Greetings!

We have news to share on a wide range of topics.

Details about the following four issues is included further down in this message:

Here are some quick links on three other important topics:

I also wanted to flag for you that AHCA/NCAL’s update #15 (March 21, 2020) includes some very good information including the following:

We will continue you to keep you updated.

Sincerely,

April Payne, LNHA

Vice President of Quality Improvement | Director of VCAL

Virginia Health Care Association | Virginia Center for Assisted Living 

VDH’s Priority Investigation Criteria for COVID-19 Testing 

VDH issued new testing guidance on March 20, 2020.

Testing performed at DCLS, Virginia’s state lab, is reserved for patients who meet VDH’s priority investigation criteria below. If you have a patient who meets VDH criteria, please contact your local health department for testing. For other patients who need COVID-19 testing, please contact a private laboratory to ask about how to submit specimens for testing. VDH approval is not needed for testing at private labs.

1. Healthcare workers and first line responders who had contact or cared for a patient with COVID19 within 14 days of last exposure AND fever or signs/symptoms of a lower respiratory illness.

2. Potential clusters of unknown respiratory illness where influenza has been ruled out, with priority for healthcare facility outbreaks. All suspected clusters or outbreaks should be reported to the local health department.

3. Persons hospitalized AND who tested negative for influenza and other respiratory pathogens on a respiratory virus panel on initial work-up** AND no alternative diagnosis. Priority will be given to ICU admissions or people on ventilators, where circumstances require a confirmed COVID-19 for compassionate use treatment with antivirals.

4. Person who resides in a nursing home or long-term care facility AND who has fever or signs/symptoms of a lower respiratory illness AND who tested negative for influenza on initial work-up** AND no alternative diagnosis.

*Close contact is defined by CDC.

** Initial work-up for influenza can be a rapid influenza diagnostic test or confirmatory PCR test performed at a routine laboratory. Initial work-up using the respiratory virus panel should be performed at a routine laboratory.

The March 20, 2020 guidance includes additional details, which we would encourage you to review.

Executive Order on Bed Capacity (COPN)

Gov. Ralph Northam has issued Executive Order 52: Increases in Hospital Bed Capacity directing the State Health Commissioner, at his discretion, to authorize any general hospital or nursing home to increase licensed bed capacity as determined necessary by the commissioner to respond to increased demand for beds resulting from COVID-19.

The order specifies that any beds added by a general hospital or nursing home pursuant to an authorization of the commissioner under this order will constitute licensed beds that do not require further approval or the issuance of a new license.

Interim Guidance on SNFs Accepting Patients from Hospitals 

AHCA is issuing interim guidance to help skilled nursing facilities (SNFs) make decisions about accepting hospital discharges to SNFs during COVID-19 pandemic. The decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community. This guidance is designed to help reduce the risk of admitting someone with COVID-19 into your building, along with the steps you should take to prevent any spread.

During a COVID-19 epidemic, the elderly will still have other medical problems that require hospitalization and post-acute care (e.g., strokes, CHF exacerbations, surgeries, etc.). The volume of some traditional post-acute admission is decreasing as hospitals are discontinuing most elective surgeries and elective admissions. However, hospitals expect to see a surge in admissions related to COVID-19, who will need post-acute care, especially as COVID-19 becomes more wide-spread in the surrounding community.

CMS has also waived the 3-day stay requirement for all discharges, regardless of COVID-19 status, to allow hospitals to more easily create new beds for the surge in COVID-19 admissions. As such, SNFs will face the challenge as to which hospital discharges, they can accept. The decision-making process will vary depending on if the SNF has COVID-19 positive residents already, the prevalence of COVID-19 in the surrounding community, and the hospital’s capacity, as well as the ability of the SNF to manage residents who are COVID-19 positive or suspected to have COVID-19.

We strongly urge SNFs to begin now creating separate wings, units or floors by moving current residents to handle admissions from the hospital and keep current resident separate, if possible . It is likely state public health officials may issue state or regional specific guidance that supersedes this guidance.

Transfers from SNFs to the Hospital

A positive test for COVID-19 or a person with fever or respiratory symptoms does not need to be hospitalized. They should be put in contact precautions and follow CDC guidance for COVID-19 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. 

Resident Laundry Guidance with COVID-19 and

When Families Want to Do Residents’ Laundry

With the restriction around non-essential visitors to skilled nursing centers and assisted living communities to minimize the risk of spread of COVID-19, there have been many questions on handling residents’ personal laundry, including for those who may have previously had their laundry done by a family member.

AHCA/NCAL has developed some additional guidance on this. You can also follow CDC guidelines for environmental infection control in healthcare facilities. CDC states that “Infection has not been linked to laundry procedures in residential-care facilities, even when consumer versions of detergents and laundry additives are used.”