Assisted Living Forum Notes — 4.7.20

The Assisted Living Forum was held on Tuesday, April 7, 2020.  These meetings will be held every Tuesday and Thursday at 10 am and questions can be submitted in advance.

Participants answering questions included Alfred Johnson, Director BAL, Beth Ellinger, DPH, Vicky Griffin, Infection Specialist DHS, Jerry Riederer RN, AL Nurse Consultant, Kathy Lyons, Deputy Director BAL, Kim Marheine, Ombudsman Services Supervisor, Dr Murphy MD, Emergency Management representative.

Here is a summary of the questions and responses:

COVID-19 Positive

When a COVID-19 positive resident is determined, the community must report to the local Health Department as soon as possible.  Resident should be placed in isolation with standard, droplet and contact precautions. Staff must wear masks, gloves, gowns and eye shields when entering the room.  If a live-in staff member is identified as COVID-19 positive, they should be isolated in their room.  Continue to monitor all staff and residents for symptoms of COVID-19

Universal Masking of staff

Beth Ellinger stated universal masking is not required at the present time. Cloth masks are not considered PPE.  It would be a positive move in a facility if community spread indicated. “It’s up to the facility”

RCAC

For an RCAC admission, is it unreasonable to expect a negative COVID-19 test for admission? Yes, no COVID Symptoms – no testing. Unrealistic to expect that.

Podiatry Services

Can we allow podiatrist or RN in to complete toe care for diabetic residents?  Defer for the time being unless there is a specific problem.  Set up if there is a problem but screen podiatrist or RN and they will have to wear PPE

Dementia Care

Dementia patients with COVID-19 or symptomatic – any suggestion on how to keep them in their rooms or away from other residents. – No easy answer.  Do your best to quarantine if needed, increase activities and interactions in their room.  Staff need to communicate with them over and over. Make more visits to them.  Use stop signs and Velcro strips.  Make sure you are doing increased cleaning and disinfecting.  Suggest moving furniture out of familiar areas. Reach out to families for pictures of family.  Do short 1:1 visits rather than longer 1:1s.  Music and memory program can be effective.  One facility used bubbly handwash that calmed residents and also promoted good hand hygiene.  Call Alzheimer’s association – check their website.

Procedures for New Residents

No difference in procedures than prior to this. Complete comprehensive assessment, if resident is high anxiety, assess why.  Pre admission is so important. Find out what triggers’ anxiety – what works.

Present Masking Requirements for LTC

Does it apply to assisted living? – “Doesn’t hurt to wear masks universally” If  you have the PPE – it doesn’t hurt.  Cloth masks if no COVID are ok

PPE Stockpile Request Process

Phase 1 – based on community spread and number of residents testing positive

Phase 2 – only distributed to hospitals, EMS, SNFs – no ALs.  Request process for AL or home care ordering if COVID positive.

Phase 3 – Email coming out today. Need to identify # of residents, using PPE preservation process, amount of staff and # of shifts. Only going to Nursing Facilities – no ALs. The state has an algorithm that determines who gets resources allocated.  Requests will be given to county emergency management who will determine is if they can supply locally or elevate it to the state level.

Home Care Agency PPE Request

They need to request if they have a COVID-19 positive resident. If testing just being done, will not distribute until there is a positive result.

Facility Notifications in the Case of COVID-19 Positive Resident

You must notify the family/responsible party of resident – this is a Change of Condition and a regulatory requirement.  Notify Public Health with 24 hours.  What about other resident’s families?  Not required but look at keeping open communication.

Staff guidance for secondary exposure – follow facility guidelines for employee health.  Public health should advise on symptom monitoring. Masking should occur at work (when nonsymptomatic), use good hand hygiene and cough etiquette. Symptomatic staff should not be at work.

TB Testing

Submit variance request. For 83.17 (2a), 83.28 (4a) (CBRF).  The entirety of code will not be waived but the TB testing will be deferred until supply is available.  You should submit what you will be doing during this time (ie. screening for communicable disease).

Staffing

When can staff return to work after COVID positive – 72 hours without fever or symptoms. Must wear mask at work.

If a physician wants a test done. What should staff do?  – same procedure for all resident kept in rooms, staff universal face masks, preserve PPE.

Make sure environmental cleaning is done frequently. Make sure high touch surfaces are cleaned with disinfectant. If resident must share a bathroom – disinfect multiple times a day.