Elevating the Post-Acute and
Long Term Care Profession

March 16, 2021

ODA Webinars Struggle. Today's Department of Aging (ODA) webinars for assisted living communities and SNFs suffered considerable audio and video difficulties that impeded the department's ability to communicate its intended messages. ODA does not seem to have posted slides or recordings from the webinars yet. The biggest news from the webinars was changes that the state plans to make in its visitation order and testing guidelines. ODA announced that a not-yet-released version of the visitation order, responding to the recent federal changes, would set 30 minutes as the minimum duration for routine visits, instead of the maximum, and would allow facilities to specify that a resident's room could be the designated visitation area. Relative to staff testing, ODA intends to vary the frequency based on whether the staff member has been fully vaccinated. Both SNFs and assisted living communities would test on the same cadence: weekly for vaccinated staff and twice weekly for unvaccinated staff. The revised guidelines, which also are not yet available, would take effect sometime in April, presumably when the current testing schedule runs out April 10.

Governor DeWine Expands Vaccinations Again. Governor Mike DeWine announced today that effective Friday, Ohioans 40 and above will be able to obtain COVID-19 vaccinations. In addition, anyone with cancer, chronic kidney disease, chronic obstructive pulmonary disease, heart disease, or obesity now qualifies. The Governor further stated that vaccinations will be opened to everyone sixteen or older by March 29. The state is expecting a large upswing in its vaccine allocation that week.

Clarification of Vaccination Maintenance Program Contracting. There continues to be some confusion about how SNFs and assisted living communities can work with long-term care pharmacies to administer vaccinations without having to enroll with the state as vaccine providers. That is understandable because it rests on a very technical distinction: who actually contracts with the pharmacy. If the facility contracts with the pharmacy, technically the facility is administering the vaccine and must enroll as a provider even though it is not storing the vaccine or reporting the vaccinations. If a facility employee contracts with the pharmacy as an individual, technically the pharmacy is administering the vaccine using a contracted employee. The facility is not a party to the administration even though it employs the individual when they are not administering vaccine, so it does not need to enroll as a vaccine provider. It is advisable that the facility nurse is "off the clock" and not under the direction of the facility while administering vaccinations to support their status as a temporary, contractual employee of the pharmacy.

Monitoring SNF Residents for COVID-19. With the recent relaxation of some Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS) guidelines based on vaccination, members have asked whether the requirements for monitoring residents for signs and symptoms of COVID-19 have changed. The answer is no. The relevance guidance is CDC's ever-popular "Preparing for COVID-19 in Nursing Homes," which has not been revised since November 20, 2020, before vaccines were available. The recommended level of monitoring depends on whether the patient exhibits symptoms.

  • No symptoms: "Actively monitor all residents upon admission and at least daily for fever (T=100.0oF) and symptoms consistent with COVID-19. Ideally, include an assessment of oxygen saturation via pulse oximetry."
  • Symptoms: "Increase monitoring of ill residents, including assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam, to at least 3 times daily to identify and quickly manage serious infection."
CDC also suggests that facilities consider increasing monitoring of asymptomatic patients to every shift if COVID-19 is present in the building. To reiterate, there is no discussion of the impact of vaccination on any of these recommendations because CDC has not updated the guidance since vaccinations became available.