Elevating the Post-Acute and
Long Term Care Profession

June 2, 2021

Health Orders Canceled. As Governor Mike DeWine announced last month, Health Director Stephanie McCloud issued an order today rescinding seven other health orders. The state identified 9 orders that were left in place. Not all of the remaining orders directly apply to long-term services and supports. As for those that do, here are the results:

Rescinded:

  • ID/DD adult day services.
  • Day services for older adults.
  • Senior centers.
Still in effect:
  • SNFs and assisted living notification of COVID-19 cases.
  • SNF visitation.
  • Assisted living visitation.
  • SNF testing.
  • Assisted living testing.
Director McCloud also rescinded the ICF/IID visitation order in late April. It is possible that the legislature could invalidate some or all of the remaining health orders after Senate Bill 22 takes effect June 23. That bill allows the legislature to terminate health orders by passing a concurrent resolution. It is unclear whether Director McCloud's action to cancel some of the orders will be sufficient to prevent the legislature from acting.

Updated DODD COVID-19 Guidance and Best Practices. Following rescission of the health orders, the Department of Developmental Disabilities (DODD) circulated the final version of its updated guidance for providers. We reported last week on a preliminary version. The final guidance recommends direct support professionals wear masks in accordance with Centers for Disease Control and Prevention (CDC) guidelines for health care personnel. While facial coverings are recommended for staff in other settings (albeit strongly encouraged by DODD), the department wrote that masks are required for staff and visitors in ICFs/IID. For day service settings, DODD emphasized that the group size limitations and cohorting requirements were eliminated.

As for people served, DODD wrote, "the general public should continue to follow the Interim Public Health Recommendations for Fully Vaccinated People issued by [CDC]" and later added, "CDC continues to recommend facial coverings for any person who is not fully vaccinated, meaning two weeks after their second dose in a two-dose series, such as the Pfizer or Moderna vaccines, or two weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine."

Please review the DODD guidance carefully, including the many linked items, to make sure you understand the department's recommendations and expectations.

Guidelines for Implementing a Vaccine Requirement for Employees (from AHCA/NCAL).
Last week, the U.S. Equal Employment Opportunity Commission (EEOC) updated their technical assistance  questions and answers for employers on COVID-19 vaccinations [scroll to bottom for new material]. Updated issues to note include:

  • Employers may implement vaccine requirements so long as certain reasonable accommodations for employees who, because of a disability or religious beliefs, do not get vaccinated, unless providing an accommodation would pose an undue hardship on the business. 
    • An example of a reasonable accommodation provided by EEOC is that an unvaccinated employee might wear a face mask. 
  • Information about an employee’s vaccination, such as a vaccination record, must be kept confidential under the Americans with Disabilities Act (ADA) just like any other medical information for employees. 
  • Guidance on how to assess employees seeking accommodation from a COVID-19 vaccination requirement. 
  • Guidance on disability-related inquiries or medical examinations as a part of employer-provided mandated vaccinations. 
  • Employer inquiries about or requests for documentation of vaccines are permitted under the ADA. However, documentation or other confirmation of vaccination is medical information and must be kept confidential. 
  • Employers may offer incentives to employees to be vaccinated so long as they are not so substantial as to be coercive.
Providers should review the full Q&A and consult with their employment attorney before implementing a vaccine requirement for employees.

OHCA comment: As noted above, EEOC affirms that the laws they administer do not prevent  an employer from establishing a vaccine mandate, with certain exceptions. That is helpful, but this particular question and answer set is troubling:

K.4.  Is information about an employee’s COVID-19 vaccination confidential medical information under the ADA?  (5/28/21)

Yes. The ADA requires an employer to maintain the confidentiality of employee medical information, such as documentation or other confirmation of COVID-19 vaccination. This ADA confidentiality requirement applies regardless of where the employee gets the vaccination. Although the EEO laws themselves do not prevent employers from requiring employees to bring in documentation or other confirmation of vaccination, this information, like all medical information, must be kept confidential and stored separately from the employee’s personnel files under the ADA.

This statement by the EEOC could be read as conflicting with CDC and CMS guidelines that allow fully vaccinated staff members in health care settings to gather with other fully vaccinated staff members without wearing masks or maintaining physical distance. This privilege, which is based on vaccination and would require at least implicitly disclosing which employees are and are not vaccinated, could be seen as running afoul of the EEOC's reading of the ADA.

While we will look for further clarification of these possibly conflicting federal directives in the coming days, we recommend for now following CDC's suggestion to try to distinguish between vaccinated and unvaccinated staff in a way that does not unduly call attention to vaccination status, such as by making announcements.

Upcoming VOMS Webinars. As part of our effort to update members who are enrolled with the Department of Health (ODH) as vaccine providers and who may wish to order and administer vaccines, we share the following notice from ODH:

COVID-19 vaccine is now widely available, the Ohio Department of Health (ODH) is transitioning the responsibility of ordering vaccine to individual providers. 

Effective Monday, June 7, all enrolled COVID-19 vaccine providers will be required to directly order COVID-19 vaccine doses each week using the Vaccine Ordering Management System (VOMS). This includes first and second doses of the Pfizer and Moderna products, as well as the single-dose Johnson & Johnson (Janssen vaccine).

You are invited to participate in a webinar Tuesday afternoon (Tuesday June 8th) from 2:00 – 3:00 p.m. to learn more about VOMS from ODH Immunization Program staff. The webinar will be hosted on the WebEx videoconferencing platform, and below is information about how to participate from your PC or by phone. If you do not have WebEx installed on your PC, you will be prompted to connect to the videoconference call using a temporary browser application.

If you have any questions or issues, please call the ODH Provider Call Center between 8:00 a.m. – 7:00 p.m. Monday through Friday, and 8:00 a.m. – 5:00 p.m. Saturday and Sunday, at 1-844-9ODHVAX (1-844-963-4829) or email COVIDVACCINE@odh.ohio.gov.

HHS Webinar on Monoclonal Antibody Treatment. AHCA/NCAL, responding to a request from the Department of Health and Human Services (HHS), asked us to inform members about a webinar HHS is presenting on monoclonal antibody (mAb) treatment for COVID-19. As readers are aware, OHCA has actively promoted mAbs for some time because the long-term services and supports population is particularly appropriate for this therapy. The HHS webinar entitled, "Use of Monoclonal Antibody (mAb) Therapies for COVID-19: A Review of New Treatments and At-Risk Populations," and featuring a panel with AHCA/NCAL, LeadingAge, and the American Medical Directors Association, will be held on June 15, 2021, at 3:00 p.m. Here are AHCA/NCAL's instructions for registering:

  • To avoid technical problems, use Google Chrome. 
  • If you are new to the site, you can create an account here using your name and email. After creating an account, you will be able to register for the webinar by clicking the green register button at the top of the page. 
  • Current ahcancalED users will need to log in using their email and password first. 
  • Once you are logged in to the website you will be able to register by clicking the green register button at the top of the page. 
  • If you have forgotten your password click here.
  • If you're unable to attend the live webinar, registrants will be notified when the recording is made available. Need further assistance? Email educate@ahca.org.

Emotional PPE Project: Free Counseling for Health Care Personnel (from AHCA/NCAL). AHCA/NCAL is excited to share information about a free resource for long term care providers. The Emotional PPE Project is a volunteer-run organization providing a public online directory of volunteer licensed mental health clinicians. Any US worker in a healthcare-related field, including long term care, that is impacted by the COVID-19 pandemic is welcome to directly contact the therapists listed in the directory for no cost, no insurance, confidential teletherapy. Resources to promote this program to staff are available on the AHCA/NCAL website at the bottom of the page under “Workforce.”

Since the pandemic began, symptoms of psychological unwellness have increased 3-fold for the United States population at large. This increase in symptoms is even more pronounced in healthcare professionals, including those working in skilled nursing facilities and assisted living centers. Multiple barriers exist for healthcare workers to get mental healthcare: financial, lack of time, and concerns for professional and personal consequences. The Emotional PPE Project lifts these barriers by facilitating no cost, no insurance, confidential therapy sessions with licensed therapists for healthcare workers impacted by COVID-19. Frequently asked questions and accompanying answers are available on the Emotional PPE Project website.