Elevating the Post-Acute and
Long Term Care Profession

June 24, 2021

OSHA Releases Resources for ETS Compliance. As members are aware, the Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) designed to protect workers facing the highest COVID-19 hazards: those working in health care settings where suspected or confirmed COVID-19 patients are treated. This fact sheet highlights some of the key requirements of the ETS, which was published in the Federal Register on June 21, 2021. 

As health care employers are expected to comply with most provisions within 14 days of the standard's publication, which is July 5, 2021, OSHA posted a variety of resources on their website to help employers implement and comply with the ETS. We highly encourage members to review and to utilize the COVID-19 Plan Template and Healthcare Worksite Checklist and Job Hazard Analysis. You also will find a sample COVID-19 log and a fact sheet on reporting work-related COVID-19 fatalities and inpatient hospitalizations to OSHA.

We also recommend paying pay particularly close attention to the two flow charts on ETS Compliance with Notification, Removal and Return to Work, which appear to limit the circumstances and symptoms that require removing an employee from work and providing paid time off. Please note that these criteria may be less stringent than Centers for Disease Control and Prevention (CDC) guidance on work restrictions that provider should follow, but they govern entitlement to the OSHA-mandated paid leave.

OHCA is continuing to work with local OSHA officials to conduct a training webinar as soon as possible.  While OSHA said it will use its enforcement discretion for employers who are making good faith efforts to comply with the ETS, we recommend all members take steps now to review the implementation resources and to begin working toward compliance.

OSHA Requirements Outline. In conjunction with the resources discussed above, OHCA developed a table outlining the requirements of the ETS as listed in the OSHA fact sheet. For comparison purposes, the table also includes a column identifying sections of key CDC guidelines for SNFs that deal with the same topics. Please note that this column technically applies only to SNFs, although other residential settings may be using the guidelines to some extent. If you currently are following the CDC guidance, the additional compliance burden of the OSHA ETS will be reduced. Providers delivering in-home services and supports should ignore the comparison column because the listed CDC guidelines do not apply to them.

The first two columns outlining the OSHA requirements, however, apply to all health care employers, broadly defined. The outline lists all the requirements in one place at a high level, along with links to OSHA's compliance resources, but to get all of the details, you will need to delve more deeply into the ETS and the resources, along with the CDC guidance as applicable. We plan to expand the table in the near future to include any CDC guidance that is specific to other member provider types.

Long-Term Care COVID-19 Cases. The case count posted on the Health Department's (ODH's) long-term care COVID-19 dashboard late last night is at a new low again. The total current cases for the week ending Tuesday are 146 across all long-term care facilities. This number is made up of 68 residents and 78 staff members. Staff cases, which previously were around 40% of the total, first eclipsed resident cases in mid-April, reflecting that more residents are vaccinated than staff. The latest daily case total for all Ohioans bumped up a little to 303.

NHSN Vaccination Rates. We received from AHCA/NCAL a new analysis of vaccination rates for the nation's SNFs, as well as state-level numbers. The data are for the week of June 13, which was the first week for which reporting was enforced. Ohio was roughly at the national average with 88.2% of SNFs reporting compared to the nation's 89.0%. Unfortunately, however, the state lagged the national figures for percentages of vaccinated residents and staff. Ohio's resident percentage was 74.8% and the staff percentage was 48.1%, below the national averages of 78.5% and 56.7%.

Aging Opens COVID-19 Care Center. SNF and assisted living members should have received an email notice from the Department of Aging (ODA) with the subject "ODA Care Center Welcome." This email relates to ODA's announcement during their webinars earlier this week that they are consolidating the testing and vaccination portals under the "COVID-19 Care Center" moniker. In case you missed it, here is what the email said:

Thank you for continuing to support and protect Ohio's residents and staff of long-term care facilities. As we move into the next phase of the pandemic, we would like to announce the launch of the new COVID-19 Care Center.

Key information to know:

  • The COVID-19 Care Center can be accessed on our website or directly at https://covidcare.age.ohio.gov/.
  • This one stop self-service portal immediately replaces: the testing and vaccine enrollment surveys, the Long-Term Care PCR Testing Schedule portal, the assisted living reporting tool survey, and links the Vaccine Maintenance Schedule portals in one consolidated location.
  • Facilities can now modify their own enrollment profile and participation preferences in the state-supported testing and vaccine programs as the facility's needs change.
  • Ability to self-order BinaxNOW rapid antigen supplies if/when needed.

The points of contact identified in your profile will receive auto-generated notifications based of program selections or changes made to your profile (coming soon).

Next Steps/Timeline:

  • Wednesday, June 23, 2021: You will receive two separate e-mails: one which will contain your facility's user name and another with your facility's password to log-in to the COVID-19 Care Center portal. If you already have Vaccine Maintenance portal credentials, you will receive two credential e-mails with the same user name and password previously provided. Feel free to share these credentials with key personnel at your facility that will need access. 
  • Wednesday, June 23, 2021 through Friday, June 25, 2021: Log-in to the COVID-19 Care Center and confirm your facility's current profile including facility information, view current testing and vaccine program selections, staff and resident census, and point(s) of contact. Facilities will also have access to their vaccine clinic schedule if participating in the Vaccine Maintenance Program. 
  • Starting Monday June 28, 2021: Facilities may adjust their testing and/or vaccine program(s) selection(s) (including level of testing support desired) and order BinaxNOW rapid antigen supplies, if applicable. Antigen supplies will no longer be auto-shipped. Facilities will continue to order PCR testing supplies and/or return shipping supplies directly through your assigned lab.
  • Starting Monday June 28, 2021: The weekly reporting tool will only be accessible on the COVID-19 Care Center portal for all assisted living facilities, replacing the previous online reporting tool through Survey Monkey. Reporting will still need to be completed before 11:59pm each Wednesday.

As the message indicates, this is a process. Members reported today that not everything, including the two-email credential delivery, is fully operational. See this user's guide that ODA supplied for more information on using the Care Center.

Nurse Aide Legislation Passes. We previously reported that our legislation on temporary nurse aides (TNAs) working in SNFs was incorporated into the budget bill, House Bill (HB) 110, and later into a separate measure, Senate Bill (SB) 6. SB 6 passed the House of Representatives yesterday with the TNA language intact. Today, the Senate concurred in the House changes, meaning the bill is on its way to Governor Mike DeWine for signature. We understand that the identical, but now unnecessary, language that was in HB 110 is being removed. SB 6 will credit TNAs for on-the-job training they received, giving them the opportunity to sit for the nurse aide test and, if they pass, to become state-tested nurse aides. This legislation was a priority for OHCA because of the number of TNAs currently employed in member SNFs. It will take effect 90 days after signature. TNAs will have 4 months after the federal waiver ends to pass the test. The Centers for Medicare and Medicaid Services has not yet set a date to terminate the waiver.

R3AP Open to All SNFs and Assisted Living Communities. With the drastic decline in COVID-19 outbreaks in Ohio facilities, the Regional Rapid Response Assistance Program (R3AP) has turned to more of a consultative role. Any assisted living or skilled nursing provider may reach out to R3AP for no-cost advice from medical directors and other clinical experts on COVID-19-related topics, including infection control, visitation, vaccination, testing, and many more. There is no connection between this technical assistance function and survey. ODH does not know which providers contact R3AP. The call center number (Monday-Friday, 7:00 a.m.-7:00 p.m.) is 855-732-7632.