IMPORTANT INFORMATION FOR LONG TERM CARE FACILITIES
Visit this webpage daily for updated news and guidance that IHCA/INCAL has to share with our members about COVID-19. As concerns arise with the emerging coronavirus, officially named COVID-19, we are working with our state partners, including the Indiana State Department of Health (ISDH) to ensure our members receive the necessary guidance to prevent the spread of this disease.
COVID-19 PPE Inventory Tracking – ISDH Data Collection: The ISDH is asking long term care facilities (nursing homes, residential care, and assisted living) to register to use EMResource.
EMResource is a web-based resource management and communication tool used to monitor and notify changes in resources statuses. ISDH is asking you to update your PPE supplies daily in this tool so that resources can be distributed efficiently.
Please email one of the following contacts to obtain a link to register for a user account:
Lori Davenport at firstname.lastname@example.org
Deeksha Kapoor at email@example.com
Zach Cattell at firstname.lastname@example.org
MARCH 16, 2020
3-Day Stay Waiver Guidance: This guidance provides more detail as to the CMS waiver of the 3-day inpatient stay for Medicare coverage of Skilled Nursing Facility services.
IHCA/INCAL, LeadingAge and HOPE’s Letter to Governor Eric Holcomb requesting additional assistance with COVID-19 response
MARCH 14, 2020
IHCA/INCAL Guidance on Communal Dining: Per the new guidance issued by CMS this week, it is recommended to cancel communal dining. This is a challenging recommendation and we have compiled some approaches that long term care providers should consider.
ISDH issues revised guidance for visitation: Please note that this guidance mirrors CMS’s visitor restrictions and communal dining restrictions, amongst others, and applies to all assisted living communities.
CMS Issues Waivers of 3-Day Stay and Spell of Illness
MARCH 13, 2020
Steps You Can Take Now To Be Prepared For a COVID-19 Case At Your Facility
New Resources on Interacting with Hospitals and Communicating with Residents & Families Refer to CMS’s updated visitation guidance released today in QSO-20-14-NH. The guidance states that all visitors should be restricted except for certain compassionate care situations (end of life situations). This is more strict than what Gov. Holcomb announced on March 12.
CMS also announced additional guidance:
- Cancel communal dining and all group activities, internal and external
- Actively screen all residents and staff for fever and respiratory symptoms
- Remind all of social distancing and hand hygiene
- Screen all staff at the beginning of shift for fever and respiratory symptoms. Take temperature and document absence of shortness of breath or change in cough/sore throat. If they are ill, place them in a mask and send them home to self-isolate.
- Communicate visitor restrictions in a variety of ways – signage, emails, letters, phone calls, recorded messages
- Screen staff that work at multiple facilities and actively screen
- Ombudsman are subject to same restrictions as visitor guidance (compassionate care only), though facilities may review on case by case basis
- Advise all that enter the facility to monitory for signs and symptoms for 14 days after leaving the facility. To self isolate at home if symptoms occur, contact their healthcare provider, immediately notify the facility of the date they were in the facility, who they were in contact with and the locations in the facility they visited. Facilities then need to screen individuals of the reported contact and take necessary actions from there.
New Resource: Video messages geared toward family members and residents about the recommendation to limit visitors to nursing homes and assisted living communities.
MARCH 12, 2020
Gov. Holcomb Announces New Steps To Protect Public From COVID-19 The guidance in this announcement concerning visitation to nursing facilities has been superseded by CMS guidance on March 13. Please see above.
CMS Releases COVID-19 Medicare FFS and Medicare Advantage Plan Guidance
Indiana State Department of Health Update on COVID-19
MARCH 11, 2020
Implement Environmental Infection Control – Cleaning & Disinfection
Preventing and mitigating the spread of COVID-19 in long term care centers is the top priority. Environmental infection control practices are essential to reduce the risk of the virus entering nursing centers and assisted living communities. Detailed information on environmental infection control in health care settings can be found on the CDC website: Guidelines for Environmental Infection Control in Health-Care Facilities and Guidelines for Isolation Precautions. Please read the full update here.
See additional information about EPA-approved emerging viral pathogens claims here.
A template handout for housekeeping staff on cleaning protocol is available here . You can modify as needed for your facility’s needs.
New CMS Guidance on Industrial Respirators
The Centers for Medicare & Medicaid Services (CMS) issued a new Quality, Safety and Oversight memo late last night about COVID-19. The memo applies to all providers.
This memo provides the following new guidance:
- Facemasks are an acceptable temporary alternative when supply chains cannot meet N-95 respirator demands. When supply chain is restored, N-95 respirators should be utilized with known or suspected COVID-19.
- Eye protection, gowns, and gloves are recommended. If there are shortages of supplies, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities.
- Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed, and airborne infection isolation rooms (AIIR) should be prioritized for patients undergoing aerosol-generating procedures.
- Increased emphasis on early identification and implementation of source control.
This memo follows the updated guidance from the Centers for Disease Control and Prevention (CDC). Additional information on the CDC’s recommendations can be found here.
MARCH 9, 2020: NEW GUIDANCE FROM CMS FOR NURSING HOMES
CMS has announced additional guidance for nursing homes to help them improve their infection control and prevention practices to prevent the transmission of COVID-19, including revised guidance for visitation. This memo was further revised by CMS on March 13 and the lastest version is available here.
AHCA/NCAL has also issued very simular recommendations to providers on March 9. Both of these guidance documents address screening staff, contractors, vendors and visitors. The intent and purposes are the same except for a few very slight variations in how the guidance documents are written. Both aim at controlling the spread of the virus.
COMMUNICATION PREPAREDNESS TOOLS
Early preparations, speed and accuracy of information is essential to managing an urgent situation. Refer to these resources and put together a communications plan for all stakeholders including employees, clinical staff, residents, families etc.
MARCH 6, 2020
MARCH 4, 2020
CMS Issues Three New Quality, Safety and Oversight Memos about COVID-19.
- Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (CMS revised this memo on March 9 and on March 13 with additional guidance. The latest version with new guidance is available here.
- Guidance on: screening visitors and who should be restricted; screening employees and contractors and who should be asked to stay at home; when patients should be managed in the facility vs sent to the hospital; what to do when transferring residents with suspected COVID-19, and; what criteria to use in accepting patients from the hospital with COVID-19.
- Suspension of Survey Activities
- Announces that CMS will re-prioritize surveys to conduct focus surveys about infection control for facilities that have had an infection control deficiency in the past to assure that they are in compliance with the new regulations.
- Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge
- Guidance to hospitals on screening visitors, employees and when to admit and discharge residents.
We strongly recommend facilities review these new guidance and also continue to keep up to date with CDC guidance on CVID-19 for health professionals and facilities as they continue to update guidance on testing and management of residents with suspected and COVID+ test results.
PREPARE YOUR LONG TERM CARE FACILITY
While long term care facilities practice quality infection control procedures, the coronavirus (COVID-19) has demanded an increased focus on infection prevention and control. Here are some helpful resources to assist your teams to be fully equipped with information and tools to manage the potential issues surrounding the COVID-19.
INFORMATION ASSETS: Review these helpful resources listed below specifically created for healthcare facilities by Centers For disease Control and Prevention (CDC):
FACILITY RESOURCE: Download informational flyers highlighting best practices
PROTECT YOURSELF AND OTHERS FROM GETTING SICK
- Handwashing: Washing your hands with soap and water for at least 20 seconds or using alcohol-based hand rub kills viruses that may be on your hands.
- Stay home if you have a fever, cough, sore throat, or difficulty breathing, seek medical attention and call in advance. Watch and share this two- minute video by World Health Organization on how you can protect yourself and others from getting sick.
- Maintain social distancing: Maintain at least three feet distance between yourself and anyone who is coughing or sneezing.
- Avoid touching eyes, nose and mouth: Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
- Practice respiratory hygiene: Make sure you, and the people around you, follow good respiratory hygiene. Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose off the used tissue immediately.
IMPORTANT TAKEAWAYS FROM LORI DAVENPORT, IHCA/INCAL DIRECTOR OF REGULATORY & CLINICAL AFFAIRS
PROTECT YOUR BUILDING
- Bold signage: Consider adding more robust language to your entrance signs, such as warning signs in bold letters asking visitors having flu and/or respiratory symptoms to temporarily refrain from visiting the facility even if they don’t have travel history.
- Encourage all staff to self-isolate at home if they display symptoms of the flu, especially if they have received the flu vaccine.
- Take precautionary removal of care staff who identify as suspected cases.
- Prohibit staff from reporting to work if they are sick until cleared to return.
- Consider restricting admissions or heightened screening.
- Environmental cleaning: At this time, retrain to and follow these guidelines from CDC about infection control and cleaning.
- Post visual alerts that remind everyone to wash their hands and cover their coughs.
- Utilize the Influenza Like Outbreak Toolkit developed by the ISDH as a resource by following this link.
- Conduct an inventory of PPE and monitor supplies accordingly. (gowns, gloves, googles, masks, and include alcohol hand-sanitizer 60% or greater in alcohol)
- Communicate with PPE supplier to establish the current ability to meet your usual ordering demands.
PROTECT YOURSELF AT WORK
- If you are experiencing sysmptoms of COVID-19, seek medical attention and report the exact symptoms to your employer.
- Continue to advise staff to wear their PPE diligently when appropriate. Currently the CDC is not recommending use of PPE for workers who are not providing direct patient care.
- Continuing best practice by washing or sanitizing hands after direct physical contact with an individual before going on with the next task.
- More stringent standards are called for if you have reason to suspect a possible cause, such as droplet precautions for the resident; full PPE for all staff within a six-foot radius; N95 masks; isolation gowns; and face/eye protection.
- If you suspect a possible coronavirus case, please report it to the local and state department of health.
- Communicate frequently with all staff to keep them informed on the expectations for prevention steps everyone can take to protect residents, at work and at home.
- Use the tools – CDC Infographics for sharing information quickly and help staff to take actions
- Learn and share what the CDC is doing to protect and prepare communities for COVID 19
- Maximize your front-line defenses – Begin a system for simple screening questions for visitors and staff before they are in contact with residents, for contact with international travelers, and any out of country travel they may take.
OVERVIEW OF COVID-19
KNOW WHO TO CONTACT
STAY UPDATED AND LEARN MORE
(1) AHCA/NCAL Webinar Recording for Long Term Care Providers – March 3, 2020
This webinar includes the latest update from officials from the Centers for Disease Control and Prevention (CDC) and AHCA/NCAL staff. In the interest of public health, this webinar is open to all long term care providers, including members and non-members of AHCA/NCAL.
(2) CDC Webinar: Coronavirus Disease 2019 (COVID-19) Update—What Clinicians Need to Know to Prepare for COVID-19 in the United States
WHEN: Thursday, March 5 at 2pm EST
WHAT: During this call, clinicians will learn what they can do to prepare for COVID-19 including identifying persons under investigation, applying infection prevention and control measures, assessing risks for exposures, optimizing the use of personal protective equipment supplies, and managing and caring for patients (inpatient and at home).
Last Updated: March 16, 2020