Elevating the Post-Acute and
Long Term Care Profession

March 15, 2021

State Urges Participation in Vaccination Maintenance Program. On Saturday, the Department of Aging (ODA) issued a press release encouraging SNFs and assisted living communities to sign up for the state's vaccination maintenance program. Of course, most facilities already registered through the program through the state's Survey Monkey. ODA wrote:

Currently, 90 percent of Ohio’s nursing homes and 74 percent of assisted living facilities have responded. The Ohio Department of Aging would like the remaining 10 percent of nursing homes (98) and 26 percent of assisted living facilities (209) to register their plans. The Ohio COVID-19 Vaccination Maintenance Program, which began in February, has already delivered 16,000 vaccine doses, with an additional 30,000 scheduled through March.

For those facilities that have not signed up, ODA reopened their Survey Monkey and provided a navigation guide to help providers use the survey. They also published a list of long-term care pharmacies enrolled with the Department of Health (ODH) as vaccine providers. Note: given the sheer size of the list, we question whether it is limited to long-term care pharmacies or includes all enrolled pharmacies.

State Webinar Reminder. The state is holding three separate webinars tomorrow and Wednesday for different provider groups that will address visitation, testing, and other issues. They are:

  • Assisted living: Tomorrow, March 16, from 11:00 a.m. to noon. See flyer here and register here.
  • Skilled nursing: Tomorrow, March 16, from 2:00 to 3:00 p.m. See flyer here and register here.
  • Adult day services for seniors: Wednesday, March 17, from 11:00 a.m. to noon. See flyer here and register here.
Also, the Centers for Medicare and Medicaid Services (CMS) issued an infographic on their revised visitation guidance designed for use with consumers, although it has a misleading sentence suggesting the ability to visit in counties with positivity below 10% is new, which it is not, and potentially causing readers to conclude that visitation is not allowed in red counties.

AHCA/NCAL Announces Care for Our Seniors Act. Attendees of OHCA's March 4 virtual Winter Conference may recall AHCA/NCAL President and CEO Mark Parkinson providing a sneak preview of the national association's reform proposal, now dubbed Care for Our Seniors Act and jointly sponsored by LeadingAge. Today, AHCA/NCAL and LeadingAge rolled the plan out publicly at a press conference. Members and others can find more details at this page. AHCA/NCAL is offering a webinar for members tomorrow at 2:00 p.m. in which Mr. Parkinson will explain the proposal. Unfortunately this session conflicts with the state webinar for SNFs mentioned above. You may register for the AHCA/NCAL webinar through this link.

Update on N95 Issue. On February 23, 2021, the Centers for Disease Control and Prevention (CDC) updated one of their guidance documents to add a discussion of what type of mask should be used in areas with high or moderate COVID-19 spread. This guidance offered three options, including N95s, acceptable substitute respirators, and well-fitting facemasks. CDC included examples of how facemasks can be made well-fitting. To the consternation of many OHCA members, the ODH Bureau of Infectious Diseases (BID) initially stated that the revised guidance required N95s or one of the alternatives (not including a well-fitting facemask) throughout the building for SNFs in yellow and red counties. We informed members of this interpretation but also pushed back because the guidelines do not say that. Late last week, BID informed us that they only offer best practices, and the survey bureau would need to weigh in on the regulatory requirements. Today, survey chief Rebecca Sandholdt did so, writing to us:

For Survey and Certification, we will continue to look for appropriate use of PPE taking into account CDC guidance and recommendations. We acknowledge the use of the word “OR” in the new CDC recommendations. We do take into account the unique findings of each survey. I do not believe we have issued citations related to this new recommendation; however, if you are aware of any let me know.

Thirty-Five Green Counties. This week's CMS county positivity ratings showed further progress in Ohio, with 35 counties now qualifying as green. The Ohio table has only five red counties (Butler, Clermont, Portage, Stark, and Summit). This week's movers were Belmont, Jefferson, Licking, and Warren Counties from red to yellow and Ashtabula, Auglaize, Carroll, Columbiana, Fayette, Guernsey, Hamilton, Jackson, Meigs, Morrow, Pickaway, Pike, Richland, Sandusky, Scioto, Shelby, Trumbull, Van Wert, and Wyandot Counties from yellow to green. On the other hand, Hocking, Miami, and Wood Counties went from green to yellow. Green status is important because it relieves staff of the need to wear eye protection in addition to facemasks. Even in green counties, eye protection (and other personal protective equipment) is needed when caring for COVID-19-positive or quarantined patients and in areas affected by an outbreak. Red county status, on the other hand, requires suspending visitation to unvaccinated residents if the facility has an overall resident vaccination rate under 70%.

Vaccine Effectiveness in SNFs. CDC published an interesting article in its flagship Morbidity and Mortality Weekly Reporter (MMWR). CDC examined the effectiveness of the BioNTech/Pfizer vaccine during outbreaks in two large Connecticut SNFs (total 463 residents) earlier this winter. CDC found even partial vaccination (defined as more than 14 days after dose 1 but less than 7 days after dose 2) was 63% effective in preventing SARS-CoV-2 infection, as measured by testing. AHCA/NCAL commented that the study was possible because the facilities voluntarily reported vaccine uptake to the National Healthcare Safety Network (NHSN). Both AHCA/NCAL and CMS encourage this reporting, including by assisted living communities, to further research on vaccine effectiveness in long-term care.