August 9, 2021
This afternoon, Governor Jay Inslee announced that vaccination against COVID 19 will be considered a condition of employment for state employees and contractors, and workers in all healthcare and long term care facilities including nursing home and assisted living facilities, effective October 18, 2021.

In his announcement, Governor Inslee said that the vaccination requirement applies to “Everyone who works in a healthcare setting.” Thus, the vaccination requirement applies to all workers, contractors, volunteers, and other positions that have an onsite presence in the healthcare workplace setting.

The actual written “Proclamation” is currently being finalized and should be available by tomorrow. It will provide greater and additional detail, and we will make it available as soon as it is released. Workers in the long term care settings have until October 18, 2021, to achieve a “fully vaccinated status.” Given the current need to wait two weeks after the last shot to be considered “fully vaccinated,” healthcare workers essentially have until October 4, 2021, to get their last shot.

Failure to show proof of vaccination by the October 18, 2021, deadline will result in loss of employment unless the employee can show the need for a reasonable accommodation for a legitimate medical reason or a sincerely held religious belief. Personal or philosophical opinions or beliefs will not qualify for an exception to the vaccination requirement. It is currently unclear whether someone who loses their job because of a failure to vaccinate will be allowed to collect unemployment insurance.

According to the State’s FAQ document, a healthcare worker’s proof of vaccination, not an attestation of vaccination, will be required.

In his announcement, the Governor compared the mandatory vaccination requirement to health and safety regulations that need to be followed by healthcare workers. Additional information will be available in the coming days. We will continue to keep you informed. 
In a Dear Administrator letter dated August 9, 2021, skilled nursing providers are notified that one of the top priorities for the Department of Social and Health Services (DSHS) is continuing to work with patients who no longer have a need for acute care in a hospital to transition to alternative settings. This will create capacity for hospitals to serve individuals who need acute care that can only be provided in a hospital setting. As during the previous surges in 2020 and earlier in 2021, DSHS responded to the COVID emergency by implementing Nursing Facility Admission Incentives.

Today, DSHS received approval to offer incentives to skilled nursing facilities that accept new resident admissions from acute hospitals and is again requesting additional assistance with expediting transitions. Effective August 9, 2021, Home and Community Services (HCS) will implement a skilled nursing facility admission incentive for transitions from acute care hospitals.

The letter explains individuals with both Medicare and Medicaid (dual eligible) newly admitting to nursing facilities from acute care hospitals during this period will receive a one-time $6000 admission incentive when:

  • A client-specific approval letter is requested and approved by Home and Community Services prior to admission. This approval letter is required to receive the incentive.
  • The Individual admits to the nursing facility during 8/9/2021 through 9/30/2021.
  • The Department receives a Nursing Facility Notice of Action (Form 15-031) confirming Admission date.
  • The Department has confirmed that this is a new Nursing Facility admission from an acute care hospital. Nursing Facility readmissions and nursing facility transfers are not eligible for this incentive.

All nursing home admission, transfer and discharge rules continue to apply. We know that the COVID-19 outbreak continues to have significant impacts on our nursing homes, and we appreciate your willingness to partner and collaborate to meet this emergent need. Please feel free to email Julie Cope, Systems Change Specialist with Home and Community Services, with any questions or for clarification about this process. 
The Department of Health (DOH) has transitioned to using the Zoom platform for the weekly long term care Q&A calls. This change is effective beginning with the weekly call being held on Thursday, August 12, at 11 AM. Due to this change in platform, a new registration is required to sign up for these weekly calls. Click here to register for the new platform. Previous links and registration confirmation information will no longer be valid. Once you register, you will receive a confirmation email with the option to add all the long term care Q&A calls to your calendar. You will also receive reminders for the calls 24 hours in advance of each scheduled event.
The Puget Sound Chapter for Professionals in Infection Control and Epidemiology (APIC) invites all infection preventionists and other healthcare providers to join them for a webinar on Thursday, August 26, 2021, from 12 - 2 PM. This webinar, Seniors as the Susceptible Host: Prevention Tips for HCWs, will help providers understand potential risks of transmission in the environment for residents, understand the high-touch surfaces in the facility, outline best practices for hand hygiene, cleaning, and disinfection, and provide tools and resources to create a safer and more satisfying environment of care. Click here to register for this free webinar.
Any providers wishing to obtain PPE from the state backstop will find information and directions to do so here. Requests for PPE go to the local emergency manager. In some counties, they are completing the Resource Request 213RR Form for providers when the request is submitted, and some counties have a PPE warehouse and are able to fulfill requests quicker because they have direct access to the materials. This new link to the PPE backstop proves information on how to request PPE, where to submit requests with the local emergency manager, and a new section that includes commonly-asked questions and the answers to those questions.
As COVID-19 cases rise in communities across the country, nursing home and assisted living communities must pay close attention to CMS and CDC visitation guidance to ensure they are facilitating safe visitation for residents and families. 

For skilled nursing facilities, CMS’ visitation guidance outlines core principles of infection control which all visitors, residents, and staff should adhere to. It also outlines scenarios where indoor visitation should be limited due to a high risk of COVID-19 transmission, including: 
  • Unvaccinated residents- if the nursing home’s COVID-19 county positivity rate is more than 10% and less than 70% of residents are fully vaccinated;  
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue Transmission-Based Precautions; and 
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine
Compassionate care visits should continue to be permitted at all times.  

CMS has relayed concerns about facilities scheduling visits without sufficient reason for doing so, which has limited resident access to visitors, such as only scheduling visits during the daytime. CMS states in their guidance to consider scheduling visits for a specified length of time if necessary, and if there is a sufficient reason for doing so. 

Facilities are encouraged to explain the restrictions in CMS’ visitation guidance to their families and residents. Facilities may also use this information to encourage residents or families who are not yet vaccinated to make an informed decision based on this and other factors. Facilities can also offer rapid COVID-19 testing to visitors but cannot make this a requirement of visitation.  
The CDC also has guidance​ that addresses visitation in all long term care facilities, which is referenced in CMS’ guidance as well. The CDC’s guidance includes practical strategies to facilitate safe visitation and preserve residents’ quality of life. 
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.