Elevating the Post-Acute and
Long Term Care Profession

May 12, 2021

Governor to Cancel Health Orders - Except LTC. Governor Mike DeWine, facing the threat of legislative action to rescind all COVID-19 health orders on June 23, announced that he plans to have the Health Department (ODH) cancel them earlier, on June 2, except for orders affecting SNFs and assisted living communities or relating to data collection. The Governor pointed to the impact of the COVID-19 vaccines, including now for children aged 12-15, and the decline in cases to 123 per 100,000 (which nonetheless remains well about the previously-set goal of 50). He also called out much lower hospitalization rates and steep reductions in SNF cases: "While at one time, we had over 2,800 new cases per week in our nursing homes, today we are averaging less than 200 per week.Despite these numbers, apparently the rationale for leaving the long-term care orders in place is the existence of similar federal guidelines, although the state orders are more stringent than the federal requirements. The Governor's Office release states, "[m]easures being removed will include facial covering protocols, social distancing guidelines, and capacity restrictions for indoor and outdoor events."

Governor DeWine also announced that the state will award 5 college scholarships to children aged 12-17 and 5 prizes of $1 million to others who take the vaccine. The state will give out the prizes each Wednesday starting May 26.

Vaccination Reporting to NHSN. A useful primer on reporting vaccination data to the National Healthcare Safety Network (NHSN), as required for SNFs by yesterday's Centers for Medicare and Medicaid Services (CMS) interim final rule with comment period, is NHSN's frequently-asked questions document (FAQ) on this topic. Although written before the rule came out, the FAQ addresses a number of issues and provides links to other resources such as data-tracking worksheets. The reporting requirement takes effect June 13. Given that most facilities were not reporting voluntarily to the vaccination module that opened months before the mandate, a key question is whether retroactive entries are required. Our reading of the FAQ is that facilities should start reporting by providing the cumulative data for their current residents and staff as of when the facility starts to report (e.g., June 13). The goal of the reporting requirement is to allow CMS to publish current, facility-specific vaccination rates. Entering past data, especially for residents or staff who are no longer present, would not further that goal. We have asked for clarification on this point, however, so please stay tuned for any additional guidance we receive.

Guidance from BID. ODH's Rebecca Sandholdt forwarded responses to two questions from Amanda Smith of the Bureau of Infectious Diseases (BID). The following is the verbatim text of the questions and answers.

Q 1. In a shared 2-bedroom  apartment with 2 residents, if one is fully vaccinated and one  is not vaccinated, what are the expectations within the apartment in regards to masks for the 2 residents?  We are aware that the unvaccinated resident would need to wear a mask at all times when in common areas, dining and activities.

A 1. A 2 bedroom assisted living apartment is more like a household setting. It would be reasonable to consider the shared apartment as the personal living space (“room”), and expect masking when outside of this shared personal living space (understanding of course that additional IPC measures would be needed if a resident was suspected to have SARS-CoV-2 infection, as you indicated below) but not when the residents are within the room.

CDC’s guidance, Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes, is specific for nursing homes, including skilled nursing facilities, but may also apply to other long-term care and residential settings such as assisted living facilities. Please see the relevant excerpt below on use of source control by residents.

Residents, if tolerated, should wear a well-fitting form of source control upon arrival and throughout their stay in the facility. Residents may remove their source control when in their rooms but should put it back on when around others (e.g., HCP or visitors enter the room) and whenever they leave their room, including when in common areas or when outside of the facility. More information on options to improve fit is available from CDC.

  • Source control should not be placed on anyone who cannot wear a mask safely, such as someone who has a disability or an underlying medical condition that precludes wearing a mask or who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

Q 2. Is ODH in alignment with CDC and CMS in that all staff in a county that is yellow or red do not have to wear eye protection but only the staff providing patient care. Eye protection would also of course be worn in a quarantine or isolation unit.

A 2. Based on the recommendations from CDC, ODH recommends eye protection in patient care areas if the facility is in a community with moderate to sustained spread.

Per CDC: “The Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html#healthcare-personnel) states that for areas with moderate to substantial community transmission “Eye protection should be worn during patient care encounters to ensure the eyes are also protected from exposure to respiratory secretions.” If in a facility where there is opportunity for staff to have spontaneous interaction with residents who may require assistance while in the hall or common areas that would not allow staff the opportunity put on eye protection before the interaction, it is certainly reasonable to have staff wear eye protection when they are in areas where these encounters with residents could potentially occur.”