Greetings!
Today we're hosting our Friday afternoon member call on COVID-19 at 3:30 pm. Call in numbers are included below.
This message also includes:
- Details about the newest CMS recommendations for nursing facilities issued yesterday;
- Guidance from AHCA/NCAL on limiting the spread of COVID-19;
- Resources for proper donning and doffing of PPE and hand washing (focused infection control surveys are showing frequent incorrect use of PPE);
- Clarification from the Virginia Department of Health Professions about CNA testing;
- Compassionate care amid the COVID-19 crisis; and
- FAQs on alignment of isolation waivers, MDS, and payment policies.
Sincerely,
April Payne, LNHA
Vice President of Quality Improvement | Director of VCAL
Virginia Health Care Association | Virginia Center for Assisted Living
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VHCA-VCAL Member Call: COVID-19
April 3, 2020 | 3:30 pm
J
oin Zoom Meeting
Phone Number: 1-646-876-9923
Meeting ID: 625 702 773
One tap mobile
+16468769923,,625702773#
Agenda
- Welcome | Novel Martin | Chairman of the Board
- Update from VHCA-VCAL | Keith Hare | President and CEO
- Legislative Outreach Update | Lisette Carbajal | Director of Government Affairs
- Hot Topic Review | April Payne | Vice President of Quality Improvement and Director of VCAL
- Q&A
Please mute your line to improve the sound quality on the call. Zoom has a chat feature you can use to send questions or comments if you join via your computer.
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CMS Issues New Recommendations to Nursing Homes,
State, and Local Governments
Late yesterday (April 2), CMS, in consultation with the CDC, issued new
COVID-19 Long Term Care Facility Guidance
with recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of COVID-19 in nursing homes.
The recommendations include:
- CMS/CDC urges state and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.
- Medicare is now covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories. These laboratories may also choose to enter facilities to conduct COVID-19 testing.
- Nursing homes should immediately implement symptom screening for all staff, residents, and visitors–including temperature checks.
- An exception to this is Emergency Medical Service (EMS) workers responding to an urgent medical need. They do not have to be screened, as they are typically screened separately.
- Facilities should limit access points and ensure that all accessible entrances have a screening station.
- Patients and residents who enter facilities should be screened for COVID-19 through testing, if available.
- This new guidance can be provided to get the hospitalized patient tested before admission to the nursing home.
- Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE. The recommendations provide NEW detail on steps to take including:
- ALL long-term care facility personnel in the country should wear a facemask while they are in the facility.
- Full PPE should be worn per CDC guidelines for the care of any resident with known or suspected COVID-19 per CDC guidance on conservation of PPE.
To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and the administration urges nursing homes to work with state and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status. The recommendations provide detail on steps to take.
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Every Interaction Is a Risk
COVID-19 spreads principally person-to-person. Every interaction between people increases the risk of spread, particularly now that the virus is in most areas of the United States.
The goal is to minimize the number of interactions with residents.
It includes:
- reducing the number of various (non-essential) people entering the building; and
- targeting the number of interactions with residents by:
- reducing the number of different staff entering a resident’s room, and
- increasing efficiency of tasks when entering in a resident’s room to decrease the number of times staff enter.
It’s a simple formula for how spread happens–the more interactions that happen with a variety of people, the greater the chance of spread. So, continue to creatively reduce the number of interactions between people and stop the spread of this deadly virus.
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CMS Reports Frequent Incorrect Use of PPE
We have heard from CMS that a common theme they are finding during COVID-19 infection control focused surveys are PPE not being used correctly, including donning and doffing procedures. Surveyors are having staff demonstrate handwashing and donning and doffing of PPE.
We encourage you to review with your teams the appropriate way to apply and remove all PPE, including gloves, gowns, masks, and eye protection. Performing observations yourself can be helpful to prepare staff for surveyor observation and to quickly correct any practices needing improvement.
These step-by-step guides can be printed and posted in your center to ensure your staff are aware of the appropriate procedures for donning and doffing PPE:
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CNA Testing
The Department of Health Professions (DHP) clarified that nurse aides who have completed their training and have received a message from Pearson Vue stating they are ready to schedule their Virginia Nurse Aide Examination, have two years to complete the exam.
We sought clarification from DHP after CMS issued the blanket CMS 1135 waiver earlier this week. Under the blanket waiver, CMS was waiving the requirement that a facility may not employ anyone for longer than four months unless they met certain training and certification requirements under § 483.35(d). CMS is waiving these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. That waiver item does not address state testing requirements which is as follows:
18VAC90-25-71. Certification by examination.
B. An applicant who fails to take the board-approved skills and written portions of the state examination within two years of completion of the training or who has failed the examination in three attempts shall reenroll and successfully complete another approved nurse aide training program before reapplying.
The Board of Nursing also wanted us to share that if there are any unique situations with nurse aides regarding testing, to please have that individual reach out to the board at (804) 367-4400.
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Compassionate Care Amid the COVID-19 Crisis
Ensuring compassionate care in the midst of this pandemic, when human, equipment and financial resources are significantly strained, when we are balancing professional and personal struggles, can be a challenge. Advance care planning or end-of-life conversations can be difficult in the best of circumstances, let alone the current environment with restrictions, heightened emotions, and scarce resources.
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FAQs on Alignment of Isolation Waivers, MDS, and Payment Policies
AHCA has developed this
FAQ document
to help providers navigate how the various CDC and CMS COVID-19 guidance and Section 1135 waivers interact with current MDS-RAI coding guidance and payment models in SNFs, specific to situations where it is determined that a resident requires isolation related to the COVID-19 virus. This guidance is intended to provide context to help guide provider decisions and will be updated as necessary as new government policies and guidance are issued.
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