COVID-19 UPDATE #21
April 13, 2020
NEW CDC GUIDANCE RELEASED ON ESSENTIAL WORKERS
Centers for Disease Control and Prevention (CDC) has released new guidance to make sure that our essential services continue through this pandemic and that our essential workers stay healthy. To ensure continuity of operations of essential functions, CDC advises that critical infrastructure workers may be permitted to continue work following potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the community. A potential exposure means being a household contact or having close contact within six feet of an individual with confirmed or suspected COVID-19. The timeframe for having contact with an individual includes the period of 48 hours before the individual became symptomatic. Critical Infrastructure workers who have had an exposure but remain asymptomatic should adhere to the practices outlined in the new guidance prior to and during their work shift.
GOVERNOR'S PROCLAMATION IMPLEMENTS HIGH-RISK EMPLOYEE PROTECTIONS
Today, Governor Inslee signed proclamation 20-46  to provide protections for high-risk employees during the COVID-19 state of emergency. The Centers for Disease Control and Prevention (CDC) defines high-risk individuals as being 65 and older or having underlying medical conditions, particularly if they are not well controlled. The key points are:
  • Employers must exhaust all available options for alternative work assignments to protect high-risk employees.
  • If alternative work is not an option, the employee may use any available employer-granted accrued leave or unemployment insurance.
  • If the employee exhausts all PTO during the period of leave, the employer must maintain all employer-related health insurance benefits.
  • Employers cannot take adverse action against the employee for exercising their rights under this proclamation.
 
This prohibition shall remain in effect until 11:59 PM on June 12, 2020, unless extended beyond that date. We will continue to update you on any new developments and how they may impact you.
NEW OSHA RESOURCES: LOW/UNAVAILABLE PPE AND REPORTING STAFF CASES
AHCA/NCAL released four new resources on guidance from the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) on critically low or unavailable Personal Protective Equipment (PPE). These new resources are applicable to all long term care providers. 
  • A form letter providers can fill in when responding to OSHA inquiries due to complaints regarding limited or unavailable PPE. 
  • A document on OSHA guidance when PPE is critically low or unavailable including steps providers can follow. 
  • An explanation of OSHA and CDC guidance on N95 respirators that are critically low or unavailable. This resource provides five options with guidance on what to do for a limited supply of N95 or other respirators to no N95 or other respirators available. 
  • A document with updated guidance from OSHA on employer recording and reporting requirements for COVID-19.
NEW CMS COHORTING GUIDANCE
Today, CMS released detailed guidance on long term care facility transfers . This matches the cohorting guidance that AHCA/NCAL shared with you previously. 
All nursing homes and assisted living communities should make plans for cohorting residents even before COVID-19 enters the building. Cohorting is imperative to help control the spread of the virus. If possible, nursing homes and assisted living communities should also begin preparing wings, units or floors as “isolation units.” An isolation unit should be a separate, well-ventilated area, ideally with a separate entrance.
GUIDANCE ON COLLABORATING WITH HOSPICE
AHCA/NCAL worked with National Hospice & Palliative Care Organization to develop joint guidance on the important role hospice plays during the spread of COVID-19 in nursing homes and assisted living. Hospice is an integral part of the resident's care team. As COVID-19 spreads, hospice may become even more important, including helping with grief counseling for not only families and residents, but for staff as well. Here are some broad principles to consider when hospice is involved:
  • Use alternate methods to conduct the visit (phone call, phone with video, or other device with audio and video capability), particularly for routine visits. 
  • Minimize the number of different hospice staff dedicated to a LTC facility. 
  • Consider assigning staff to facilities and minimizing entry into multiple buildings as movement of staff between buildings is suspected to be one mechanism of COVID-19 spread. 
  • If COVID-19 is discovered in a building, hospice staff should strongly consider limiting their movement to other buildings and self-monitor for fever or respiratory symptoms. 
  • Bundle visits to minimize the number of different days hospice needs to be in the building. 
  • Maximize the number and types of care and services provided by a single staff member (hospice or LTC) to minimize different people needing to enter a room, particularly as COVID-19 spreads.
  • Utilize hospice’s grief counselling services with families and also with staff. 
ACTION BRIEF ON INFECTION CONTROL FOCUSED SNF SURVEYS
On March 23, 2020, CMS announced federal and state surveyors will conduct targeted infection control surveys of providers. They will base the survey on the abbreviated infection and prevention survey tool. AHCA developed an action brief  to help centers navigate the focused surveys, including implementation and preparation strategies. Centers are strongly encouraged to enact peer monitoring by all staff to ensure just-in-time teaching practices that reflect appropriate infection control procedures. In order to expedite these surveys and limit the time RCS is in your building, it is highly recommended that you have worked the survey tool, have it updated accordingly as information changes, and have it available for the surveyor conducting the inspection. 
DSHS TO HOST STAKEHOLDER WEBINAR TO PROVIDE COVID-19 RESPONSE UPDATE
On Thursday, April 16, the Department of Social and Health Services Aging and Long Term Supports Administration will host a webinar at 3:00 p.m. The purpose of the webinar is to update stakeholders on the actions they have taken in response to COVID-19. Please join Assistant Secretary Bill Moss, Bea Rector, HCS Director, and Candy Goehring, RCS Director, as they discuss the response to this unprecedented global event. Register here .
NOTIFICATION GUIDELINES FOR CONFIRMED COVID-19 CASES
Today, AHCA/NCAL released new guidance  and a press statement  on notifying public health officials and stakeholders about confirmed cases of COVID-19 in long term care facilities. This guidance reinforces much of what long term care providers are already doing and are currently required to do in their states. Our guidance today suggests that long term care providers should also report to the state survey agency, if you are not already, so that CMS and other federal agencies have another way to gather national information. Read more .
NCQAC AIMS TO MEET 24-HOUR NURSE LICENSING TIMELINE
Governor Inslee recently requested that the Nursing Care Quality Assurance Commission (NCQAC) process all nursing applications within 24 hours during the COVID-19 emergency. NCQAC requested approval to hire 25 full-time employees. Within one week of the approval, NCQAC recruited, interviewed, and hired new staff, who started on Friday, April 3, and are now trained and working towards full productivity. The Commission anticipates being fully up to speed by April 17. Click here for the NCQAC site  on nursing licensing.
NCQAC ANSWERS QUESTIONS FOR NAR TRAINING AND PROGRAMS
Based on Inslee Proclamation 20-32, the NQCAC can now temporarily allow programs to count students’ nursing assistant-registered (NAR) work hours as clinical hours on a temporary basis during the COVID-19 crisis. The Commission provides details  on the documentation requirements and other issues for nursing assistants-registered. The NAR skills competency checklist  is also available. Visit the Nursing Commission News page to review previously sent GovDelivery messages related to COVID-19 and other topics.
SOCIAL MEDIA BEST PRACTICE REMINDERS
Today, social media is intertwined with our lives; it is entertainment, news, a way to connect with family and friends, as well as a means to share both accomplishments and frustrations. Even when "off the clock," long term care professionals need to adhere to best practices when posting or even sharing their thoughts, photos, and concerns. As we all work to respond to the COVID-19 public health emergency, please be mindful that social media can be a powerful tool when used appropriately.

The Nursing Service Organization (NSO) recently sent a reminder to its members regarding social media and nurses. Their tips included:

  1. Nurses are held to a higher standard than others because of their role as caretakers and because they have intimate access to patients’ private information. Their social media presence should reflect this heightened responsibility, especially in this uncertain time. They must consider patients’ right to privacy and act professionally before posting.
  2. To maintain patients’ confidentiality, nurses must refrain from sharing photos, comments, or details that may identify patients on social media. Breaching patient confidentiality or behaving unprofessionally can lead to legal action or complaints filed with the state board of nursing which can impose a variety of penalties, including fines, probation, suspensions, and a permanent revocation of licensure. 
  3. As the media and social media are consumed by COVID-19 news, nurses may want to join in and share their thoughts or may be tempted to air their grievances. Online comments or comments to members of the media by a nurse regarding employers or co-workers, even if posted from home during non-work hours, may violate their employer’s social media or media relations policies. Violations of employer policies may lead to employment consequences for the nurse, including termination. Nurses may want to think twice before posting or otherwise giving the appearance they are speaking on behalf of their employer unless authorized to do so, and must follow all applicable employer policies.

Please remind staff that social media—both in their professional and personal lives—reflects on their employer. Ensure that all staff are aware of your social media policy and procedures. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has shared a flyer on social media best practices to help providers.
DEPARTMENT OF HEALTH TO HOST WEBINAR | THURSDAY, APRIL 16 | 11 AM
Join leaders and experts from the Department of Health each Thursday at 11 AM to receive an update on current COVID-19 impacts and resources for long term care. They review FAQs they are receiving, and they make themselves available to answer questions. Visit the WHCA COVID-19 resources page  for Q&A information from previous calls. The webinar is free and open to all. Click here  to join the meeting.
WA PA-LTC TO HOST WEBINAR ON CRUCIAL CONVERSATIONS
The Society for Post-Acute and Long Term Care Medicine in Washington is presenting a complimentary webinar Crucial Conversations During the COVID-19 Pandemic. The webinar will be hosted on April 15, 2020, at 6:00 p.m. PST. Click here to register.
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.