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November 4, 2020


OHCA Project ECHO Enrollment, Limited Space Remains! We want to give our member SNFs a final notice on the OHCA Project ECHO enrollment. Sessions will begin next week, and only 30 spots remain! Please submit your facility information no later than 12:00 p.m. tomorrow, November 5. 

If you believe you registered through OHCA and your facility did not receive an email today from OHCA’s Erin Begin regarding your parent hub assignment, please contact her directly at ebegin@ohca.org to ensure we have your information. 

COVID-19 Cases in Ohio Facilities Continue to Skyrocket. Today's state dashboard showed 1,788 new resident cases in SNFs, assisted living communities, and ICFs/IID and 1,228 cases among staff. The total of more than 3,000 long-term care cases in one week easily surpasses previous levels. The explosion of weekly cases in long-term care from 1,097 as recently as September 30 to 3,016 this week thankfully has not been accompanied by an increase in COVID-19-related deaths.

Reminder: Post-Election Analysis Member Call with Mark Parkinson This Friday. On Friday, November 6 at 2 PM Eastern, AHCA/NCAL CEO Mark Parkinson will provide an analysis of the impact of the recent election results on the long term care sector. All members are invited to participate.

Registration is limited, and the webinar will be recorded and available for playback within 24 hours.
 
How to Register: 

  • To avoid technical problems, use Google Chrome. 
  • Members will need to log in using their existing AHCA/NCAL username 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 are new to the site, you can create an account here. Answer all fields on the create an account page- especially locating your company name. You can search by name or zip code. After creating an account, you will be able to register for the webinar. 

Please email educate@ahca.org for additional assistance.                      

Updates from ODH for Home Health and Hospice. Today, OHCA participated in a non-long term care provider association meeting with the Department of Health (ODH). We sent several questions in advance to be addressed during the meeting. Please find below a summary of updates and comments:

  • Survey activity: Currently, ODH still is conducting only complaint surveys and initial certification surveys for non-long term care providers, with the exception of maternity units. ODH does not have a date when they expect regular survey activity will resume. ODH personnel did clarify that once surveys resume, ODH will prioritize providers whose dates for recertification lapsed. Providers are not subject to penalty at this time, as the state reserves the right to suspend regular survey activity during the Public Health Emergency (PHE). Additionally, ODH staff stated that there have not been any citation trends on the complaint surveys, but they issued several individual citations. ODH provided examples of screening practices for staff, lack of eye protection in COVID-19-positive patient rooms, and lack of COVID-19 policies.
  • Accrediting Organizations (AOs) and virtual surveys: In previous meetings, ODH informed OHCA that Centers for Medicare and Medicaid Services (CMS) does not accept the virtual surveys conducted by the Joint Commission. ODH subsequently reached out to CMS, who explained that they intend to release a memo to the AOs providing clarification and guidance on resumption of recertification surveys that will address this question. We will advise members once that information is available.
  • Ohio vaccination program: ODH staff were unable to provide an update on prioritization of home health and hospice workers in the Ohio Vaccination Distribution Plan at this time.
  • Line-level Clinical Laboratory Improvement Amendments (CLIA) reporting: ODH's CLIA program will conduct random inspections of providers who perform CLIA-waived tests for compliance, including line-level reporting, in the near future. ODH is not aware of any compliance issue associated with home health or hospice specifically.
  • Alternative testing options: OHCA requested an update on availability of point-of-care antigen tests for home health and hospice staff. While Abbott BinaxNOW tests are not available for purchase, ODH’s Shannon Richey said they have seen several applications come through for other approved CLIA-waived options. She agreed to share the list with us. As soon as we receive the information, we will pass that on to home health and hospice members.
  • Palliative Care Interdisciplinary Council: Because of the PHE, the council temporarily suspended its work and meetings. Bimonthly meetings are set to resume in January 2021.

Suggestions for Holiday Leaves of Absence. One of the hottest questions lately is how facilities should handle requests for residents to leave for a family gathering or other holiday celebration. The question becomes more urgent with the proliferation of red counties under either the Ohio or CMS measures. We continue to discuss the question of leaves of absence and their ramifications with ODH, the Department of Aging, and the Department of Developmental Disabilities (DODD), but there as yet is no definitive guidance for providers from either the state or CMS. In that context, we have the following recommendations:

  • It is highly unlikely the government agencies will condone any regulated facility establishing a blanket prohibition against residents going out to visit relatives or friends on a holiday (or other occasion). We do not recommend considering such a blanket policy, even in red counties. That does not mean it is a good idea for vulnerable individuals in congregate settings to go into the community, particularly for an extended period or in the absence of social distancing and masking.  In fact, DODD told us compliance issues could arise if an ICF/IID creates blanket policies that include any provisions under which leaving the facility would be prohibited.
  • Facilities should communicate fully with family members who wish to take their loved ones out so they can make an informed decision. The discussion should be person-centered and should cover the risks based on such factors as the residents' health status, the COVID-19 prevalence in the community, the time that the resident will be out, and the anticipated activities and precautionary measures. The risk is both to the resident themselves and to other facility residents.
  • Based on the person-centered discussion and risk assessment, the provider should determine which precautionary measures should be implemented upon the resident’s return to the facility to minimize the risk of COVID-19 spread.
  • One such measure may include whether the facility will require the resident to be quarantined upon return, including the circumstances that will require quarantine (which should be applied evenly to all residents), the duration of quarantine, and the reasons why quarantine is necessary. Please note that quarantine is not governmentally mandated for a leave of absence from any regulated facility, but may be an appropriate precautionary measure for infection control and prevention reasons if determined by the risk assessment and if the resident is capable of complying with quarantine.  
  • If the facility will be unable to provide quarantine accommodations, for instance because of lack of an available private room, inform the family what other potential precautionary measures are available depending on the individual circumstances.
  • If you expect it will be difficult to quarantine a person, for instance because of dementia or intellectual disability, explain how the situation will be handled and offer other preventive measures such as having staff assist individuals in remaining in their room as much as possible, utilizing COVID-19 testing, or having the resident wear a mask and face shield when leaving their room.  Other preventive measures may be applicable, and we encourage providers to work with residents and their families to determine the best course of action for the given circumstances.

If we receive any further guidance on this topic, we will share it with members immediately for their holiday planning.

Follow-Up on Chat from Yesterday's SNF Member Call. As usual, we were unable to get through all the questions members posted in chat yesterday during the 90 minutes allotted for our weekly SNF member call. The following are answers to some of the posts.

Q. When does the 8-hour temporay nurse aide certificate expire?

A. The federal waiver to utilize individuals as nurse aides who have not completed the normal nurse aide training and testing requirements expires with the PHE on January 21, 2021, unless the PHE is extended again.

Q. We received a positive PCR result today on a test that was administered on 10/29. The employee is a PRN STNA and has not worked since 10/14. Do we need to start outbreak testing?

A. No, this person could not have infected anyone else in the facility because the incubation period for COVID-19 is 14 days.

Q. Can you give the Ohio COVID email for requesting supplies for outbreak testing?

A. Covidtesting@age.ohio.gov.

Q. If our testing day is the same as a holiday, can we pick a different day or will the ODH report just let us know?

A. It is our understanding that the schedule will be adjusted accordingly. 

Q. With compassionate care visits, we are having family members from other states who want the compassionate care visit twice a day and every day because they are only in town for one week. They are traveling here by plane, in an airport, staff are nervous, we are already trying to manage hundreds of visits a week.  

A. While the visitation order specifies that compassionate care visits are not to be conducted on a routine basis, if the circumstances call for compassionate care visits, we recommend flexibility to accommodate residents and families in those difficult situations. A facility, however, can establish reasonable limits on the number and frequency of compassionate care visits, which should consider individual circumstances and should be communicated clearly and in advance.