Elevating the Post-Acute and
Long Term Care Profession

April 1, 2021

Long-Term Care Cases Tick Up. This week's Department of Health (ODH) COVID-19 dashboard for long-term care revealed an increase in cases for the first time in more than 3 months. Total current cases between residents and staff rose from 926 last week to 957 this week. In keeping with reports that infections in the general public are rising primarily among younger age groups, all of the long-term care increase was in staff, while resident cases declined slightly. Among the general population, Governor Mike DeWine announced that Ohio's cases per 100,000 rose from under 150 to 167.1. The death data for long-term care still are difficult to characterize because ODH changed how and when it recognizes COVID-19-related deaths. The dashboard shows 7,119 total deaths connected to long-term care facilities. A note on the web page states that it now gives deaths from March 2020 instead of April 15, 2020, as was the case previously.

Annual Surveys to Restart this Month. ODH's Rebecca Sandholdt emailed this morning to notify us that annual surveys of both SNFs and residential care facilities (assisted living) will begin sometime this month. Upon our further inquiry, she responded that the timing likely will be mid to late April. Her original message was, "I wanted to give you a heads up that we are planning to restart our annual surveys this month. CMS-Chicago has notified us that with a decrease in the Focused Infection Control Surveys for Ohio, we need to restart following QSO 20-35. It will a slow start at first as we work to reorient everyone. Additionally, we will begin our RCF annuals as well."

Vaccination Maintenance Program. The most recent published list of facilities the state said have not completed the vaccination maintenance program survey numbers 3 SNFs and 16 assisted living communities, but it is dated Tuesday. Governor DeWine said today the list is down to two SNFs and 6 assisted living communities.

In daily discussions with members, we find many more of them either have had vaccination clinics already or have them scheduled. In some cases, they received erroneous emails from the state about clinics. The key seems to be that the state confirms the long-term care pharmacy assignment and then the pharmacy schedules the clinic with the facility, so you should stay in close contact with your chosen or assigned pharmacy. If you do not foresee reaching the 10-person threshold for vaccinations, you may be better served by working with your local health department or another community vaccine provider to vaccinate occasional new staff or residents.

Guideline Reminders. We would like to share a couple of timely reminders about specific Centers for Disease Control and Prevention (CDC) guidance. 

  • Travel. With spring break occurring now and summer vacations coming up, it is advisable to review CDC's travel guidance so you can work with staff who may be planning travel. This guidance is mentioned in CDC's recent statement that vaccinated health care workers ordinarily do not need to be excluded from work if exposed to COVID-19. CDC still takes a dim view of travel: "Travel increases your chance of spreading and getting COVID-19. Delay travel and stay home to protect yourself and others from COVID-19, even if you are vaccinated." CDC goes on to give suggestions for people who must travel, including: "Get tested 3-5 days after your trip and stay home and self-quarantine for a full 7 days after travel, even if your test is negative. If you don’t get tested, stay home and self-quarantine for 10 days after travel." The guidelines include various additional recommendations.
  • Patients in quarantine. Although CDC's guidelines recommend not quarantining patients who come to the facility fully vaccinated and without close contact with COVID-19 in the past 14 days, the recommendations for patients who do require quarantine have not changed. That includes the statement that unless absolutely necessary, these patients should be placed in private rooms. CDC writes in their key guidance for SNFs:
Residents in quarantine should be placed in a single-person room. If limited single rooms are available or if numerous residents are simultaneously identified to have known SARS-CoV-2 exposures or symptoms concerning for COVID-19, residents should shelter-in-place at their current location while being monitored for evidence of SARS-CoV-2 infection.

CDC recognizes that there could be exceptions to private-room placement for extenuating circumstances, but these should be rare and very well-documente because they increase risk of viral spread.

Vaccination and SNF Residents: Quick Reference Guide. As requested during our most recent SNF member call, OHCA developed a quick reference guide showing how to address three common situations for SNF residents. These situations are new admissions/readmissions, leaves of absence, and visitation. Based on the most recent CDC and Centers for Medicare and Medicaid Services (CMS) guidance, the quick reference guide differentiates treatment of residents who are fully vaccinated from those who are not.

President's Infrastructure Plan Includes HCBS. Yesterday, President Joe Biden announced the American Jobs Plan, the first part of his proposal to invest in infrastructure. The $1.9 trillion package includes a proposal to spend $400 billion on home and community-based services (HCBS). Although the White House fact sheet is short on details, it gives a few broad brushstrokes:

  • Expand access to long-term care services under Medicaid. President Biden believes more people should have the opportunity to receive care at home, in a supportive community, or from a loved one. President Biden’s plan will expand access to home and community-based services (HCBS) and extend the longstanding Money Follows the Person program that supports innovations in the delivery of long-term care.

  • Put in place an infrastructure to create good middle-class jobs with a free and fair choice to join a union. The HCBS expansion under Medicaid can support well-paying caregiving jobs that include benefits and the ability to collectively bargain, building state infrastructure to improve the quality of services and to support workers. This will improve wages and quality of life for essential home health workers and yield significant economic benefits for low-income communities and communities of color.
A document from last year's Presidential campaign has more information (see "Expand Access to Dignified Care for Older Americans and Those with Disabilities") that may describe the current proposal. In around two weeks, the President is expected to release a second "human infrastructure" initiative, which will address health care in more depth. Both pieces, which may be combined legislatively, face tough sledding in a Congress where Republicans already have expressed objections.

Pfizer Data Shows Safety, Efficacy Among Younger People. Pfizer announced yesterday that a trial involving 2,260 12 to 15-year-olds resulted in no cases of COVID-19 among fully vaccinated participants (100% efficacy). Vaccine side effects were minimal, as with previous trials involving older people. The data have not yet been published or submitted to the Food and Drug Administration for Emergency Use Authorization. Pfizer and BioNTech plan to submit in the coming weeks. Trials involving other vaccines and younger children are proceeding as well.

FEMA Funeral Cost Assistance. Beginning April 12, 2021, the Federal Emergency Management Agency (FEMA) will begin providing financial assistance of up to $9,000 for funeral expenses for individuals who died from COVID-19 since January 20, 2020. Please see FEMA's web page on this program for more information and a call center number to apply once it kicks off.

IRS Issues Third Round of Economic Impact Payments (from AHCA/NCAL). The IRS began issuing the third round of Economic Impact Payments (EIPs), which aim to support Americans and provide some financial relief. Many people will receive the third payment the same way they received the first and second EIPs. Because these payments are automatic for most eligible people, there’s no need to contact financial institutions or the IRS. People can check the Get My Payment tool on the IRS' website for the status of their third stimulus payment.

It is important to note that previous EIP requirements also apply to the EIPs in the most recent stimulus package. If you or someone you know serves as a representative payee for a Social Security or Supplemental Security Income (SSI) beneficiary, that designee is only responsible for managing Social Security or SSI benefits. The EIP is not an SSA benefit, and it belongs to the beneficiary. Representative payees should discuss the payment with the beneficiary whenever possible. If the beneficiary requests access to the funds, they representative payee is obligated to provide it. 

More details about the third round of EIPs are available on the IRS's website. AHCA/NCAL also recorded a webinar in 2020 focused on EIPs from the IRS and important facts for skilled nursing facilities, ICFs/IID, and assisted living centers to know about the use of them. A variety of resources ranging from the Social Security Administration to the National Center on Elder Law and Rights are also available at the end of the webinar. 

Please contact COVID19@ahca.org with any questions.

HHS Confirms Deadline for Spending PRF Money. In updates to its frequently-asked questions yesterday, the Department of Health and Human Services (HHS) stated clearly that June 30, 2021, remains the deadline for spending Provider Relief Fund (PRF) allocations. AHCA/NCAL had requested an extension of the deadline. HHS wrote, "[a]s explained in the notice of reporting requirements on the Provider Relief Fund website, available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/index.html, funds must be expended no later than June 30, 2021." HHS further stated, "Provider Relief Fund payment amounts that have not been fully expended on health care expenses or lost revenues attributable to coronavirus by the end of the final reporting period must be returned to HHS." In addition to the audit and recoupment responses, HHS modified several answers relating to transfers among related entities.

R3AP Rollout. In a meeting today, Dr. John Weigand explained the Department of Aging's new Regional Rapid Response Assistance Program (R3AP), which is operated by a group of clinicians and the National Guard. This program, which supplements and expands upon the state's Bridge Team and builds on the history of the Post-Acute Regional Rapid Testing Program (PARRT), offers assistance to congregate settings mainly in response to outbreaks or potential outbreaks. Its coverage goes beyond SNFs and assisted living communities to include senior housing, day centers, and senior centers. R3AP is organized on a regional basis, each region headed by a medical director, and can furnish clinical consultation, personal protective equipment, testing and vaccination support, and more to providers in need. Please see this flyer, which includes the R3AP call center number. The call center triages callers based on location and assistance needed. Dr. Weigand organized the available services as follows:

  • Acute outbreak management
    • Deployment of swab team
    • Staffing support
    • Crisis management
    • Outbreak mitigation
    • Personal protective equipment (PPE) shortages
  • Rising/receding risk
    • Predictive model outreach
    • Index case testing
    • Infection prevention and control review
    • Community asset assessment
    • mAb infusion services
    • Facilities in crisis network
  • Information/education
    • State and federal guidelines
    • Best practices
    • Training on PPE use
    • Nurse aide educational forum
    • Medical director support
    • Infection prevention and control
  • Equipment/supplies
    • PPE inventory
    • Ongoing testing supplies
    • Vaccine and related