Notes from DQA Call on SNF/AL COVID-19 Response, Held Thursday 3.19.20

On the morning of Thursday, March 19, state long-term care officials held a sector-wide call titled, COVID-19 WEBINAR FOR LONG TERM CARE AND ASSISTED LIVING FACILITIES.

The call began with a basic explanation of the origins and spread of COVID-19 by Dr. Chris Crnich, MD. Basic details of the disease can be found on this DHS website.

Next, Otis Woods, director of the DHS Division of Quality Assurance, provided a regulatory update:

Woods reiterated that the state has suspended all survey activities except allegations of immediate jeopardy and follow up inspections to remove IJ scenarios for federal, and actual harm for state surveys. Woods said they have suspended all nonessential Medicare/Medicaid inspections. They are still waiting for formal guidance from CMS, but Woods stressed that the CMS memo would serve to legitimize state survey agencies’ decisions.

Woods said that DQA is currently accepting waivers from state administrative code, including admin code related to HCBS, Ch. 83 (CBRF), Ch. 88 (AFH), and Ch. 89 (RCAC). WHCA/WiCAL plans to work with providers and stakeholders to consider certain waiver requests. Woods indicated that the state does not have the authority to grant blanket waivers, but is looking at the possibility of accepting waivers on behalf of multiple facilities.

Next, the webinar turned to the Q&A section. Questions were accepted ahead of time and also during the webinar. Alfred Johnson indicated that numerous questions had been submitted before and during the webinar, and that not all questions could be answered in the time allotted, but that additional guidance was forthcoming which should address a lot of the concerns.

Questions (and responses) included:

  • Question: What do facilities do if Medical Directors tell us they will not be making physical visits to the facility during this outbreak?
    • Response from Ann Angell, Director of the Bureau of Nursing Home Resident Care: Medical Directors are okay to not do routine 30/60/90 day visits – We understand if they can’t come to the facility, as long as they can still be in contact in some way. We will be granting more flexibility for nonessential visits such as QAPI committee meetings. But, if the visit is essential, and telehealth can’t work, an in-person visit would still be required.
  • Question: How often must we be screening staff?
    • Crnich: we are recommending at least once at the beginning of each shift.
  • Question: What recommendations/guidance do you have for residents showing respiratory symptoms? How long should they be under additional precautions?
    • Crnich broke this question down to address employees and residents.
      • Employees – facilities should screen employees as they enter the facility for shift start. The screening could be question-based, but particularly in areas where there is community spread, direct temperature measurement of employees is appropriate. Exclude those with flu-like symptoms. Since we can’t test everyone yet, if you have an employee who is symptomatic, exclude them for 14 days. If they are tested and are negative, they can return after 48-72 hours after improvement of symptoms.
      • Residents – be as aggressive with testing as possible. If testing isn’t available, 14 day quarantine. If the resident does test positive for COVID-19, call the public health office right away and quarantine the resident right away.
  • Question: Should facilities be granting access to hospice workers?
    • Angell said that end of life visits are essential visits and should be allowed on a case-by-case basis. Be sure to conduct appropriate screening and make sure they’re wearing appropriate PPE.
      • WHCA has followed up with DQA to see if facilities could require end-of-life workers to bring their own PPE, since it is in such limited supply. This information will be updated once more information has been made available.
  • Question: Are we allowed to let residents ambulate in the hall or go outside?
      • Crnich: asymptomatic residents should be allowed to ambulate around the facility, and facility staff should assist as needed, with appropriate PPE determined on a case-by-case basis. This same protocol should be used for residents who want to go outside.
  • Question: Is there a screening tool to screen employees in LTC?
    • Crnich: yes, there are screening tools available.
    • Note: WHCA has made this screening checklist from AHCA available to members.
  • Question: Can facilities use volunteers for screening staff/visitors?
    • Crnich: Generally, exclude volunteers from the facility. However, if protocol includes screening from an appropriate 6 ft distance or a physical barrier, and also the screening area is separate from the facility, you could make it work.
    • Angell agreed with Crnich. She also added to make sure the volunteer knows the risk of getting the virus in their volunteer capacity. They also need to know what to do if someone screens positive.
  • Question: Why can’t a healthy/asymptomatic relative/visitor visit an asymptomatic resident?
    • Crnich: Facilities must remain focused on preventing spread of the disease among a population so susceptible to serious reaction to COVID-19. There are exceptions for psychosocial needs of residents, but should be taken on a case-by-case basis.
    • Woods: if your facility is having difficulty explaining this to families or residents, contact your local ombudsman so they can help explain to the family why heightened precautions are taken during this extraordinary time.
  • Question: Is it right that if someone has a runny nose, we must exclude them from working/visiting?
    • Crnich: if visitors/staff have runny noses, they cannot come in.
  • Question: How should facilities change policies for delivery of supplies in order to prevent spread of Covid-19?
    • Crnich: remember that the virus has capacity to live on different surfaces from hours to days, perhaps up to 7 days. If you are providing care to a patient with suspected COVID-19, you should plan to wipe it down with a standard healthcare cleaning wipe anything used in their room.
  • Question: Can providers use handmade fabric masks that are laundered when we run out of PPE masks?
    • Crnich: While they are being used in other developed countries, there is no evidence that they are effective barriers. So we can’t give a recommendation to use them as of today, but that could change.
  • Question: Would you recommend AL facilities continue regular head-to-toe assessments for fall risk for RCAC or CBRF?
      • BAL Director Alfred Johnson: make it resident-centered. These assessments probably should continue but it’s good to identify other significant issues that we traditionally see in ALs.
  • Question: Will MCOs pay for telehealth?
      • Kiva Graves, Director of the Bureau of Adult Quality and Oversight: MCOs are trying to figure out what telesupport can be provided. More info will come out.
  • Question: Should adult day care centers connected to residential facilities or healthcare facilities temporarily close?
    • Woods: we are working for clarification on whether the 10-person ban order includes adult day care centers. Child care centers were exempted.

Johnson indicated that additional guidance will be made available to clarify answers to the above questions, as well as answer the many other questions which were asked but not addressed during this webinar.

Otis Woods made reference to stakeholder meetings that are being held twice a week.  WHCA/WiCAL is part of those meetings. We ask that you submit questions to us as issues arise so we can place on the agenda for response.