Elevating the Post-Acute and
Long Term Care Profession

March 18, 2021

Fewer Than 1,000 COVID-19 Cases in LTC. This week's state dashboard shows Ohio's long-term care facilities (SNFs, assisted living communities, and ICFs/IID combined) with 993 current COVID-19 cases. Of these, 570 are residents and 423 staff. This is the 13th straight week with fewer cases than the week before. Unfortunately, cases in the community have bounced up somewhat, with today's daily total of 2,104 coming in well above the three-week average of 1,590. Hospitalizations also are higher. Hopefully this is a momentary phenomenon, as the long-term care statistics in Ohio have tracked the community numbers fairly closely.

Maintenance Vaccinations. In his press conference today, Governor Mike DeWine echoed Saturday's release on the maintenance vaccine program by pointing out that now 93% of SNFs and 77% of assisted living communities have signed up through the Department of Aging (ODA) survey. He further noted, however, that 243 facilities have not registered. We continue to urge any members who have not done so to complete the survey.

We hear more from members, though, that they have not received any vaccinations through the maintenance program. ODA offers a schedule, similar to the testing schedule, for providers to check on their vaccine clinics. This may offer a window into where things stand, although it may not help if you do not have an assigned long-term care pharmacy, your pharmacy is not an enrolled vaccine provider, or it has not bee allocated any vaccine. ODA also provided a navigation guide for the clinic schedule.

Verifying Vaccination Status for Quarantine. Last week's revised Centers for Disease Control and Prevention (CDC) guidelines on quarantining new admissions and readmissions allow SNFs not to quarantine new admissions and readmissions who are fully vaccinated unless they had a known, significant COVID-19 exposure in the past 14 days. The question then becomes how to verify the patient has been vaccinated, especially if they do not have a vaccination card.

The Health Department (ODH) maintains a vaccine registry called the Ohio Impact Statewide Immunization Information System (ImpactSIIS). ImpactSIIS is the place where all vaccine providers report individual vaccinations. If your long-term care pharmacy is enrolled as a vaccine provider, we recommend you ask them to check the patient's vaccination status in ImpactSIIS.

ODA Webinar Recording Posted. Viewers were disappointed Tuesday when ODA's assisted living and SNF webinars offered were plagued by severe audio and video difficulties. ODA posted a freshly recorded version of the SNF webinar on their YouTube channel. Neither the assisted living nor the adult day/senior center webinar recordings appear to be posted yet. None of the slides from the webinars are available either.

Speaking of webinar for senior adult day providers, ODA announced that the reopening order will be changed soon, but the revised order may not provide any relief for adult day services. The webinar featured a panel of physicians explaining why they felt weekly testing should be required. On the other hand, ODA and the Office of Budget and Management reopened the Coronavirus Relief Fund opportunity for adult day providers. The original program ended December 31, 2020, and disbursed only $4.8 million of the $15 million authorized. The reopened portal will be available only through April 9, 2021. Applications are based on actual and projected cost and lost revenue from March 1, 2020, to June 30, 2021. See this page for more information about the funding opportunity and a link for applying.

ODH Revises Adult Day Order for DD Service. Today, the Department of Developmental Disabilities (DODD) notified us that ODH again revised the health order for adult day and vocational habilitation providers. The only change is to the language in the previous order that required staff to be tested before returning to work if they had a suspected infection or exposure to someone who was COVID-19-positive. The new language advises contacting the local health department or following current CDC or ODH guidance regarding safe return to work.

Left-Over Questions from OHCA's SNF Member Call. As promised, here are answers to remaining questions in chat at the end of the member call on Tuesday.

  • Is there a definitive answer to when staff are required to wear a surgical mask or N95? I called around to different SNFs and some were wearing N95s and some wearing surgical only. Best practice may be to wear N95s throughout the building if it is located in a Centers for Medicare and Medicaid Services (CMS) red or yellow county. The minimum requirement, however, is for N95s when caring for patients with COVID-19 or whose status is unknown (quarantine/isolation) and in parts of the building affected by an outbreak.
  • Can you discuss the guidelines for sanitizing or disinfecting faceshields in between rooms on quarantine unit vs. goggles you don't? Why? The same cleaning and disinfection standards apply to both types of eye protection. See this CDC guidance for more information on this topic.
  • Do the surgical masks have to be the tie ones or can we wear surgical masks with the ear loops? Ties are one option for making a mask well-fitting, but there are others. See this CDC guidance, among others, for the latest on masks.
  • Our original vaccinated percentage of residents was 78%. With deaths and skilled discharges, we are now at 64%. Do we "go by" the original 78% or the current 64%? It is the current percentage.
  • Will the visits still be required to have supervision? Monitoring of visits is required by the 6th amended ODH visitation order, but not by revised CMS Quality, Safety, and Oversight letter (QSO) 20-39-NH. The 6th amended order is still in effect, although it will be changed in the wake of the QSO. It is unclear if the monitoring requirement will stay.
  • Goggles are not needed for visitors in an orange or red county, so where they are required? Eye protection is recommended for compassionate care visits to patients who have COVID-19 or who are in quarantine.

Senate Finance Hearing on SNFs and COVID-19. Yesterday, the US Senate Finance Committee held a hearing entitled, "A National Tragedy: COVID-19 in the Nation’s Nursing Homes." As the title would suggest, the hearing was full of blame toward SNFs and operators, particularly for-profit operators, for COVID-19 deaths, as well as significant political overtones. AHCA/NCAL's Dr. David Gifford defended the industry and proffered the newly-minted Care for Our Seniors Act, but the hearing also included a representative of AARP, an ombudsman, a union-member nursing assistant, an official from the Government Accountability Office, and a university researcher. Many of their comments, along with those of some Senators, were quite concerning.