March 18, 2021
Earlier today Governor Inslee announced several reopening measures that will apply to the state’s licensed long term care facilities. The measures announced by Governor Inslee are in some ways similar to the measures WHCA worked on with the Governor’s office and other stakeholders near the end of last week and in some ways very different. A press release outlining the Governor’s actions can be found here. The three biggest takeaways from the Governor’s announcement are (1) increased visitation for assisted living and skilled nursing residents; (2) the elimination of required quarantine in most situations; and (3) the reinstitution of facility tours for prospective residents.
The Long Term Care Safe Start Plan for assisted living providers can be found here. The Long Term Care Safe Start Plan for skilled nursing providers can be found here
Effective immediately, visitation at long term care facilities may resume. Under the Governor’s plan, outdoor visitation remains the safest, preferred option, but indoor visitation will be permitted for visitors or residents who are fully vaccinated. Compassionate care visits will still be permitted, regardless of vaccination of either party.
Indoor visitation is not allowed if there is a current active outbreak in a facility or for residents with confirmed cases of COVID-19 or in quarantine due to known exposure to the virus. An “outbreak” is a community acquired case of COVID-19 by one or more residents, or two or more staff members being onsite while they were infectious. Outdoor visitation remains the only visitation option if both the resident and the visitor are unvaccinated.
The most important changes to the safe start plan have to do with the Governor requiring that unvaccinated residents can only have a visitor inside the facility if the visitor is fully vaccinated. Under the Governor’s plan, visitation of an unvaccinated resident by an unvaccinated visitor would be prohibited unless done outside. This non-negotiable requirement by the Governor obviously will complicate visitation and it has prompted much discussion. WHCA and other stakeholders advocated against assisted living and skilled nursing home providers being put in the role of “vaccination police” requiring visitors to prove their vaccination status. After much discussion, it was agreed that facilities would post appropriate warnings about the dangers of unvaccinated visitors interacting with unvaccinated residents and further provide sign-in logs where visitors would acknowledge in an attestation the dangers of unvaccinated visitors interacting with unvaccinated residents. Compassionate care visits are still allowed under an expanded definition and for all residents regardless of resident/visitor vaccination status.
Informational posters and samples of appropriate visitor acknowledgement are being reviewed by the Department of Health and should be available tomorrow.

Risk Assessment Form Updated
The Department of Health (DOH) updated the Risk Assessment Form used to determine exposure risk for residents leaving the facility on community outings, regardless of reason for the trip. The major change involves fully vaccinated residents (defined as being at least two weeks following the second dose in a two-dose series, or at least two weeks following the one-dose Johnson & Johnson/Janssen vaccine).

Fully vaccinated residents who leave the facility and do not have prolonged contact with a person who has COVID-19 do not need to quarantine upon return. There is no change to the quarantine guidelines for residents who are unvaccinated or not yet fully vaccinated. Governor Inslee announced on March 18, 2021, that residents moving into long term care facilities, who are fully vaccinated at the time of move-in, will not need to quarantine.

Facility Tours
According to the revised LTC Safe Start Plan, in setting up indoor visitation, the facility must establish policies and procedures around tours of the facility for the purpose of screening for prospective new residents. The policies and procedures should include when tours will occur, screening process before entry of visitor(s), movement about the facility during the tour, and adherence to core principles of infection prevention. Keep in mind that tours would be a type of “Indoor Visitation” and outlined guidance and restrictions as such would apply.

DOH LTC Safe Start Plan Webinars
Residential Care Services (RCS) sent out invites for three webinars related to updates about the new “Safe Start for Long Term Care” plans. If you have not registered yet, please sign up for one of the times below. Please note: You may need to copy and paste the link of the webinar you want to attend into your internet browser in order to open it. Unfortunately for some users, clicking directly on the links below may prompt an error message or not open a browser window automatically. 

March 19, 2021, 9:00 – 10:30

March 19, 2021, 2:00 – 3:30

March 23, 2021, 8:30 - 10:00

These LTC Safe Start Plan changes will allow some return to “normalcy” for our residents, staff, and facilities as well as usher in the next phase of COVID response for your facility. Please read all documents thoroughly. It is vitally important that each facility develop, implement, and train staff on policies and procedures structured to support the elements of the Safe Start LTC Plan. It is also important to share this information with residents and families.

In order to expedite the needed changes around visitation and quarantine, there remain a number of areas in the Safe Start LTC plans that continue to need revision and were not addressed in the currently adopted plan. WHCA continues to work with DSHS, DOH, and stakeholders to address areas such as activities, communal dining, and other areas of concern. These documents are a work in progress and that work continues next week.
For months, WHCA and LeadingAge Washington have been asking Governor Inslee to fully exempt assisted living providers from his Evictions and Housing Proclamation. We have pointed out that the cost to provide care has continued to increase. We have argued that state and federal COVID-related support has been extremely limited in this setting, and that provider revenue has been deeply impacted by prohibitions on admissions by local health jurisdictions. Further, we have pointed out that residents in assisted living are not impacted by job loss, unlike general members of the public. Despite our efforts, we are deeply disappointed that our recommendation to fully exempt assisted living and senior housing providers from this proclamation was not adopted in the Governor’s re-issued proclamation today.

This afternoon, Governor Inslee announced he will extend his statewide prohibition on rent increases and a moratorium on evictions until June 2021. The proclamation includes home and community-based care settings like assisted living and adult family homes, but does not apply to skilled nursing facilities.

Early in the pandemic, we successfully argued for a limited carve-out for long term care. Those provisions are continued in the current proclamation:
  • Providers may continue to appropriately transfer or discharge residents for health or safety reasons, or for change in payor source that the facility is unable to accept.
  • While specific across-the-board rent increases are prohibited, providers may increase charges for cost of care (including charges for personal care, utilities, and other reasonable and customary operating expenses), and they may also impose reasonable charges or fees related to COVID-19 (such as the costs of PPE and testing).
  • Fees or charges must be outlined in facilities’ notice of services and must be applied in accordance with current law, including any advance notice requirements.

While we had hoped for legislative resolution of this issue, a bill that would have addressed rent increases during the pandemic died in the Senate. The Governor has sole authority over renewal of this proclamation, relying mostly upon RCW 43.06.220 regarding a governor’s powers during times of emergency. There is no legislative oversight. We will continue to press this issue with the Governor’s staff. Please let us know if you have questions. 
A portion of the Biden Administration American Rescue Plan Act includes a time-limited 10% enhanced federal matching rate (FMAP) for Home and Community Based Services. 
Would you like to learn more about the state of Washington’s enhancement and the process for utilization of this funding? If so, you may participate in a webinar where presenters will outline the new funding allocation and ideas and process for its use. The webinar will be held on Friday, March 19, from 2 - 3:00 PM. Click here to register. After registering, you will receive a confirmation email containing information about joining the webinar. Read more.
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.