Greetings!

This message includes details on some of VHCA-VCAL advocacy and outreach activities on your behalf including:

 

In addition, we wanted to be sure you saw the new guidance from AHCA/NCAL on hospital transfers issued this afternoon. This replaces the guidance from March 20.

 

We have also provided you with links from some of the latest AHCA/NCAL updates. Those are included at the bottom of this message with a description of the topics covered in them.

Sincerely,

April Payne, LNHA

Vice President of Quality Improvement | Director of VCAL

Virginia Health Care Association | Virginia Center for Assisted Living 

VHCA-VCAL Asks CMS for Flexibilities under 1135 Waiver

We have submitted a consolidated waiver request to CMS requesting a series of flexibilities to help nursing facilities as they deal with COVID-19. Formally called an 1135 waiver, VHCA-VCAL prepared the request in cooperation with LeadingAge Virginia on behalf of all nursing facilities in Virginia.

 

The waiver details a number of areas where regulatory relief is needed related to staffing and non-staffing issues. The staffing related items address issues related to CNA 120-day limitation for testing ; CNA training; the use of licensed or certified physical and occupational therapists to perform custodial care activities; allowing licensed speech language pathologists to provide feeding and restorative nursing activities; and the authorization of the use of paid feeding assistants.

 

The non-staffing related requests are related to bed certification; preadmission screening; the number of residents accommodated in resident rooms and the allowed square footage per resident in multiple rooms; PBJ submission requirements; ombudsman notices for discharges and transfers; the timing of meals; in-person physician visit requirements; timeframes for therapy services and the use of telehealth for other providers; training and performance review requirements (except those related to abuse/neglect/exploitation and infection control/COVID-19 management); nursing staff information posting; and certain Life Safety Code requirements requiring the presences of outside vendors or drills during which social distancing cannot be maintained.

 

DMAS is separately working on its own waiver request for Virginia. AHCA/NCAL and other state affiliates have submitted waiver requests as well. Given the influx of waiver requests being sent to CMS, we do not know the timeline for review and/or approval if the agency will grant the association standing.

OLC Guidance on Temporary Changes

The VDH Office of Licensure and Certification (OLC) has provided guidance that nursing facilities should notify their LTC supervisor in the event of any temporary changes that need to be made that do not impact licensure requirements (for example, in an effort to create a dedicated area within a nursing facility for COIVD-19 response, the facility may need to move non-ambulatory residents into available rooms within secure environments). Follow-up communication to the LTC supervisor should be made notifying OLC that the situation has resolved, and residents have returned to their appropriate space/room.

 

OLC LTC Supervisors can be reached at the following addresses:

Personal Assistants: Training and Task Guide

In response to the COVID-19 pandemic, we know many facilities are using various non-clinical staff members to continue to provide the much needed services and care to their residents and patients, as well as sustain the operations of the facility.

 

In collaboration with Chiles Healthcare Consulting , we developed the Personal Assistants - A Training and Task Guide ( word version ) as a tool for facilities which are hiring and training these additional staff members. This guide represents a compilation of resources that are intended to provide long term care facilities with the necessary educational tools and some recommended tasks that are appropriate for a personal assistant.

 

The personal assistant role may be known as other titles throughout the industry (e.g., hospitality aide, customer service associate, ancillary services associate, etc.)

This guide is intended to supplement the facility’s existing practices and protocols. It includes examples of education material that may be used during orientation of Personal Assistants as well as a sampling of step by step task assignments that the facility may find appropriate for the employees.

 

Adoption of any education or task tools should be carefully reviewed by the facility’s leadership and clinical management team prior to implementation. If you have questions regarding this guide or any of the tools, please contact me or Mary Chiles .

The tools within this resource are provided to you in a format that you can easily modify to meet the unique needs, characteristics, protocols, and practices of your facility.

Supply Donation Forms

We have set up two webforms on our COVID-19 Resources webpage related to PPE supplies. One is a form businesses and others can use if they have supplies to donate. The other is a form you can use to specify a need you may have. VHCA-VCAL will be monitoring the responses and work to put members in touch with any organization that has items to donate.

 

 

Read and share our press release . 

New Guidance on Hospital Transfers

AHCA/NCAL has revised the guidance for long term care facilities  on accepting admissions from and transferring patients to hospitals during COVID-19 (previously released on March 20). The revisions are based on new evidence from the CDC published in its March 27 Morbidity and Mortality Weekly Report (MMWR), which found that 57 percent of elderly who tested positive for COVID-19 did not have symptoms but shed virus at levels that likely made them infectious to others.

As more data becomes available, this guidance may continue to change. Some state or federal officials may issue state specific guidance that supersedes this guidance.

Admitting Residents from the Hospital



AHCA/NCAL revised the decision-making and guidance from the earlier version.

Based on this new CDC data, unless a person is tested for COVID-19 and negative before admitting them to your building, you should assume the person has COVID-19 regardless of their having or not having symptoms .

The decision-making process to accept hospital admissions will vary depending on the ability of the LTC facility to manage residents who are COVID-19 positive or suspected to have COVID-19. Accepting residents from the hospital is also contingent on the LTC facility having adequate staffing levels and PPE to manage COVID positive residents. If not possible, the LTC facility should stop accepting all admissions until the facility has staffing levels and PPE to manage residents, which may not be at typical levels from prior to this pandemic.

We strongly urge LTC facilities to begin creating separate wings, units or floors now, by moving current residents to handle admissions from the hospital and keeping current residents separate, if possible . LTC facilities should also start now to develop plans for consolidating residents between facilities to create “new” facilities that can accept hospital discharges who may be COVID-19 positive or negative or harboring the virus because testing is not available.

Transferring Residents to the Hospital

Sending a resident to hospital, even if they test positive for COVID-19 or they have a fever or respiratory symptoms, is not always necessary. Facilities should implement droplet precaution procedure and follow CDC guidance for COVID-19 for all 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. We urge members to update residents' advanced directives accordingly after having these discussions .

Recent AHCA/NCAL Updates

COVID-19 Update #24 | DOL Guidance on Leave Exemptions (March 29, 2020)

 

COVID-19 Update #23 | Medicare Accelerated and Advanced Payments Now Available (March 28, 2020)

COVID-19 Update #22 | Third Stimulus Package Signed into Law (March 27, 2020)