November 16, 2020
On Sunday, November 15, 2020, Governor Jay Inslee announced a four-week statewide set of restrictions in response to the recent rapid spread of the COVID-19 virus in Washington and across the country. Most of the new restrictions will be in effect at 12:01 AM Tuesday, November 17. New restrictions on indoor dining will go into effect at 12:01 AM Wednesday, November 18, 2020. The new restrictions come as Washington sees dramatically increasing daily case counts with average cases in the state doubling over the past two weeks.

Along with his announcement, the Governor issued a revised Proclamation rolling back, limiting, or prohibiting a number of activities that had been allowed, including indoor restaurant-style dining, group activities, and visitation.

In addition, an easy reference Guidance was also issued. The Governor’s press release provides additional information on the new restrictions.

Currently, WHCA is receiving a large number of questions regarding the Governor’s Proclamation. We are seeking clarification from DSHS, the Department of Health, and the Governor’s office. In addition, we are pressing them to compile a FAQ document to address the large number of questions being raised. In order to make sure that we are looking at all angles, we ask you to continue to provide us with questions.

Many members are questioning whether the Proclamation prohibits the use of facility dining rooms. The confusion stems from the fact that the Proclamation mentions “bars and restaurants” but does not clarify if congregate settings like facility dining rooms or dormitory/school cafeterias should be closed. We would note, however, that the Proclamation does mention (in the section referencing “In-Store Retail”) that “common/congregate seating areas and indoor dining facilities such as food courts are closed.” We expect that the Governor’s office will tell us that our skilled nursing, assisted living, and senior living dining rooms will need to close, but we are not going to assume that will happen. We are currently engaged in ongoing discussions with the Governor’s office and we are trying to get answers. As soon as we have answers, we will pass the information on to you. Please note that the “restaurant and bar” closure provisions do not go into effect until 12:01 AM Wednesday, November 18, 2020. We hope to have further clarification before then.

Members also have questions about the Governor’s visitation provisions. In his Proclamation, the Governor directs that: “Outdoor visits are permitted. Indoor visits are prohibited, but individual exceptions for an essential support person or end-of-life care are permitted.” At first glance this would appear to be a loosening or relaxing of the visitation provisions, but we do not believe that to be the case. Currently, “essential support persons” can only visit a facility that is in Phase 2 or higher. That limitation remains in effect.

In addition, the Governor’s recent Proclamation also appears to impose a more restrictive standard on “compassionate care” visits. Before the Governor’s recent Proclamation, Phase 1 indoor visitation was prohibited, except for “Compassionate care situations restricted to end-of-life and psycho-social needs.” The Governor’s more recent Proclamation is more stringent, eliminating any reference to “compassionate care” and “psycho-social needs” and instead clearly stating “individual exceptions for an essential support person or end-of-life care are permitted.

The Governor’s recent Proclamation does not give the “essential support person” unhindered access and carte blanche to come and go at will. The current “Safe Start” provision pertaining to “essential support persons” for both assisted living and skilled nursing are still in effect.

Under these “Safe Start” guidelines, an “essential support person” can be considered if a resident is unable to participate in outdoor visits and is unable to utilize remote visitation through technology. In these circumstances, the resident may have one essential support person who visits in the facility up to once daily. The visits should be conducted under limited and controlled conditions, coordinated by the facility, taking the facility’s situation into account, in consideration of social distancing, PPE use, and universal source control.

WHCA is working diligently to seek clarification and advocate on behalf of our members and the residents they serve. We will pass on any clarification as soon as it becomes available. Please continue to reach out to Elena Madrid or Vicki McNealley with questions.
In a Dear Administrator letter dated November 13, 2020, all providers are given insight on risk assessment during holiday travel. The letter reminds providers of the importance of using the risk assessment to determine COVID-19 exposure risk in long term care facilities. The letter provides links specifically for assisted living, skilled nursing, and certified community residential services and supports. If anybody on your team plans to engage in holiday travel, please share this insight with them to ensure they mitigate risk of exposure. If any resident plans to leave the facility for any reason, ensure you use the risk assessment to determine safety measures to minimize infection spread upon returning to the facility.
In a Dear Administrator letter dated October 9, 2020, and amended November 13, 2020, Residential Care Services (RCS) informs all providers that full reimplementation of inspection and investigation for RCS is postponed indefinitely. The letter provides insight and background for the decision. The letter also explains that the Reimplementation of Inspection and Investigation Activity for RCS document dated November 1, 2020, is available for providers to review in preparation for when full survey activity does resume.

RCS will continue to provide focused infection control inspections and investigations as well as immediate jeopardy (two-day) investigations and other intake investigations for serious allegation of substandard care or services. 
You are invited to a webinar on November 19, 2020, at 6 PM hosted by the Washington Society of Post Acute and Long Term Care Medicine (WA-PALTC). The webinar, Testing for COVID in Long Term Care: What is the best way to do it? will be presented by Charissa Fotinos, MD, Deputy Chief Medical Officer, Washington Health Care Authority; Cyndee Jones, MSHCA, CLS, Director Lab & Blood Services, Swedish; James Lewis, MD, Infectious Disease Specialist, King County Department of Health, and moderated by Sabine von Preyss-Friedman, MD, CMS, Washington Society of Post-Acute and Long Term Care Medicine. Click here to register.
All skilled nursing and assisted living facilities are invited to join the AHRQ ECHO National Nursing Home COVID-19 Action Network. Nursing homes that actively participate in the Network will receive $6,000 in compensation in recognition of the staff time involved. This reimbursement is available to those eligible to receive funding from the Provider Relief Fund and that have agreed to its terms and conditions. The vast majority of nursing homes are eligible. CME and CNE credits will also be available.

Broadly, the Network aims to address the following goals:
  • Keep the virus from entering nursing homes where it has not entered.
  • Identify residents and staff who have been infected with the virus early.
  • Prevent the spread of the virus between staff, residents and visitors.
  • Provide safe and appropriate care to residents with mild and asymptomatic cases.
  • Ensure staff have the knowledge, skills and confidence to implement best-practice safety measures to protect residents and themselves.
  • Reduce social isolation for residents, families, and staff during these difficult times.

There are currently 30 spots remaining. If your facility would like to participate, click here to register today.
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.