07/06/2020

Today's COVID-19 Report: Monday, July 6, 2020

Monday, July 6, 2020

Here are the latest need-to-know updates for Monday, July 6 regarding the COVID-19 pandemic.

Nursing Home Visitation, Hair Salons, and Communal Activities Order Released

On July 2, an ODH Order on guidance for nursing home visitation was signed. The order is consistent with the Residential Care Facility outdoor visitation order released on June 4 with a few additional requirements. These changes also apply to RCF’s. The differences include restricting visits to three visitors per resident per visit for a maximum of one hour in length. Children under two and others unable to follow social distancing are restricted. Homes are to consider COVID-19 cases in the community and within the home, staffing, testing, PPE, and hospital capacity. The nursing home must be in compliance with staff testing as established in the May 27 Director’s Order.

The Order encourages homes to continue offering communal activities including eating in the same room with social distancing. Group and various activities are also encouraged with infection control precautions. Hair salons within a nursing home are permitted to reopen in accordance with the May 14 Director’s Order that reopens hair salons.

LeadingAge Ohio is working on a communication toolkit for members that incorporates these new guidelines and will share with members later this week.  

Paycheck Protection Loan Application Deadline Extended

Both the House and Senate have passed a bill that would extend the Paycheck Protection Program (PPP) loan application deadline to August 8. The bill is on its way to the President to sign. This measure will allow potential borrowers to access the PPP loans who haven’t been able to do so already. 

Remember the Elders of Coronavirus: Special Remembrance Day July 8

Join the Global Ageing Network on July 8 for a special day of remembrance. Remember the Elders of Coronavirus pays tribute to the elders we have lost worldwide during the coronavirus pandemic. As
aging services providers are fighting day in and day out to protect older adults and their care workers, it is important to pause to remember these are real people and real lives lost.

On July 8, LeadingAge Ohio encourages its community to join the Global Ageing Network community, care providers, elders, and their families around the world by lighting a candle to honor their loved ones. Learn how to share an organization-wide Zoom candle lighting and use this toolkit to help promote this special day of remembrance.

LeadingAge Ohio Advance Directives Booklet Helps Members Launch Important Conversations

During this pandemic, lives have been changed forever and the need for advance care planning has come to light. LeadingAge Ohio encourages efforts to educate consumers on the importance of advance care planning and is pleased to offer a resource packet to assist in this work.

Choices: Living Well at the End of Life is an advance directives packet that includes Ohio’s official documents, as well as other information and resources, for end-of-life conversations.  The following official advance directive forms and detailed information are included in this packet:

• Living Will (LW) document 
• Donor Registry Enrollment Form for “Anatomical Gift” to be filed with the Ohio Bureau of Motor Vehicles
• Health Care Power of Attorney (HCPOA) form
• Explanation of Do Not Resuscitate Order (DNR) 
• Explanation of hospice care and services, along with answers to frequently asked questions

For a printable copy of the complete advance directive booklet and companion guide, download Choices: Living Well at the End of Life (7th edition pdf).

To order the advance directive booklet online, discounted as a benefit of LeadingAge Ohio membership, use code LAOADV at checkout. The booklets can be customized with the LeadingAge Ohio member’s logo printed on the cover for a personalized resource for residents, patients and their families.  

You Asked... We Answered

This week’s You Asked... We Answered column highlights two questions.

You asked:  “How long should a staff member be taken off work if they have been exposed to COVID-19?”

You asked: "We have a nurse who was exposed to someone in the community. How long should they be taken off work?"

We answered: The Centers for Disease Control (CDC) recommends testing and identifying the level of risk exposure to determine when the healthcare worker should return to work. Work with the local health department to determine if the worker met the definition of close contact. The worker should be prioritized for testing. If the worker tests negative, a second test timed greater than 24 hours from the first test is recommended. The organization should also work with the local health department to determine to what extent the worker was exposed and what the level of risk was. The risk assessment guidance can be found in the Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19.

An organization should evaluate the current staffing situation and use the CDC’s staffing mitigation guidance. When an organization is in a staffing crisis, the guidance allows for the health care personnel (HCP) to work during their 14-day post-exposure period, barring they are not exhibiting symptoms.

• For certain exposures believed to pose a higher risk for transmission, CDC recommends that exposed HCP be excluded from work for 14 days following the exposure.
• For other, lower risk exposures, HCP may continue to work; however, CDC recommends screening for symptoms prior to starting work each day and using source control measures as described in CDC’s infection control recommendations.

If you have a question you would like to see featured in You Asked... We Answered, email Stephanie DeWees Quality & Regulatory Specialist - Long Term Care at sdewees@leadingageohio.org.

Expanding Direct Care Workforce in Ohio's HCBS Waivers

The Ohio Department of Medicaid (ODM) asked LeadingAge Ohio to make providers aware of new emergency provisions affecting Ohio’s direct care workforce.  ODM sought and received approval from the Centers for Medicare and Medicaid Services (CMS) to ease restrictions on family members being providers in Ohio’s home and community-based services (HCBS) waivers.  Effective immediately, agency providers of specific waiver services are permitted to hire individuals who may have been previously excluded from furnishing waiver services.  This flexibility is intended to expand the direct care workforce available in HCBS waivers administered by ODM, the Ohio Department of Aging and the Ohio Department of Developmental Disabilities.  For additional information regarding these new provisions access the links below. Expanding Direct Care Workforce Agency Providers and Expanding Direct Care Workforce Participant Directed. 

In addition, a copy of the press release issued on June 30, 2020 highlights ODM's efforts to receive authorization from CMS that ease the restrictions on family members being providers in the state’s PASSPORT program. 

OSHA Respiratory Protection Plan & Mask Fittings  

Some state agencies have been investigating and/or reminding providers of the CDC recommendation and the OSHA requirement of a respiratory protection plan in nursing communities pursuant to 29 CFR § 1910.134.  This issue involves the fitting of N95 masks and training protocols around respiratory protection.  Pursuant to the language of the OSHA regulation, it should also include a medical evaluation of each employee on whether they are medically appropriate to wear such a mask. The purpose of this regulation is to protect employees from occupational diseases by breathing air contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, sprays, or vapors.  

The only CMS memo on respirators and facemasks was issued March 10. The Centers for Medicare & Medicaid Services (CMS) acknowledged that PPE was in short supply, including respirators, and allows the use of facemasks on a temporary basis and directs surveyors to not validate the latest fit test by providers.

National Healthcare Safety Network Provides Updates to COVID-19 Module for Long-Term Care Facilities 

In efforts to continue support of the nation’s COVID-19 response, the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) have released updates to the COVID-19 Module for Long-Term Care Facilities (LTCF).  Updates include a NHSN COVID-19 Module Dashboard for LTCFs.  The dashboard provides a summary of data entered in the COVID-19 Module and includes an interactive chart display where a user may customize data views. This first edition of the dashboard is focused on the Resident Impact and Facility Capacity pathway. Guidance documents for groups and facilities to assist with navigating and understanding the features are available on the NHSN LTCF COVID-19 Web-page.

In addition, NHSN recognized that many SNFs are setting up COVID-19 units to receive transfers from other LTCFs, such as Assisted Living Residences. These transfers result in increased demand on the receiving LTCFs. In response, the count for “Admissions” has been revised to include admissions and readmissions of residents who were previously diagnosed with COVID-19 from another facility. For additional information, please review the revised data collection form and accompanying instructions for the Resident Impact and Facility Capacity pathway. Note: LTCFs may update previously entered “Admissions” counts, but this is not a requirement.   

Updates also include non-modifiable fields added to each of the four pathway screens. Users will notice that each pathway now has three additional pieces of information displayed at the top of each pathway: Date Created, Facility CCN, and Facility Type.  The purpose of Date Created is to display the first date and time of data entry (manual or CSV file upload) for a selected calendar date and pathway. The date and time will automatically save and cannot be modified by the user.

The Facility CCN and Facility Type will also populate for each facility, allowing users to quickly verify the information associated with the data being submitted to CMS. These two variables may be edited by a facility user with NHSN Administrative rights; however, edits must be done outside of the COVID-19 Module by accessing Facility Info on the left navigation panel. Guidance documents are provided and are also available under Facility Resources on the NHSN LTCF COVID-19 Web-page. 

Governor Implements New Public Health Advisory System

Just prior to the Fourth of July holiday weekend, Governor DeWine announced Ohio will maintain vital, necessary baseline orders to control the spread of COVID-19 while also implementing a new alert system. 

The Ohio Public Health Advisory System will provide local health departments' and community leaders' data and information to combat flare-ups as they occur in different parts of the state. The system consists of four alert levels that provide Ohioans with guidance as to the severity of the problem in the counties in which they live. 

Data Indicators

A county's alert level is determined by seven data indicators:

1. New Cases Per Capita
2. Sustained Increase in New Cases
3. Proportion of Cases that Are Not Congregate Cases
4. Sustained Increase in Emergency Room Visits
5. Sustained Increase in Outpatient Visits
6. Sustained Increase in New COVID-19 Hospital Admissions
7. Intensive Care Unit (ICU) Bed Occupancy

Additional measurements still in development include county-level data on contact tracing, tests per capita, and percent positivity.  A detailed description for each indicator is provided. 

Alert Levels

Alert Level 1 Public Emergency (Yellow): Baseline level. County has met zero or one indicator. Active exposure and spread. Follow all health orders. 

Alert Level 2 Public Emergency (Orange): County has met two or three indicators. Increased exposure and spread. Exercise high degree of caution. Follow all current health orders. 

Alert Level 3 Public Emergency (Red): County has met four or five indicators. Very high exposure and spread. Limit Activities as much as possible. Follow all current health orders. 

Alert Level 4 Public Emergency (Purple): County has met six or seven indicators. Severe exposure and spread. Only leave home for supplies and services. Follow all current health orders. 

Counties that are approaching Alert Level 4 are indicated with a star.  Each alert level includes specific risk-level guidelines, including the requirement that all citizens comply with all health orders. 

Value First Offers Access to Long-Term Solution for Screenings

LeadingAge Need to Know: COVID-19 – July 6, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured LeadingAge's call with HUD REAC leadership as well as new tools and insights available to members.

Check out the full report here. 

Links: 

COVID-19 in Nursing Homes (released July 1)

A report by Senators Bob Casey (D-PA), Ranking Member of the Senate Aging Committee, Gary Peters (D-MI), Ranking Member of the Homeland Security and Government Affairs Committee (HSGAC), and Ron Wyden (D-OR), Ranking Member of the Finance Committee. Much of the report's analysis tracks the experience of LeadingAge members, and a summary of the report has been provided for members. 

 

                                        

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Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register at here.