Coronavirus Disease (COVID-19)

An outbreak of respiratory disease caused by a novel coronavirus that was first detected in China has now been detected in all 50 states and US territories.


Statewide Mandates

On July 30, Governor Tony Evers declared a new public health emergency  and issued an Emergency Order requiring all Wisconsin residents to wear face masks while indoors until the end of September.

The order, which took effect on August 1, requires masks for anyone age 5 or older while indoors except at a private residence. Violating the order could result in fines of up to $200.

PREVIOUS STATEWIDE STAY-AT-HOME ORDER HAS ENDED: On March 24, Wisconsin Governor Tony Evers issued a “Safer at Home” order , which was extended and was supposed to be effective through May 26. The Wisconsin Supreme Court struck down the extension of the Safer at Home order on Wednesday, May 13 on a 4-3 vote saying that it was “unlawful” and “unenforceable.”

Some local counties and municipalities have imposed local restrictions similar to the previous statewide stay-at-home order. For the most up-to-date information, please reach out to your local health department.

Wisconsin – Visitation restrictions are still in place due to this CMS memo. This CMS memo had limited SNF survey activity, but it will be phased out in place of this CMS memo, which creates a very punitive survey/enforcement framework moving forward. WHCA/WiCAL has reached out to DQA and AHCA about these changes.

DHS has released visitation guidance for assisted living centers, available here.

DHS has also released visitation guidance for on-site hair salon and barber services, available here.

On June 10, DHS released three new guidance documents for long-term care facilities related to COVID-19:

1135 waivers are still in effect. Since assisted living facilities are not governed by CMS, the CDC and DHS do continue to recommend visitation restrictions.

While long term care facilities practice quality infection control procedures, the coronavirus (COVID-19) has heightened focus on infection prevention and control. We are providing resources to assist long term care facilities with issues surrounding the COVID-19 and this rapidly evolving situation.

Current Guidance

Skilled Nursing Facility Guidance

[Jump to AL guidance]

Centers for Medicaid and Medicare Services

CMS issued a memo and frequently asked questions addressing the new requirement that nursing homes and long term care facilities report COVID-19 facility data to the Centers for Disease Control and Prevention (CDC) and to residents, their representatives, and their families. This action, included in the recent Interim Final Rule with Comment Period, will support surveillance of COVID-19 cases and increase transparency. Memo and Frequently Asked Questions

WI Department of Health Services

On June 10, DHS released three new guidance documents for long-term care facilities related to COVID-19:

Learn more about visitation guidance in the “Visitation” drop menu below.

Centers for Disease Control

American Health Care Association


Assisted Living Guidance

Department of Health Services

  • DHS has released visitation guidance for assisted living centers, available here.
  • DHS has also released visitation guidance for on-site hair salon and barber services, available here.

Learn more about visitation guidance in the “Visitation” drop menu below.

Centers for Disease Control

National Center for Assisted Living

Wisconsin Center for Assisted Living

Visitation

Skilled Nursing Facility Outdoor Visitation

The below is reproduced from the DHS COVID website for LTC providers. The full guidance is available at https://www.dhs.wisconsin.gov/covid-19/ltc.htm#-outdoor-visitation-guidance-for-nursing-homes

If an organization wishes to proceed with outdoor visitation, recommendations for safer outdoor visits are listed below. Nursing homes may choose to wait longer before implementing outdoor visitation. Because the pandemic is affecting communities in different ways, facilities should use their best clinical judgment, regularly monitor the factors for outdoor visitation, work with local and tribal public health departments, and adjust their plans accordingly.

This guidance contains recommendations that we strongly encourage nursing homes to follow and implement. To prevent outbreaks of COVID-19 in nursing homes, the Centers for Medicare & Medicaid Services (CMS) provided direction related to restricting visitation. See CMS QSO-20-14-NH(link is external).

Facility criteria

  • Establish a schedule for visitation hours. Facilities should work with prospective visitors individually to schedule an appointment to visit a resident, and should discuss in advance the length of the appointment.
  • Have adequate staff present to allow for help with outdoor transition of residents, and to assist with cleaning and disinfecting any visitation areas as necessary.
  • Clean and disinfect the visitation area, including tables, chairs, and other shared surfaces between visits.
  • Clearly communicate and supervise each visit to ensure the use of face masks or cloth face coverings by visitors, and social distancing of 6 feet between residents and all visitors.
  • Staff should maintain visual observation but provide as much distance as necessary to allow for privacy of the visit conversation.
  • Have a system to ensure all visitors are prescreened for fever and any other symptoms of COVID-19(link is external) not more than 24 hours in advance. Ill visitors must not visit.
  • Have a system to screen visitors on arrival for fever and any other symptoms of COVID-19(link is external) at a screening location designated outside the building, and exclude those with these symptoms from visiting.
  • Have a system to ensure residents and visitors wear a face mask or other cloth face covering at all times, as tolerated.
  • Outdoor visitation may take place under a canopy or tent with not more than two walls.
  • Outdoor visitation spaces must be designed to be accessible without visitors having to walk through the facility.
  • Outdoor visitation spaces must ensure that a minimum distancing of at least 6 feet between the visitors and resident is achievable in the outdoor space when determining the maximum number of residents and visitors who can simultaneously occupy the outdoor space.
  • Provide alcohol-based hand sanitizer to people visiting residents and provide signage and verbal reminders of correct use.
  • Establish additional guidelines as needed and as determined by the facility to ensure the safety of visitations and their facility operations. These guidelines must be reasonable and must take into account the individual needs and wishes of residents.

Resident criteria

  • Current COVID-19 positive residents, residents with COVID-19 signs or symptoms, and residents in a 14-day quarantine or observation period due to their admission or re-admission status are not eligible for outside visits.
  • Residents who have had COVID-19 must no longer require transmission-based precautions as outlined by the CDC and DHS guidelines to be eligible for outside visits.
  • Residents must wear a mask (or other face covering to prevent spread of respiratory secretions when they are talking, sneezing, or coughing) at all times, as tolerated.

Visitor criteria

  • Visitors must wear a mask (or other face covering to prevent spread of respiratory secretions when they are talking, sneezing, or coughing) during the entire visit unless they are unable to do so for medical reasons.
  • Visitors must use alcohol-based hand sanitizer upon entering and exiting the visitation area.
  • Visitors must be prescreened and actively screened for fever and any other symptoms of COVID-19(link is external), and must attest to COVID-19 status if known. This should be done during prescreening and again upon arrival at a designated location outside the building. Any individual with symptoms of COVID-19 should be excluded from visitation.
  • Any gifts or packages for the resident should be dropped off with staff to give to the resident.
  • Visitors should not walk through the facility to get to the outdoor visitation area.
  • Visitors must sign in and provide contact information.
  • Due to the risk of exposure, holding hands, hugging, kissing, or other physical contact is not allowed during family visits. Physical distancing of 6 feet must be maintained for the duration of the visit.
    • Visitors under age 12 years must be in the control of adults who bring them and must also comply with physical distancing requirements. Visitors under age 12 years must wear a mask.
  • Pets must be under the control of the visitor bringing them.
  • Visitors must stay in designated visitation locations.

Weather

Visits should occur only on days when there are no weather warnings that would put either the visitor or resident at risk.


Facilities that meet the criteria above and elect to permit outdoor visits must make this option available to all residents unless they believe:

  1. Circumstances pose a risk of transmitting COVID-19 to the facility because the resident or visitor does not comply with infection prevention and control guidance, or
  2. The resident or visitor is at risk of abuse/harm.

Residents and their loved ones may contact providers with questions about outdoor visits. Facilities should ensure residents, and their loved ones, have access to the Ombudsman Program at the Board on Aging and Long Term Care at 1-800-815-0015.


Assisted Living Facility Visitation

The below is reproduced from the DHS COVID website for LTC providers. The full guidance is available at https://www.dhs.wisconsin.gov/covid-19/ltc.htm#-safer-visits-in-assisted-living-facilities

COVID-19 is a serious viral infection and based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19 (HHS, 2020). This increases the need for vigilance in avoiding the introduction and transmission of COVID-19 into congregate living settings, such as assisted living facilities.

Safe visiting practices are already in place in assisted living facilities but are designated for “compassionate care situations” such as end-of-life visits. Recommended infection prevention and control practices can provide an opportunity for expanded visitation for residents, specific to their person-centered plan, while maintaining the goal of avoiding introduction and/or transmission of COVID-19 to our most vulnerable citizens.

This guidance is intended for assisted living facilities that are able to develop and implement a Safer Visiting Policy, that includes effective infection prevention and control measures and addresses the psychosocial needs of the resident. Facilities’ practices must be consistent with current CDC and local/tribal public health departments. (See Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs)(link is external)CDC Assisted Living Guidance(link is external)contact for local health departments.)

Physical distancing and use of cloth face coverings have proven to be a significant infection prevention and control practice to prevent the spread of COVID-19. These can be accomplished by providing a 6-foot distance or other barriers between individuals, and ensuring that all individuals wear either a face mask or cloth face covering.

However, there are valid concerns that may prevent an individual from wearing one safely. Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the covering without assistance. Medical considerations, including respiratory conditions, as well as traumatic personal experiences, mean some individuals are not able to wear a face covering safely. Wearing a cloth face covering may be dangerous or stressful for individuals with disabilities and young children. Individuals may also fear racial profiling or discrimination based on wearing—or not wearing—a face covering. Access to clean, multiple, or appropriate face coverings may also be a barrier.

Similarly, facilities should consider the unique needs of people who are hard of hearing when developing and implementing policies to adopt the use of cloth face coverings.

Screening of visitors and staff have shown to provide an early detection and surveillance method to impede the spread of COVID–19 in assisted living facilities. This screening allows for the prohibition of individuals entering assisted living facilities with even minor changes in health status.

Education of residents and families is important to ensure all parties understand the need to follow infection prevention and control practices. Education should include:

Recommendations for Safer Visits
  1. Each facility should develop a procedure that takes into consideration the recommendations for infection prevention and control measures and management of safer visits, as desired or needed by residents.
  2. Assisted living facilities should develop policies on visitation based on the following considerations:
    • Expressed or observed desires and needs of the individual resident for whom visits are being considered.
    • Current CDC guidance, local/tribal public health requirements and based on care team review.
    • Safe visits are listed in a hierarchy of most safe visits to least safe visits as follows:
      • Virtual visits, such as Skype, Zoom, etc.
      • Outside visits, maintaining physical distancing and face covering. If inclement weather is present, the outside visit should be rescheduled rather than moving the visit into the facility.
      • Inside visits if dedicated room is available and only if the resident is unable to visit virtually or by an outside visit.
      • Resident room visits if the resident has single room and only if the resident is unable to visit in any of the above-noted ways.
  3. Care team (as required under applicable regulations that must include the resident or resident’s surrogate decision maker) determines the safest type of visit based on resident’s need and/or desire.
  4. Assisted living facilities should provide educational information about COVID-19, such as CDC’s How to Protect Yourself & Others(link is external), to potential visitors and residents.
  5. Infection prevention and control measures should include:
    • Screening prior to visitation for any COVID-19 symptoms.
      • CDC guidance for COVID -19 symptoms(link is external) according to current federal, state, or local public health guidelines.
      • Implement active screening of visitors for fever and respiratory symptoms. Actively take their temperature and document the presence of a fever and respiratory symptoms including: new or worsening cough, unexplained muscle weakness or pain, and sore throat.
      • If screening discovers signs and symptoms for fever and respiratory infection, visitation should be cancelled. The visitor should self-isolate at home and inform their medical provider.
    • Limit the distance a visitor travels in the assisted living facility. This may be accomplished by:
      • Having a separate visiting room close to the entrance that is disinfected between each visit.
      • Developing paths that avoid walking through care areas.
      • Asking visitors to avoid interacting with anyone other than the resident they are visiting.
    • Ensure physical distancing between the visitor and resident by designating a 6-foot distance, such as using plexiglas barriers, outdoor visits with 6-foot distance, placing taping or signage to identify 6-foot clearances. Consider environmental changes such as hard surface furniture with 6-foot spacing and removing all extraneous items such as magazines and books from visiting areas.
    • Ensure visitor and resident complete frequent hand hygiene by using hand sanitizer with at least 60% alcohol before, during, and after their visit.
    • Ensure visitor and resident are using source control measures such as cloth face covering or face mask for the entire visit, even if social distancing. Ensure visitor and resident use cloth face coverings and/or PPE as required per facility policy and resident need.
    • Between each visit, the visitation area must be disinfected according to current guidelines(link is external).
  6. Administrative controls to monitor compliance and provide instruction:
    • The assisted living facility should continually review its visitation policy based on local transmission of COVID-19 and adjust as needed to ensure maximum protection for residents. This includes temporarily stopping all inside visitation when a COVID-19 case is identified in a staff member or resident.
    • Consider prescribing date and time limitations on the number of visitors in the setting at any one time, limit the number of visitors per resident and limit length of the visit.
    • The visits should occur at scheduled times when there are adequately trained staff available to provide education on COVID-19 mitigation procedures and facility expectations.
    • The length of visits should be established by the assisted living facility policy to ensure continuous compliance with infection prevention and control procedures.
    • The facility should develop and implement an ongoing self-monitoring system to ensure staff, residents, and visitors are complying with all procedures for safer visitations.
    • The facility should revise visitation plans based on resident responses, the facility’s data, the facility’s and the local community’s COVID-19 status, and current local, state and federal guidelines.
  7. Visitor and resident education shall be conducted prior to each visit and include:
    • Facility’s procedure for visitation.
    • Screening process for COVID-19 symptoms per CDC guidelines(link is external).
    • Education to self-monitor after the visit for 14 days and report any symptoms of illness to the assisted living facility immediately as well as notifying their Medical Provider, if they have one, and local/tribal Public Health Department.
    • Reminder that subsequent visits must be pre-arranged and will not occur if the setting experiences any incidence of COVID-19.

Assisted living facilities will need to determine whether they can follow these guidelines to ensure they can provide safer visitations. Due to PPE availability, staffing patterns, and facility lay-out and/or location, every facility may not be able to meet the guidance requirements necessary to offer all of the safer visit options, nor will the options available at each facility necessarily be available at all times.

Testing

Considerations for Use of SARS-CoV2 Antigen Testing in Nursing Homes

CDC Antigen Testing Decision Tree

FDA Guidance for “Off-Label” Antigen Testing

Wisconsin COVID-19 Collection Supplies Request

DHS Testing Criteria Page

The State of Wisconsin is currently working to increase testing capacity to meet its pledge to test symptomatic residents and to test nursing home and ICF/ID staff every two weeks. While DHS had announced in July that the state would cover these testing costs through 2020, testing capacity limitations have prevented the state from implementing a statewide biweekly testing plan – but the state is working to increase capacity.

WHCA/WiCAL continues to advocate for funding to be allocated for Assisted Living testing, and also to encourage DHS to not issue a testing mandate without funding tied to it.

WHCA/WiCAL also continues to work with AHCA/NCAL to discern the practical effectiveness of antigen testing units which are currently being shipped to some SNFs across the country.

Workforce and Staffing Resources

Temporary and Emergency Nurse Aide Training

On April 3, Governor Evers issued Emergency Order 21, which created the framework for two COVID-related nurse aide programs: the Emergency Nurse Aide program and the Temporary Nurse Aide program. Details on those programs are below. The order expired May 11, and DHS has published an emergency rule to extend those programs (note, now that the emergency rule is in place, there is no waiver process).

Learn more about the Emergency Rule here.

Option 1: Emergency Nurse Aide Training (download template waiver request)

  • 16 hours initial training before direct care
  • Must be deemed competent to provide nursing services before direct care
  • 75 hours total (on-the-job training allowed)
  • Eligible for inclusion on nurse aide registry

Option 2: Temporary Nurse Aide Training (download template waiver request)

  • 16 hours initial training before direct care
  • Must be deemed competent to provide nursing services before direct care
  • Can provide services for which individual has been trained.
  • Not eligible for inclusion on nurse aide registry
  • Out-of-state CNAs can serve as Temporary Nurse Aides in Wisconsin

WHCA/WiCAL has confirmed with DHS officials that nurse aides certified in other states can serve as temporary nurse aides in Wisconsin. The temporary nurse aide program approved by DHS allows individuals to serve as nurse aides during the duration of the state’s public health emergency (please note: DHS officials have indicated there will be a grace period after the declared emergency ends, but the duration of that grace period has not yet been announced).

Handwashing

Relearn how to wash your hands, review cough and sneeze etiquette, and get the facts about face masks.

Reinforce and remind yourself, residents, and staff about hand washing best practices. Watch or share this video, put this flyer on handwashing from ServSafe up in kitchen areas, and share the CDC’s instructions:

  • Wash with soap and water for at least 20 seconds.
  • Wash hands often, but especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with 60 percent to 95 percent alcohol.
  • You may want to place hand sanitizer on dining room tables or in outside dining areas, for residents who can use hand sanitizer safely.

Cough, sneeze, and distance etiquette:

  • Cover coughs and sneezes with a tissue, then dispose of it in a trash can, preferably one with a touchless lid opener.
  • Avoid touching your eyes, nose, and mouth. This makes it more difficult for the virus to get from a surface to yourself.
  • Check your community for supplies of tissues, touchless trash cans, hand sanitizer, and soap.
  • Practice social distance: Keep about three feet between yourself and anyone coughing or sneezing.
Cleaning

Review best practices, clean the major touch points, and use the right cleaning products.

Coronavirus is an enveloped virus, which means it can be effectively killed with disinfectant, and it appears to be able to survive only a few hours on surfaces.

Check with your vendor to learn what cleaning products and supplies to use for disinfecting and how to use them properly. Use any cleaning products according to the manufacturer’s instructions, or they may not be fully effective.

The CDC recommends using “products with EPA-approved emerging viral pathogens claims.” This means that while it may be too soon to label a product as definitely killing this virus, products approved for emerging viral pathogens are recommended.

Residents in their own apartments or homes can use the same cleaners or wipes in their residences as they usually do.

The major touchpoints to clean are the same as those for the flu:

  • Doorknobs
  • Handrails
  • Elevator buttons
  • Phones
  • Keyboards
  • You may also want to put wipes out in communal areas such as game rooms or exercise studios.

Another tip: Add periodic wipedowns to the schedule or create a checklist of areas.

Use the appropriate cleaning solutions: The ones you use for regular flu-level cleaning are best, or see this EPA list of products.

Personal Protective Equipment

PPE Resources:

PPE Donations to Wisconsin’s Long-Term Care Providers

Wisconsin’s long-term care providers are on the front lines of caring for patients with COVID-19.

Since the COVID-19 outbreak began, our providers have been working tirelessly to protect their residents and mitigate the spread of this terrible virus. But this has been a real challenge thus far, and it will only get more difficult.

To ensure safety, providers need PPE (personal protective equipment) for staff and residents. Gowns, masks, gloves and goggles are in high demand, yet there is currently a very limited supply.

Consider donating any PPE supplies that aren’t immediately needed, especially gowns, masks, gloves and goggles (whether they are surgical, N95 or other), to help our caregivers on the front lines who are protecting Wisconsin’s most vulnerable population from this virus.

Please complete the following form so we can put you in touch with those organizations that most need the supplies. Thank you for your consideration.

Someone from WHCA/WiCAL will respond to your responses. (Note: Sales inquiries will not be returned.)

Medication Management

Recently, the American Society of Consultant Pharmacists shared several documents that are very helpful to facilities. They would especially be useful during the COVID-19 crisis and after as well.  The first Optimizing Medication Management during the COVID-19 Pandemic: Implementation Guide for Post-Acute and Long Term Care is a document that can assist you in decisions about medications during this difficult time.  It includes tables that can help prioritize and implement recommendations including:

  • Table 1 – Medications that may be discontinued, reduced, or changed
  • Table 2 – Changes how medications are administered and monitored
  • Table 3 – Appropriate alignment of medication administration times
  • Table 4 – Medication issues specific to COVID-19 and infection prevention

The second document COVID-10 (SARS- CoV-2) Pandemic Medication Management Strategies gives several strategies that should be considered to ensure resident-centered interdisciplinary approach to pharmacist deprescribing recommendations. This includes:

  • Current evidence and most practical approach to using Hydroxychloroquine and/or Azithromycin
  • Current evidence and most practical approach to assessing and potentially changing nebulized treatments to other inhaled treatments
  • Should the use of non-steroidal anti-inflammatory medications (NSAIDS) be avoided.
  • Should Angiotensin Converting Enzyme Inhibitors (ACE) and Angiotensin Receptor Blocker (ARBS) be avoided in patients suspected of the COVID-19 Virus?

Contact Pat Boyer at pat@whcawical.org with any questions.

Monitor Health

Monitoring and surveillance are critical in this situation. Do what you can to stay healthy. If you feel sick, whether you’re an employee, a visitor, or a resident, speak up and stay home. But here’s what to do if someone in your community presents with a respiratory illness.

Remind yourself, staff, and residents to get plenty of rest; have regular, nutritious meals; and stay away from others who have cold and flu symptoms. By practicing self-care, you’re taking the best action against this virus.

Click HERE to view AHCA/NCAL’s COVID-19 Screening Checklist for Visitors and Employees

Click HERE to view a Start of Shift Daily Employee Screening Log

Encourage residents to report any illness they are experiencing, and staff should check residents for symptoms of fever, cough, shortness of breath every day.

Post notices that visitors who are sick in any way should refrain from visiting and work with staff on keeping in touch by phone or video calls.

Add signage at the front desk entrance reminding everyone to wash hands, use hand sanitizer, and practice respiratory hygiene.

Make sure staff gets the message to monitor and report any symptoms they or the  residents have. Review policies on sick leave and time off. You may want to check in at the beginning of work shifts to ask how staff are feeling, remind them to keep watching for symptoms among residents and visitors, and remind them of sick leave policies.

This applies to any temporary, on-call employment services and third-party health care providers as well–review policies with the agency and in person, when any other worker  arrives. Keeping an infectious disease out of the community is worth the time.

The Occupational Safety and Health Administration guidelines are the same as those found in this toolkit but having them on hand if there’s a workplace issue question could be useful.

Communication Resources

All sources consulted said this was the most important activity. All other actions won’t work without it. Find out what to communicate, who to communicate with, and how to keep the communication channels open.

Review and Refresh Your Communication Plans for Critical, Official, and Operational Communications:

  • Health department: This is the communication most critical to health. Viruses appear in clusters, so they’re best fought on the local level. Follow protocols given for state and local jurisdictions.As most communities know, certain illnesses MUST be reported to the correct health department. If coronavirus presents itself, communicate early. The health department makes the rules–they’ll tell you what number or percentage of cases constitute a need for limited contact or quarantine.Work from above AND below. Following the CDC website will help you keep up with the general trends and what’s happening. Communicating with your health department and watching local news will help you with specifics.
  • Other regulatory agencies: Review what your state or city requires in terms of putting up signs, providing notice to vendors and visitors, and limiting new resident admissions in the event of an outbreak in your community.
  • Medical and emergency services: Review plans and procedures. Health care workers at this time are largely still practicing basic infection control at the flu level, too. If a physician recommends someone in your community go to a hospital or treatment center, call to let the hospital know, so they can get their infection prevention plan into action.
  • Suppliers, vendors, and maintenance: Make an effort to keep maintenance service people who periodically visit the community updated on any limitations in entering the community. Ask the supervisors or check websites to see if vendors and maintenance from outside the community have awareness and prevention programs in place. If this is not already part of your emergency plan, sketch out a scenario of what you’d do if they couldn’t enter your community–and act as needed to prevent that outcome.

Communicate with residents and families: Put up flyers with reminders, post on social media, keep families up to date so they know you have a plan. Review policies on concerned family communications.

Be prepared for residents, families, and staff alike to see sensationalized news reports. The more you communicate, even just to say hello, the more you’ll help avoid escalating their stress. Remind residents to communicate with family and each other–that can help reduce stress as well.

Residents, families, and staff may come to you with concerns based on misinformation. Residents may be vulnerable to scam “cures” and supplements. Create an easy way for them to find accurate information by linking to this website on community communications, closed-circuit channels, and display signage: cdc.gov. The CDC site is well-labeled and easy to navigate.

The World Health Organization has a “Mythbusters” page that addresses all kinds of odd rumors and theories.

Reporting Requirements:

On April 31, CMS issued an interim final rule which established explicit reporting requirements for skilled nursing facilities to report information related to COVID-19 cases among facility residents and staff. Among other requirements, facilities are required to inform residents, their representatives, and families of those residing in facilities by 5:00 p.m. the next calendar day following the occurrence of:

    • Either a single confirmed infection of COVID-19, or
    • Three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other.

This information must:

  • Not include personally identifiable information;
  • Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered; and
  • Include any cumulative updates for residents, their representatives, and families at least weekly or by 5 p.m. the next calendar day following the subsequent occurrence of either:
    • Each time a confirmed infection of COVID-19 is identified, or
    • Whenever three or more residents or staff with new onset of respiratory symptoms occur within 72 hours of each other.
  • The preamble to the rule states that facilities are not expected to make individual calls. Providers may use general communication platforms easily available to residents, representatives and families such as listservs, website postings, and recorded telephone messages.

Supreme Court Strikes Down “Safer at Home” Communication Tools:

On the evening of Wednesday, March 13, the Wisconsin Supreme Court issued an opinion which struck down Emergency Order 28, an Order which had extended the original stay-at-home order from April 24 to May 26. The conservative Court voted 4-3 to overturn the Order.

Nursing homes are still bound by CMS regulation which currently restricts visitation. Survey activity will still remain limited under this CMS memo. CDC guidance continues to recommend visitation restrictions. DHS guidance continues to recommend visitation restrictions for all LTC settings, as well as screening residents/staff regularly, practicing social distancing, and restricting communal dining.

WHCA/WiCAL has created three documents (available here) to help notify residents, families, and staff that current visitation restrictions remain in place in Wisconsin nursing homes:
    • Template letter – notification to families that the CMS visitation restriction memo is still active
    • Template door posting – notification that visitation restrictions remain in effect
    • Template communication to staff encouraging the use of caution and social responsibility

Signage:

Check Your Communication Tools:

  • How’s your website functionality? You may want to include a message to site visitors with a link to updated information.
  • Getting cross-training on communication tools such as how to post a notice on the community TV channel or change display signs is a good thing to cover before it’s critical.
  • Are your tools, computers, phones, and systems in good working order? Is it easy to charge phones, tablets, and laptops?

Conversation, concern, and searching for information are all part of a normal, automatic, and temporary psychological function. A certain amount of talking things over or vigilance even has the effect of lowering stress, psychologists say, and denial or silence makes it worse. Listening and validating concerns before offering advice or tips on precautions can help people through this process. You can find out more about this phenomenon here and here.

Review media, privacy, and social media policies.

Know what to do if a member of the media contacts you. It’s a good idea to ensure everyone who might be answering a community office phone knows what to do and what not to do.

Remind everyone of your policies to ensure the privacy and dignity of residents. Review social media policies. Rumors can spread like wildfire, and incorrect information can do a lot of damage.

Sharing the name and personal information of anyone who may have this virus or illness of any kind requires great care to be done in compliance with HIPAA regulations, which allow disclosure only to health officials and disclosure to family members only under certain circumstances.

Leaders at all levels can model good communication. The more transparent and open about communication you can be, the less likely people will be to speculate among themselves.

If you think someone has the virus…

The symptoms of coronavirus mimic other conditions and the flu: fever, cough, and shortness of breath. For anyone with these symptoms, immediately contact medical professionals and follow their guidance. That is the most important response.

Depending on the physician’s diagnosis and department of health directions, your community may also:

  • The Society for Post-Acute and Long-Term Care Medicine recommends placing the person in a single room with a closed door while waiting for guidance from the health department.
  • Implement isolation for all residents, suspend group gatherings and use standard precautions for respiratory infection. Suspend prospect tours and new admissions.
  • Find out where in the past 30 days the resident has traveled and whether they’ve come in contact with someone who may have the virus.
  • Ask the physician to assess the resident under the CDC Persons Under Investigation (PUI) guidelines.

Keep in mind that the virus can have an effect from mild to severe. People are not usually tested unless they show distinct symptoms, and for now, testing takes time and goes through CDC authorized labs.

If there is a confirmed case, take your direction from the health department. As you would for the flu, keep watch for anyone else who may be showing symptoms. If two cases are confirmed within 72 hours of each other, implement outbreak control measures, according to direction from the health department.

The CDC recommends that people who are sick also avoid contact with pets. It’s not yet known if pets can catch this virus.

Follow Plans

Follow Plans
Every virus is different, but dealing with them safely remains essentially the same, from year to year. Stick to your plan for infection control. Don’t get thrown off course by the potential misinformation coming through in this fast-changing environment.

  • Review and refresh emergency and outbreak plans.
  • Go over your plans and practice or reinforce uncertain areas.
  • Keep working on the basics of infection prevention.
  • Check your staff’s level of cross training. What would happen if someone had to care for someone in isolation in another department or area of the building?
  • Refresh security practices: Know who’s coming and going in the community. Go over or create new visitor policies for changing circumstances. Establish a single entrance to the community.
  • Evaluate supplies and supply processes. Will you need additional hand sanitizers, disinfectants, gloves, food, or linens to get through an infectious disease event? Do you need personal protective equipment (PPE)? Consult your plan for what you should have on hand and how you can get it. The action of the virus in other countries could cause a supply chain disruption in medical supplies and medicines. Does your plan cover what to do if there’s a supply chain disruption? This could become very important as time goes on, so ask the questions now and take action if you need to. Your local health department is the first place to go for help if you are experiencing shortages. The CDC has a plan in place to mitigate shortages.
  • Review medication management processes for emergencies. For now, pharmacy association representatives are asking that communities follow policy for medications in a congregate care environment, as they would for the flu, such as antibiotic stewardship. They are not recommending stockpiling or excessive purchasing.
WHCA/WiCAL Business Partner Resources

Don’t forget to utilize our valued Business Partners for resources to help you during this time.

Click HERE to view WHCA/WiCAL’s Partners in Care.

Click HERE to view resources from WHCA/WiCAL Elite Premier business partner, M3 Insurance.

Click HERE to access a recording for a recent webinar entitled “Communications as a Risk Management Strategy” with M3’s Chris Kenyon, managing director of Senior Living & Social Services, Chris Halverson, risk management sales director, and Kimberly Kane, President and CEO of Kane Communications to discuss communication best practices and strategies for helping facilities manage communications in a crisis.

The Vivera Pharmaceuticals COVx-RT is a lateral flow rapid test intended for the qualitative detection of IgM and IgG antibodies to SARS-CoV2 in human serum or whole blood. These tests are available through Navigator Group Purchasing. The antibody tests can be ordered directly from Vivera Rx on the MHA/Navigator Site. Please call (949) 234-6161 EXT. 219 or email MHAORDERS@VIVERAPHARMA.COM for more information.

Infectious Disease Screening Solutions

Health-Key Infection Control Keyboard

CREST Healthcare Infection Control Solutions

Disinfect with Confidence: Plasma Air Purification Technology

AUVS Completes Your Hand Hygiene Program

CURAVI Health: A Partner for Long-Term, Post-Acute Care

Economic Relief Fund Expense Tracking Tool

Congress has provided trillions of dollars in economic relief to help businesses get through the financial challenges brought by COVID-19. These economic relief opportunities have specific rules for how they can be used, especially for health care organizations. Tracking and monitoring is critical, but can be very complicated, especially when funding is received from multiple sources.

CliftonLarsonAllen, WHCA/WiCAL Select Business Partner, has developed an expense tracking tool that creates the foundation to organize spending in accordance with compliance and reporting initiatives that are sure to follow.

Click here to see an overview of the tool and make a purchase.

Click here to access their Expense Tracking for Economic Relief Fund Recipients webinar that was hosted on May 15.

This webinar covered allowable uses, latest updates on terms and conditions of HHS, key tips and insights on effective tracking and a more detailed overview. The presentation slides are also available at this link.

Fusion’s here for you in a crisis!

Preferred Podiatry partnered with Polaris to offer an Infection Control Program Risk Assessment and Interim Staffing.

Pathway Health has designed a Leadership Preparation Strategies Guide for leadership providing strategies for addressing COVID-19.

Click HERE to view a full set of complimentary COVID-19 resources for your use, including policies and procedures, leadership checklists, and preparation and response strategies.

Water and Mold Damage Restoration in New Haven, Springfield | CT ...

Shared Purchasing Solutions

Shared Purchasing Solutions/Health Resource Services, an affiliate of Intalere, is closely monitoring the Coronavirus’ impact to the global healthcare supply chain, including the ongoing demand for personal protective equipment (PPE).

HRS/Intalere is providing updated information including supplier updates and resources as they become available through their Operational Continuity & Emergency Management team.

In addition,HRS/ Intalere advises practices to consider the following tips when making supply orders:

  • Prioritize ordering from your current suppliers – Every vendor is going to service their existing customers on the items they currently purchase before moving on to expanded product orders from current customers and orders from new customers.
  • Increase your order volume wisely – Practices may decide to increase the volume of their standard orders as a preventative measure, but it is important to keep in mind that suppliers are closely monitoring order volumes and may cancel large orders to prevent the hoarding of supplies. In most scenarios, a marginal increase (5 cases of a product as opposed to the standard order of 3 cases, for example) will not trigger order cancellation.
  • Place additional orders with a variety of vendors – By marginally increasing the volume of your orders with your current vendors and by placing additional small orders at a variety of suppliers, you can increase the likelihood of receiving your practice’s needed supplies in a timely fashion.
  • Reduce the “burn rate” (usage) of hand sanitizer and other Personal Protection Equipment (PPE) –   It’s estimated that over 60% of the PPE products used in the United States are manufactured in China, which means vendors are receiving these products at a much slower rate, if at all.

For more information, please contact Stacey Royston, Stacey.Royston@Intalere.com or at (608) 239-1372