COVID-19 UPDATE #36
May 28, 2020
REQUIRED UNIVERSAL TESTING: NURSING HOMES AND ASSISTED LIVING FACILITIES WITH MEMORY CARE UNITS
Today, John Wiesman, Washington’s Secretary of the Department of Health (DOH) has ordered  all skilled nursing facilities to complete universal testing of residents and staff by June 12 and every assisted living with a memory care unit to complete universal testing of residents and staff by June 26. The order takes effect immediately.
 
The order addresses a one-time test, with the test kits and PPE supplied by the State and with lab work paid by CMS and HCA for tests performed for those residents and staff who are covered by Medicare and Medicaid. The state of Washington will pay laboratories for tests performed for staff who are not covered by Medicare or Medicaid.
 
Facilities that have completed universal testing since April 1 do not need to conduct re-testing at this time. 
 
According to the order, all staff must be tested, except those providing medical justification from a health care provider declining testing. A staff member is any employee, contractor, volunteer, or other personnel who provides health care, personal care, social, administrative, clerical, dietary, environmental, or any other kind of services in the facility.
 
DSHS/ALTSA-Residential Care Services will be issuing a Dear Administrator/Provider letter today or tomorrow that addresses specifics regarding the testing. DOH is currently working on additional guidance and protocols for repeat/ongoing testing. A second order may be issued soon requiring a one-time test in all other long term care facilities not included in the first order by July 31. We will continue to keep you informed.
TESTING AND COHORTING IN SKILLED NURSING: WHEN AND HOW?
Trying to figure out what to do about testing and cohorting can be a challenge. AHCA has created an algorithm for testing and cohorting nursing home residents which incorporates the latest CDC guidance. The algorithm walks through three primary entry points for testing prior to deciding on who and how to cohort individuals. The entry points include testing residents who develop symptoms, testing all residents simultaneously, and testing new admissions. The algorithm also walks through how to cohort if the person(s) tested are in a single-person room or with roommates.
WASHINGTON STATE DEPARTMENT OF HEALTH PROVIDES NEW DEFINITION OF "CLOSE CONTACT"
The Washington State Department of Health (DOH) updated the definition of a COVID-19 close contact to align with new CDC guidance . The new guidance states that a close contact is defined as someone who was within six feet of someone with COVID-19 for at least 15 minutes. Previous guidance stated 10 minutes.

"Our guidance has changed over time as we learn more about COVID-19, and will continue to do so in the future,” said State Health Officer Dr. Kathy Lofy. “This update doesn’t change our recommendations for members of the public. We continue to urge people to maintain physical distance to protect themselves and others.” The DOH will be working over the next few days to update its website and associated guidance documents.
INNOVATIVE METHODS TO KEEPING RESIDENTS CONNECTED
AHCA/NCAL has prepared a resource to help providers continue to keep residents connected to their loved ones. As visitation restrictions and social distancing continues, we need to find ways to keep people connected in person when possible. Using an infection prevention and control mindset can help generate innovative methods to engage residents and families and fellow residents.

This resource is a starting point and intended to kick off additional ideas each center or community is able to try based on the status of COVID-19 in their building and in their community as well as the availability of necessary resources to support these innovative efforts. This resource can be used by nursing homes, assisted living communities, and ICF/IID as each sees fit.
CDC WEBSITE UPDATES
On May 19, the Centers for Disease Control and Prevention (CDC) updated several of their webpages to be reflective of the Centers for Medicare & Medicaid Services (CMS) updates on reopening guidance. The three webpages that were updated include: 

Below is a summary of what was changed. Review your infection prevention and control procedures to ensure they are consistent with the latest guidance. 
  • Tiered recommendations to address nursing homes in different phases of COVID-19 response.
  • Added a recommendation to assign an individual to manage the facility’s infection control program – this is new. CDC strongly feels that “Facilities should assign at least one individual with training in IPC to provide on-site management of their COVID-19 prevention and response activities,” because of the breadth of activities for which an Infection Prevention and Control (IPC) program is responsible, including developing IPC policies and procedures, performing infection surveillance, providing competency-based training of HCP, and auditing adherence to recommended IPC practices. 
  • Added guidance about new requirements for nursing homes to report to the National Healthcare Safety Network (NHSN). 
  • Added a recommendation to create a plan for testing residents and healthcare personnel for SARS-CoV-2. Note, AHCA/NCAL provided recent guidance on testing which incorporate the latest from CDC. 
  • Additional descriptive information for certain areas like universal source control, hand hygiene, optimization of PPE, and the COVID unit section based on common questions received, including: 
  • Removed language to move residents with symptoms or suspect COVID to an observation unit, if one was available, as this has been a point of confusion and has not been feasible for most facilities.

CDC recommends creating a COVID unit for residents with confirmed COVID and, if possible, an observation area for new admissions with no known COVID history (those with known COVID would go to COVID unit), but recommend that if possible those with symptoms or suspect COVID-19 go to a private room. Testing should be prioritized for these individuals and, if positive, they would move to a COVID unit. PPE should be worn.
THE YELLOW BRICK ROAD TO PPP LOAN FORGIVENESS: NEW INTERIM FINAL RULE SUPPLEMENTS FAVORABLE GUIDANCE PROVIDED IN THE LOAN FORGIVENESS APPLICATION
The Small Business Administration’s (SBA) fourteenth in the continuing saga of Interim Final Rules (IFR) for the paycheck protection program (PPP) loans is out and provides details PPP borrowers need for obtaining loan forgiveness. (All of the IFRs can be found here .) This IFR, issued May 22, comes on the heels of the SBA loan forgiveness application , which Lane Powell covered here . Overall, the IFR conforms to the guidance provided by the forgiveness application and provides more details, but the primary addition in this IFR is the new guidance for the SBA’s evolving treatment of payroll costs for owners of businesses. Read the entire article here . Many thanks to legal experts at Lane Powell for providing this article.
UPCOMING WEBINAR FOCUSES ON COVID-19 INFECTION PREVENTION IN BEHAVIORAL HEALTH SETTINGS AND WITH PATIENTS WITH COGNITIVE IMPAIRMENTS
WSHA will host a webinar on June 8 from 1:00 p.m.–2:00 p.m. regarding COVID-19 infection prevention strategies, innovative approaches, and lessons learned in behavioral health settings, as well as with patients with cognitive impairments. Webinar speakers will highlight best practices surrounding a variety of COVID-19 infection prevention topics, such as universal masking, managing accidents and exposure, testing, and working with challenging patient behaviors. Please bring questions and lessons learned from your facility as there will be time for discussion and Q&A. Register online here .
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.