
Senator Matt Huffman joined staff from LeadingAge Ohio and Green Hills Community in West Liberty to review challenges posed by the pandemic. As Mike Ray from Green Hills put it, "Providers are driving with their eyes on the gas tank."
Senator Rob McColley took time to discuss workforce pressures in long-term care with Genacross Lutheran Services and LeadingAge Ohio. Long-term care staff have adapted to daily regulatory changes while caring for Ohio's most vulnerable citizens.

Representative Bill Reineke recently spoke to LeadingAge Ohio members as part of the Advocacy Bootcamp webinar series. Rep. Reineke, who was honored with LeadingAge Ohio's Public Service Award in 2019, shared how best to reach state leaders and offered important tips for improving as an advocate.
Workforce crisis in long-term care takes spotlight during COVID pandemic
The ongoing pandemic has exposed an issue that was occurring long before COVID-19 emerged – the workforce recruitment crisis that exists in long-term care and the services that assist senior citizens. Providers of these important services have been at the forefront of the COVID-19 battle since its start, and the resulting emotional and physical strain on this workforce has shined a light on the importance and need of these individuals like never before. 

NBC4 in Columbus recently profiled this issue, tapping LeadingAge Ohio's Patrick Schwartz and Dr. Bob Applebaum of Scripps Gerontology Center at Miami University to discuss.
About LeadingAge Ohio
Founded in 1937, LeadingAge Ohio is a nonprofit trade association that represents over 400 long-term care organizations and hospices, as well as those providing ancillary health care and housing services, in more than 150 Ohio towns and cities. The continuum of care reflected by the member organizations serve an estimated 400,000 elderly Ohioans daily and employ more than 35,000 persons statewide.

Want to meet with LeadingAge Ohio? Share a story? Visit a provider in your community?