July 31, 2020
DSHS provided information via webinars this week on reopening guidance for skilled nursing and assisted living facilities. This guidance, set forth in phases similar to the Governor’s Safe Start phases for individual counties, will go into effect once the Governor issues a proclamation, likely sometime next week. If you were unable to attend the webinars, the slides for skilled nursing and assisted living are available for your review. In the meantime, we recommend you review the “Safe Start for Long Term Care Recommendations and Requirements” document for your setting ( skilled nursing or assisted living) and the affiliated risk assessment document. The COVID Risk Assessment Dashboard is to be utilized by facilities in conjunction with the reopening guidance.

There are several policies/procedures and written plans, along with suggested inclusions in these documents, that are highlighted in the “Safe Start for Long Term Care” document that, if not already written, should be in place by the time Governor Inslee announces the proclamation. Those policies/procedures/plans include, but are not limited to:
  • Access to COVID-19 testing for residents and staff at an established commercial lab, with capacity to conduct testing as needed;
  • Response plan for caring for COVID-19 positive residents and cohorting residents (or, if unable to do so, plan for transferring COVID-19 positive residents to another care setting);
  • Screening all staff and visitors;
  • Identification and isolation of residents showing signs and/or testing positive;
  • Infection control strategies to minimize infection and spread;
  • Methods to manage new admissions with unknown COVID-19 status;
  • Methods to manage residents who routinely attend outside appointments or other activities away from the facility;
  • Procedures to engage in remote/virtual visits with family, friends, and the ombuds;
  • Procedures for remote/virtual activities and, when in later phases, safe group activities;
  • Visitation methods, limitations;
  • Methods to determine and utilize a resident’s “Essential Support Person;”
  • Procedures for communal dining, once the facility reaches that phase of re-opening;
  • Universal masking for all residents and visitors; and
  • Methods of obtaining ample PPE.

WHCA will keep members up to date on developments regarding the Safe Start for Long Term Care proclamation. For questions, you can contact Elena Madrid or Vicki McNealley.
Personal protective equipment (PPE) shortages are continuing to strain the long term care system as outbreaks surge and re-emerge throughout the state. The Department of Health guidelines for PPE allocation elevating long term care facilities to the Tier One category also remain in effect. Facilities should continue to use the DSHS online store as a backup for your emergency needs if your local health jurisdiction or emergency management system cannot fulfill your PPE requests.

In emergency situations, local health jurisdictions are responsible for processing requests for emergency supplies.

For any facility outside of King County, contact your local health jurisdiction and follow the process of submitting the emergency supply request form RR213 for resources. For
King County providers, PPE is ordered from the King County Office of Emergency Management. Fill out this form and send your request to The weekly deadline to submit is each Wednesday at 12:00 noon. Questions about King County PPE requests should be sent to the same email address used for ordering,

As a backup for SNF and AL facilities, DSHS has limited supplies of PPE. You can order them on the online DSHS store, although there is no guarantee that you will receive the items ordered.
Questions persist regarding admission and readmission of residents to our LTC facilities. As COVID cases and outbreaks continue throughout our state and facilities, it is necessary for all facilities to stay current with the guidance from CDC. According to the current CDC guidance, Responding to Coronavirus (COVID-19) in Nursing Homes, testing residents upon admission could identify those who are infected but otherwise without symptoms and might help direct placement of asymptomatic SARS-CoV-2-infected residents into the COVID-19 care unit. However, a single negative test upon admission does not mean that the resident was not exposed or will not become infected in the future. Newly admitted or readmitted residents should still be monitored for evidence of COVID-19 for 14 days after admission and cared for using all recommended COVID-19 PPE.  Testing should not be required prior to transfer of a resident from an acute care facility to a nursing home. If you have additional questions, please contact your local health jurisdiction for guidance.
On July 30, the Washington Legislature’s “four corners” approved an extension of LTC-related COVID-19 waivers. Here is the letter affirming the extension until September 1, 2020. These waivers, which have been in effect since the statewide COVID-19 emergency was declared, must be extended by legislative leadership to remain in effect.

This includes but is not limited to the waivers related to resident rights, visitation, training, certification, and fingerprint-based background checks. For a complete listing of waivers, click here for the WHCA waiver tracker. Please note that the hyperlinks to proclamations are not yet updated; we are waiting for that information to be posted by the Governor’s office. Expiration dates are updated for your ease of review.

If you have questions or need additional information regarding waivers, please contact Lauri St. Ours.
The Department of Health (DOH) hosts a weekly call for healthcare workers to provide updated information on COVID-19 response and to answer questions providers may have. You can join the call each Thursday at 11:00 am. Next week’s call will be August 6, 2020. Click here to register.
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.