March 17, 2020
We previously reported that the Nursing Commission had implemented an expedited licensing process in King County for out-of-state nurses. The expedited process is now available in Pierce and Snohomish Counties. Click here for information detailing the application process. The letter also provides information about how VOLUNTEER health care providers can register for temporary licensing. These are the only two ways for nurses outside of Washington to practice in our state.
Governor Inslee took bold action on residential care training standards in his Executive Order 20-10 pertaining to assisted living and residential settings. Training and certification standards for home care aides are waived and/or suspended until midnight on April 9, 2020. Of particular note is the repeal of the residential care training standards in Chapter 388-112A WAC. This should remove barriers to getting long term care workers into the workforce to assist during this time by waiving the 120-day timeline to meet the minimum training and specialty training requirements. Click here for the summary of regulations that are repealed.
In short, individuals currently in training will not be required to complete training within 120 days of hire, nor be certified within 200 days. The 12 hours of required continuing education for caregivers is also currently repealed. If a caregiver has a birthday between now and April 9, they will not be required to complete those hours of training by that birthday. If deadlines are looming for caregivers, those are put on hold for now.
The Nursing Care Quality Assurance Program is working now on an advisory to statewide certified nursing assistant programs to more broadly allow distance learning for workers in training programs, and to permit more expeditious onboarding of nursing assistants registered. The Commission is currently working on strategies to on-board workers more expeditiously, including developing standards for a 16-hour, on-line training program, front-loaded in safety and emergency services, so that nursing assistants registered could be on-boarded, with supervision. While there are no current considerations for eliminating the 120-day timeline for becoming a CNA, this is an issue that could be revisited. An advisory will be sent through CNA training program and the DSHS nursing home listservs.
Last night, March 16, 2020, Governor Jay Inslee amended his original proclamation addressing visitation to long term care facilities. The amended proclamation prohibits ALL visitors to assisted living facilities, skilled nursing facilities, enhanced services facilities, adult family homes, and other various state hospitals and correctional facilities. The prohibition does not apply in end-of-life situations.
Because the proclamation is broad, and because it also addresses correctional facilities, there is language in the proclamation allowing visitation by “attorneys, administrative law judges, advocates, or similar persons who represent a resident.” Be aware of this provision, but don’t be confused by it. The provision is not meant to apply to family members claiming to be “resident representatives” in order to get into your community to visit their relatives.
The Governor’s proclamation also clearly provides that you can admit “vendors or volunteers who supply or work in the facility.” But, note anyone who you allow into the facility should undergo the screening protocol established by the Governor and wear appropriate personal protective equipment (PPE), if appropriate.
We would also note that the prohibition on visitation does not apply to RCS surveyors or APS personnel. However, these individuals should go through the screening routine demanded by the Governor. With respect the LTC Ombuds, they have temporarily adopted a virtual visit protocol. When the Ombuds program returns to in-person facility visits, we will let you know.
What was not addressed in the Governor’s Proclamation (or in any RCS guidance) is how to deal with residents who want to leave the building for social or family visits. This is of particular concern for assisted living and independent living residents. Since the beginning of this crisis, WHCA has been consistent in telling providers that their central focus should always be the protection of their residents.
A number of approaches are being tried by our members. Regardless of the approach, we recommend that all assisted living and independent living residents should be informed in writing of the risks associated with leaving the building. These risks apply not only to their own health, but the other independent and assisted living residents residing in the community, and also the staff caring for them and their families. In addition, they should be informed that if they leave they will be subject to active screening when they return.
Independent living residents present a range of issues because of their “independent” classification. These residents may have a verified need to visit the grocery store or the pharmacy. Providers, to the best of their ability, should try to educate these residents of the risks and do as much as they can to help the resident with these tasks in order to minimize the need for the resident to leave. Other communities are limiting independent living residents to one trip outside the community a day, with an additional limitation of the hours a resident can leave and return.
Some assisted living companies in western Washington report that they have imposed a voluntary quarantine for the next 14 days. These providers report that all residents are staying in the community and receiving care and services in their apartments. The companies report that this has been working well since March 13, 2020, and that keeping residents and family regularly informed is key.
Other companies report that they are taking the position that residents, particularly independent living residents, continue to have a right to leave the building but they are screened upon return. If the resident (AL or IL) develops symptoms or does not pass the screening, they are self-isolated to their room for 14 days.
There are a number of approaches to the issue of residents leaving the building and a number of ways to keep your residents safe. Adopt a plan that best meets the needs of your community and most importantly the safety of your residents and staff. Ensure that residents (both AL and IL), their families/representatives, and staff know what the facility plan/policy is and that staff are trained to implement it 24/7.
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.