Last week, the Bureau of Assisted Living sent out guidance on using staff who are COVID-19 positive. According to the return to work for asymptomatic employees guidance:

For Community-Based Residential Facilities (CBRFs) and Adult Family Homes (AFHs): After exhausting all other opportunities, if the facility still does not have adequate staff to provide the care, treatment and services to the residents, CBRFs and AFHs should coordinate with their local/tribal public health department (LTHD) and submit a waiver request to the Division of Quality Assurance (DQA) Bureau of Assisted Living (BAL) regional office to utilize asymptomatic COVID-19 positive staff who are asymptomatic or who have mild to moderate illness with improving symptoms.

• The CBRF waiver request should include the applicable code reference CBRF, Wis. Admin. Code § DHS 83.17(2)(c)(link is external); AFH waiver request should include AFH, Wis. Admin. Code § DHS 88.04(2)(g)2(link is external). All facilities should include steps the provider has taken prior to arriving at this phase.
• Upon receipt of the waiver request, the DQA BAL regional office will consult with the LTHD, the Division of Public Health (DPH), and the BAL bureau/deputy director. If the request contains sufficient information, the request will be approved for a limited time period with reporting to the DQA BAL regional office. The DQA BAL regional office will share this reporting with the LTHD and other pertinent areas of the Department of Health Services (DHS). In alignment with the CDC strategies to mitigate staffing shortages, the following criteria should be met if this is allowed:
  • The COVID positive staff member must be well enough and willing to work.
  • The facility has established a prioritization process for determining which COVID positive staff members may be allowed to return prior to the end of the established isolation period, taking into account staff members’ work duties, symptoms, stage of illness, and the types of residents with whom they will work.
  • The facility should have enough of the proper personal protective equipment (PPE) to prevent transmission of the virus, including fit-tested N95 respirators (or equivalent) or well-fitting face masks, gowns, gloves, and eye protection (goggles or face shields that cover the front and sides of the face).
  • A fit-tested N95 respirator (or equivalent) or a well-fitting facemask must be worn by the COVID-19 positive staff at all times including as they walk in the building and in other non-patient care areas in the facility to prevent transmission to co-workers, residents, and visitors.
  • Practice physical distancing from others, as able.
  • COVID-19 positive staff should self-monitor for all COVID-19-compatible symptoms and immediately notify facility leadership if symptoms recur or worsen, thus warranting re-evaluation.
  • Residents should be encouraged to wear well-fitting source control while interacting with these staff, if tolerated.
• Facility representatives should confer daily with their LTHD to assess current staffing levels to determine when allowing COVID staff who are asymptomatic or who have mild to moderate illness with improving symptoms to return to work prior to completion of isolation should be discontinued.

IMPORTANT: During the Bureau of Assisted Living Forum on 2/14/22, Dan Perron, Bureau of Assisted Living Director, explained that the waiver process should be used even if the ALF has to use a COVID-positive employee during an immediate staffing crisis. He stated that they will respond usually within 24 hours, but if the community does not receive the waiver prior to the staffing need, he stated that the community should staff as they need to for resident care even if they have not yet received the approved waiver. Formal waivers are needed for CBRFs and AFHs. RCACs do not have any requirements but are asked to notify BAL. We have asked if these directions would be issued formally in print but as of today, we have not heard a response from BAL.

Please contact Jim Stoa at jstoa@whcawical.org or Jena Jackson at jena@whcawical.org with any questions.