IHCA/INCAL will be updating this page regularly as guidance and information from state and federal authorities changes. If you have questions related to workforce issues, please contact Emily Berger at email@example.com or 317-616-9036.
Last updated 4.2.2020 at 12:00 p.m.
GENERAL INFORMATION AND RESOURCES
Department of Labor Guidance on New Leave Benefits Excludes Health Facility Employees - UPDATED 3.29.20
In response to AHCA/NCAL’s advocacy to include nursing home, assisted living, and ID/DD staff in their definition of “health care provider,” the Department of Labor has published guidance to address exemptions and employer requirements to the expanded Family Medical Leave Act and sick leave benefits included in the recently passed Families First Coronavirus Response Act.
Of note, the Department’s exemptions FAQ (see #56) states that the “health care provider” exemption to these new leave requirements applies to “anyone employed at any... nursing facility, retirement facility, nursing home, home health care provider... This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.” The exemption also applies to employees of contractors with the above institutions who “provide services or to maintain the operation of the facility." Employers with over 500 employees are also exempted. Please review this FAQ closely.
To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA.
Additionally, the Department of Labor has posted an Employer Fact Sheet and an Employer Notice Requirements FAQ.
Governor’s “Stay At Home” Order
IHCA/INCAL has developed this Essential Healthcare Personnel form for you to place your facility logo on and provide to each of your staff members so that they can have this with them while they travel for work during the Stay at Home Order issued by Governor Holcomb on March 23, 2020, effective until 11.59 p.m. on April 6, 2020.
IHCA/INCAL hosted an all-member call on 3/26 on Operationalizing CMS’s Infection Control Protocol. That webinar is recorded and available here, and slides are posted here. During the webinar, IHCA/INCAL shared guidance on preparing for a staffing emergency in your facility (see page 10, slide 29 of the “IC Protocol Webinar PPT” document, shared roughly 75 minutes into the webinar recording).
Personal Screening and Return to Work Screening
During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention
(CDC) are directing facilities to screen healthcare personnel (HCP) prior to allowing them to work or provide services in the facility. AANAC, AAPACN, and AADNS have created a screening questionnaire for health care professionals, as well as screening questions for HCP' returning to work. Access the questionnaire here.
Child Care Resources
- IHCA engaged the Indiana Family and Social Services Administration Office of Early Childhood and Out of School Learning (OECOSL) regarding available child care options and supports for our workforce and their children. There are two main options:
- The OECOSL can work with employers to establish “pop-up” child care for any facility, in partnership with Early Learning Indiana and resources in your local area. This opportunity may permit employers to pay for all of the child care facility directly for use by employees and children or partner to establish new child care options for employees to access with their own resources. Daycare options can be set up rapidly – within days to a week.
- Another option offered by the OECOSL is by engaging their team to scout out open slots at existing daycare centers in areas of need to then generate a list of availability that employer can provide to employees.
For assistance with either of these options contact Nicole Norvell, Director, Office of Early Childhood and Out of School Learning, 317.234.3313 or Nicole.Norvell@fssa.IN.gov.
- AHCA/NCAL has been in touch the YMCA of the USA. They have 559 local YMCA chapters within their national federation that are providing child care for essential health care workers. All have different fees and also work with parents if they need financial assistance. View the list of the chapter contacts for each state and the guidance that has been provided to ensure CDC guidelines are followed at each site (just as an FYI). AHCA/NCAL has shared our webpage listing all state affiliate contacts, so local Y's may reach out to connect also. There will be limited space but some Y's have reported they haven't had much interest. Again, the YMCA will work with parents for financial assistance if they can't afford the fee.
HIRING AND ONBOARDING
TB Testing Requirements
The Indiana State Department of Health issues two orders that had been requested by the IHCA. Seperate orders apply to nursing facilities (March 20) and residential care facilities (March 20). The orders do the following:
- Changes the TB testing requirements for new hires to be completed within 90 days of employment;
- Suspends the required diagnostic chest X-ray for residents; and
- Changes the TB testing requirement for new admissions to be completed within 90 days of admission.
- Waives the requirement that a pre-employment physical examination of employees be completed 1-mohth prior to employment (410 IAC 16.2-3.1-14(t).
- The current order applies only to nursing facilities (March 23).
- Limited Criminal History: LCH checks are still available and providing an instantaneous response via the ISP website. If you are experiencing delays on LCH background checks via your 3rd party vendors, the fastest way to meet your statutory LCH background check requirement is to have your facility or HR staff directly enter applicant info to the site. We are aware that fingerprinting for follow ups on inconclusive results is currently unavailable. Please refer to the details below from March 28 guidance issued by ISDH.
- On-Boarding Employees Fingerprinting - Clarifying Guidance for Comprehensive Care Facilities - Health care facility includes residential care facility (even though the ISDH newsletter announcement only referenced comprehensive care facilities.)
- ?C § 16-28-13-4(a) (“Criminal History of Nurse Aides and Other Unlicensed Employees”) provides:
(a) Except as provided in subsection (b), a person who:
(1) operates or administers a health care facility; or
(2) operates an entity in the business of contracting to provide nurse aides or other unlicensed employees for a health care facility; shall apply within three (3) business days from the date a person is employed as nurse aide or other unlicensed employee for a copy of the person's state nurse aide registry report from the state department and a limited criminal history from the Indiana central repository for criminal history information under IC 10-13-3 or another source allowed by law.
This statute requires that the facility owner or staffing agency “apply” for the limited criminal history, but not that the requested report actually be obtained. All ISDH requires as proof of compliance is documentation that a facility has applied for either the limited criminal history or the more extensive fingerprint-based history available through the Indiana State Police.
This guidance does not affect or relax the requirements of IC 16-28-13-3 (“Crimes barring employment at certain health care facilities”) or 42 CFR §483.12(a) (“Freedom from abuse, neglect, and exploitation”).
Fingerprinting: IHCA/INCAL been working closely with the Indiana Department of Administration, who administers the third-party fingerprint vendor contract for the state, and they have listed to our recommendation to allow our mission critical LTC sector to continue signing up for fingerprints.
LTC facilities may now schedule the fingerprinting online using the unique “COVID-19 Criminal Record Review” option from the dropdown menu. Please note that many of the former fingerprinting sites are still unavailable, which may mean that you have to send your prospective employees further away to get fingerprinted. The ISDH guidance regarding background checks still stands, but know that you do now have availability of some fingerprinting options and we encourage you to use them, as well as the MyCase check and/or your third party vendor to make sure you are protecting your company and residents.
As of 3/31 minors are unable to complete the fingerprint scheduling using the COVID-19 Criminal Record Review designation. IDOA and ISP are working on a resolution to this issue and we will have an update soon.
Workforce update: Bureau of Child Labor
Effective March 16, 2020 through May 1, 2020: In conjunction with Governor Holcomb's mandated school closing date, the Indiana Department of Labor is suspending enforcement of:
- the requirement for employers to have on-file work permits for minor employees, and
- the requirement to have permission letters from the school allowing minors to work during restricted hours of 7:30 a.m. to 3:30 p.m. on E-Learning days (applicable to 16- and 17-year-old employees only).
- Learn more.
SnapShyft Dynamic Recruitment Intro Webinar
LTC providers can learn how to recruit and hire hospitality and food service workers who may be looking for temporary work. Leaders from SnapShyft will walk through the SnapShyft process, with a brief demo of the desktop software and mobile app, and provide and opportunity for Q&A. Visit the SnapShyft website, or access their intro flyer.
SnapShyft Contact: Thor Wood, Founder/CEO, Thor@snapshyft.com
RestUp is an app and website that healthcare facilities use to find RNs, LPNs, QMA’s, CNAs, HHAs and now PCA’s for open shifts that need to be filled immediately or within the next few days/weeks. Simply put, RestUp is like the Uber/Lyft of staffing for facilities. We have a licensed HFA as our COO who completes all the credentialing of our caregivers to ensure compliance with your regulations. There is no minimum use requirement. You just use it when you need it and only pay for what you use. http://www.restup.today
RestUp Contacts: Clifton Dennis, CEO and Founder, firstname.lastname@example.org, or Heather Soots, COO and Co-Founder, email@example.com
LICENSED AND CERTIFIED POSITIONS
Temporary COVID-19 Personal Care Attendant (Waiver Aide) Eight (8) Hour Course
- The COVID-19 Personal Care Attendant (PCA) Course permits comprehensive care facilities (nursing homes) to employ a trained Personal Care Attendant to perform defined resident care procedures that do not require the skill or training required for a Certified Nurse Aide (CNA).
- The Indiana State Department of Health’s March 21, 2020 “Emergency Order Authorizing Temporary Personal Care Attendant Positions and Training for Nursing Homes” (“First PCA Order”) is AMENDED as follows:
- Effective March 16, 2020 through May 1, 2020, minors age 16 and 17 are also eligible for training and work as Personal Care Attendants (“PCAs”).
- Please note that ANY NATCEP training waiver prohibition of training is being waived for this course, so if your facility is currently not able to provide formal CNA training, that facility CAN train this temporary PCA role, but as this is currently written, the trainer must be a nurse who has completed an ISDH-approved training program as outlined in the NATCEP administrative standards.
- Access the related COVID-19 Personal Care Attendant Simulation/Competency Check-Off
- Access the PCA PROCEDURE CARD develoepd by ISDH to assist the PCA and other staff in identifying the procedures the PCA is trained to perform.
- The ISDH Division of Long Term Care and the Nurse Aide Registry is requesting that following the successful completion of PCA training, the spreadsheet linked below to be used to submit the new PCAs name to the registry. The spreadsheet should then be emailed to: firstname.lastname@example.org To access the spreadsheet, please click here and look for Personal Care Attendant section.
- The temporary PCA role is available to both nursing facilities and residential care facilities (March 23).
External PCA Training Options:
- Ivy Tech Community College is providing, free of charge to facilities, the five- (5) hour didactic portion of the PCA class. This class will be taught virtually using Zoom by an Ivy Tech CNA Program Director. After completion of the class, the candidate will perform the three (3) hours of skills training at their facility with qualified facility staff.
- Classes are taught twice daily on weekdays with offerings from 8 a.m. - 1 p.m. OR 1 p.m. - 6 p.m.
- Content is meant to be delivered to the facility where the PCA is employed and is not intended for the PCA to participate independently.
- Learn more and register here.
- Ivy Tech contacts:
o Registration: Martha Moody, email@example.com
o Content/Materials: Charlene Mantock, firstname.lastname@example.org
- Associate member Senior1Care, under their Legacy CNA training arm, is also providing two in-person PCA training programs at their Mishawaka and Noblesville locations. Details here: https://www.legacycnatraining.com/personal-care-attendant/
- Please note that the AHCA/NCAL Temporary Nurse Aide program that was highlighted after the 3/30/20 CMS blanket waiver was issued is NOT yet approved by ISDH. Please use the existing PCA framework until further details are communicated from ISDH. We will post additional details to our website as they are available.
Certified Nurse Aides
- Status of Testing - As of March 24, Ivy Tech Community College still had testers available to schedule CNA testing at facilities and third-party training sites.
- CNA Instruction and Testing Extensions (March21, 2020) ISDH issued a temporary waiver extending the testing and instruction window for CNAs.
- CNA employment prior to completion of training and testing is expanded to eight (8) months rather than four (4) months.
- CNA required completion of classroom instruction from date of employment is expanded to two hundred forty (240) days rather than one hundred twenty (120) days
Dining Assistant Training
- Dining Assistants training is waived and is waived and modified as follows (410 IAC 16.2-3.1-53). Read the formal language and guidance for nursing facilities (March 21) and residential facilities (March 23).
Executive Orders related to LTC workforce licensure and practice flexibility
Executive Order 20-09 (signed 3/23/2020) - Extends all State Issued Licenses until Friday, May 22nd. Applies to occupational, professional, and firearms licenses.
Executive Order 20-05 (signed 3/19/2020)
- Suspends telehealth restrictions and requirements for face-to-face encounters
- FSSA may modify or suspend provider staffing requirements for FSSA providers/facilities
- Suspension of the requirement that a health care provider hold an Indiana license if he or she: (1) has an equivalent license from another State, and (2) is not suspended or barred from practice in that State or any State.
- Mental health professionals are permitted to practice via telemedicine.
- Advanced Practice Registered Nurses are permitted to provide services in multiple locations while under a single written collaboration agreement.
Executive Order 20-13 (signed 3/30/2020)
- The EO permits individuals who seek to provide health care in Indiana in response to this public health emergency who are not currently licensed to practice in the state, either because their Indiana license is no longer active, they are currently a student, or they are licensed by another state, to obtain temporary authorization to provide health care services. The EO outlines specific requirements for retired health care professionals, medical students, medical residents, physician assistant students, nursing students, respiratory care practitioner students, and out-of-state health care professionals, as follows:
- Retired Health Care Professionals: Any health care professional, whether licensed in the state or not, who within the past five (5) years has retired, surrendered his or her license, or whose license is otherwise inactive but whose license was not revoked, suspended, or relinquished, may provide health care services in Indiana during this public health emergency without reinstatement or approval by the relevant licensing board.
- Medical Students: If a medical student is in his or her last semester of a four (4) year program or has completed a four (4) year program within the past 90 days from an accredited medical school, the Professional Licensing Agency (“PLA”) may issue a limited scope temporary medical permit to these individuals to practice under the indirect supervision of a licensed physician.
- Medical Residents: Current holders of a Post-Graduate Training Permit who are also enrolled in an accredited residency program are temporarily granted authority to practice under a full medical license without supervision.
- Physician Assistant Students: If a physician assistant student has successful completed all required course work at an accredited school, has applied for a license with the PLA, and has supplied the PLA with a certificate of completion, the requirements that the physician assistant student take the Physician Assistant National Certifying Examination and complete a background check are suspended.
- Nursing Students: If a nursing student has successfully completed all required course work at an accredited school, has applied for a license with the PLA, and has supplied the PLA with a certificate of completion, the requirements that the nursing student take the NCLEX exam and complete a background check are suspended.
- Respiratory Care Practitioner Students: If a respiratory care practitioner student has successful completed all required course work at an approved school, has applied for a license at the PLA, and supplied the PLA with a certificate of completion, the requirements that the respiratory care practitioner student pass the respiratory care practitioner licensing or certification exam and complete a background check are suspended.
- Out-of-State Health Care Professionals: Individuals who are currently licensed by another state were authorized to provide health care services in Indiana pursuant to Executive Order 20-05.
- Please note, professionals who do not currently hold an active license to practice in Indiana and are granted a temporary license to provide health care services in response to this public health emergency must register with the PLA via www.in.gov/pla. These individuals include Indiana professionals who retired or became inactive within the past five (5) years and are temporarily reinstated; graduating students of physician assistance programs, nursing programs, or respiratory care programs who obtain a temporary license under this EO; out-of-state professionals who are currently licensed by another state and work in Indiana during this emergency; and out-of-state professionals who retired or became inactive within the past five (5) years and work in Indiana during this emergency.