COVID-19 UPDATE #108
December 3, 2020
DOH TO ALLOW SNFs TO UTILIZE DOH-CONTRACTED LABS
The Department of Health (DOH) is sharing a list of contracted labs that skilled nursing facilities can utilize and how they may order COVID PCR test kits from the DOH warehouse. The orders for supplies can be placed using Smart Sheets, and specimens can be sent to the DOH-contracted labs. In addition to allowing nursing facilities to utilize the labs, DOH has agreed to pay for the lab costs if skilled nursing facilities use the DOH-contracted labs. DOH will not pay for a facility to use its own lab and then get reimbursed. The turnaround time is close to 48 hours. If you have questions about supply or ordering, you may email DOH-CBTS. 
COVID-19 VACCINE: WHAT WE KNOW TODAY
This week saw dramatic action by the Advisory Committee on Immunization Practices (ACIP) recommending that residents and employees of long term care facilities, along with health care workers who are especially at risk of being exposed to the virus, be the first people in the United States to receive coronavirus vaccines. A day later, CDC Director Dr. Robert Redfield accepted the Advisory Committee's recommendation as formal guidance to states as they prepare to start giving people vaccines. States are not required to follow the panel’s recommendations, but in most instances they do.

Washington State will make a formal decision as to which groups receive priority sometime in the next few days. Luckily, WHCA has been able to provide input into this decision making process over the course of the last several weeks. We have consistently argued that long term care residents and staff should receive priority and to date we have not received any information to the contrary. In order to ensure that our position remains very clear, yesterday WHCA drafted a letter, that was joined by LeadingAge Washington, The Adult Family Home Council, and the Long Term Care Ombudsman and sent to the Governor, DOH and important decision makers, demanding that long term care residents and staff get priority.

Events on the vaccination front are moving quickly and information changes hourly. Based upon our interactions with the CDC and the Washington State Department of Health here is what we know, as of Thursday afternoon, December 3, 2020.
WASHINGTON STATE ADOPTING CDC's NEW QUARANTINE GUIDELINES
The Washington State Department of Health is adopting the new Centers for Disease Control and Prevention (CDC) guidelines to reduce quarantine for people who have been exposed to COVID-19. Although both the Washington State Department of Health and CDC currently recommend a quarantine period of 14 days, there are circumstances that allow for a shortened quarantine. These include:
  • If a person who is in quarantine has no symptoms, quarantine can end after Day 10.
  • If a person who is in quarantine receives a negative COVID-19 test within 48 hours of the planned end of quarantine and has no symptoms, quarantine can end after Day 7.

There is a small chance that people who choose to shorten their quarantine period may transmit the infection to others post-quarantine. Therefore, it is critical that the person who has been in quarantine continue to monitor their symptoms and wear a mask through Day 14. If they develop symptoms, they should isolate themselves to avoid infecting others and get tested.

Quarantine is used to reduce the risk that infected people might unknowingly transmit infection to others. It also ensures that people who become symptomatic during quarantine can rapidly be tested.

Both Washington State officials and the CDC recognize that a 14-day quarantine can impose personal burdens that may affect physical and mental health as well as cause economic hardship. This change in guidelines is meant to help reduce that burden, while continuing to keep our community safe.

These recommendations are based on the best information available in November 2020 and reflect the realities of an evolving pandemic. The Washington State Department of Health and CDC will continue to closely monitor the evolving science for information that would warrant reconsideration of these recommendations.

The Washington Department of Health has asked CDC if the shortened quarantine time applies to healthcare, specifically if CDC anticipates updating the guidance for a 14-day observation period for newly-admitted long term care facility residents and the 14-day work exclusion for health care workers (HCWs) to align with the reduced quarantine time.  The CDC informed the Washington DOH that they are considering changes to the healthcare facility guidance, including LTCFs, but for now the currently posted guidance still stands as the official CDC recommendations. If you have questions, please contact your Local Health Jurisdiction.
DEAR PROVIDER LETTER EXPLAINS DOH POINT-OF-CARE TESTING REPORTING FOR AL AND SNF PROVIDERS
In a Dear Provider letter dated December 2, 2020, assisted living and skilled nursing providers are informed that facilities administering point-of-care (POC) testing for COVID-19 (such as BD Veritor, Sofia Quidel, AbbottBinex NOW, and other similar COVID-19 antigen testing) must report all their COVID-19 testing results to the Department of Health (DOH). DOH released a letter regarding the process for reporting of POC testing results and provided a link to a website with detailed information for reporting test results to DOH. The process for reporting can be accessed via this link.

Please note, the first option on the list is the use of the National Healthcare Safety Network (NHSN). Many facilities have already started using this option. If your facility is already enrolled and has level 3 access for reporting, continue to do so; however, at this time the DOH system is not able to accept results from the NHSN system. As a result, your facility will need to use a second reporting system on the list along with NHSN until the DOH system is able to accept information from NHSN. The DOH is actively working with the Center for Disease Control and Prevention (CDC) to be granted access to the NHSN data reported by facilities. If you have questions, you can email the RCS Policy Unit.
DEAR PROVIDER LETTER GIVES INSIGHT ON RAPID RESPONSE SHORT-TERM CRISIS STAFFING
In a Dear Provider letter dated December 2, 2020, all providers are notified the Department of Social and Health Services Aging and Long-Term Support Administration (ALTSA) is contracting with temporary nurse staffing agencies to provide Rapid Response Crisis Staffing teams located in multiple geographic areas across the state. The intent of establishing these Rapid Response teams is to quickly provide short-term staffing support to supplement long term care and developmental disability facilities and agencies experiencing challenges in caring for residents and clients.

Providers can request support from a Rapid Response team for one or more of the following reasons:
  • Staff or resident/client COVID outbreak that threatens the ability of the facility or agency to meet the ongoing needs of residents or clients.
  • Situations where a facility or agency will significantly benefit from short-term respite for direct nursing and personal care assistance staff; and
  • Facilities with a sudden and unexpected nursing and aide staff absences for COVID or other infectious disease related reasons that would threaten the ability to provide care or services to residents or clients.

As requests come in from facilities for short-term nursing support, DSHS will work with the Rapid Response teams to triage requests based on the level of risk to resident/client safety and the Rapid Response team’s ability to meet that need. Please work with your staff to be prepared to orient the Rapid Response teams to your facility, agency, and residents or clients. These staff are accustomed to responding to temporary assignments but will need orientation to the residents or clients they are assigned to care for and the operations of your facility or agency. For example, medication administration systems, personal care or behavioral health care needs of the residents or clients, emergency response and contact information, and other vital information.

The letter provides the program logistics as well as the list of information items necessary if you submit a request. If you have questions about the Rapid Response staffing, you may email Kristin Ferrell or call her at (253) 234-6089.
DEAR PROVIDER LETTER SHARES INFORMATION ON LTC VISITATION STANDARDS AND FITNESS FACILITIES
In a Dear Provider letter dated December 2, 2020, all providers are given information about visitation standards and fitness centers. The letter outlines Phase 1 and Phase 2 standards for visitation and fitness centers in all long term care facilities. Of note, the letter provides definition of “compassionate care” and explains that “compassionate care visits” does not exclusively refer to end-of-life situations. It is important to understand the guidance and requirements for each Phase and to know what Phase your facility (county) is in. If you have questions about visitation standards or fitness centers, the letter encourages you to reach out to your RCS Field Manager.
ADDITIONAL RESOURCES
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.