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04/27/2021

Today's COVID-19 Report: Friday, April 30

Friday, April 30, 2021

Here are the latest need-to-know updates for Friday, April 30 regarding the COVID-19 pandemic and other topics of importance.


REMINDER TO ALL MEMBERS

LeadingAge Ohio releases weekly Affordable Housing newsletters on Mondays and Home Health and Hospice newsletters on Tuesdays. Please email info@leadingageohio.org to receive either/both publications.

In Today's Report

  • Nursing facility policy guidance supporting documentation required for NF claims
  • It’s OK to Grieve: Encourage staff and family members to access bereavement resources
  • CDC updated select infection prevention and control recommendations, still awaiting alignment of Ohio orders
  • Survey Tip of the Week: Weight loss
  • LeadingAge Need to Know

Nursing facility policy guidance supporting documentation required for NF claims

In accordance with Ohio Administrative Code 5160-1-27 “Review of provider records”, all Medicaid providers are required to keep such records as are necessary to establish that conditions of payment for Medicaid covered services have been met, and to fully disclose the basis for the type, frequency, extent, duration, and delivery setting of services provided to Medicaid recipients, and to document significant business transactions. Medicaid providers are required to provide such records and documentation to the Ohio Department of Medicaid (ODM) or its designee, the secretary of the federal Department of Health and Human Services, or the state Medicaid fraud control unit upon request.

The Ohio Department of Medicaid has recently released a fact sheet to explain this policy. To read the full fact sheet, please click here.

It’s OK to Grieve: Encourage staff and family members to access bereavement resources

Yesterday, LeadingAge Ohio had the opportunity to hear a case study presentation of a long-term care provider whose staff reflected on the extraordinary emotional toll of COVID-19. The provider reported how COVID-19 replaced the routine bustle and noise of the nursing home with an eerie quiet as residents were too sick to ring call bells; they spoke of the guilt many staff members felt when required to quarantine. The grief experienced by these team members highlighted the importance of directing staff as well as family members to bereavement resources.

LeadingAge Ohio recently completed a digital advocacy campaign titled “It’s OK to Grieve” in an effort to connect Ohioans to bereavement resources. Please note on the LeadingAge Ohio website how to access bereavement resources through LeadingAge Ohio’s member hospice programs, many of whom offer bereavement support and trauma response not only to their patients and families, but to their wider communities. Members should encourage team members and family members in need to reach out.

CDC updated select infection prevention and control recommendations, still awaiting alignment of Ohio orders

Yesterday, the Centers for Disease Control & Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) hosted a stakeholder call on the updated select infection prevention and control recommendations in the Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC. These updates are meant for healthcare personnel (HCP) while at work as well as patients/residents while they are being cared for in a healthcare facility, including nursing homes.

Dr. Kara Jacobs-Slifka from the CDC began the call with answering questions that they have continued to receive either from previous calls or emails, including:

Question: How does CDC define moderate to sustained spread?
Answer: Moderate to sustained spread is when there is greater than 5% positivity rates in a county.

Question: What does CDC mean when they reference source control?
Answer: Source control refers to use of well-fitting cloth masks, facemasks, or respirators to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. In addition to providing source control, these devices also offer varying levels of protection for the wearer against exposure to infectious droplets and particles produced by infected people.

Question: What PPE should be worn when there is moderate to sustained spread?
Answer: CDC guidance did not change with the April 27 updated guidance. CDC’s February 23, 2021 guidance states that HCP working in facilities located in areas with moderate to substantial community transmission are more likely to encounter asymptomatic or pre-symptomatic patients with SARS-CoV-2 infection. HCP should at a minimum wear a well-fitting face mask while in the facility and while providing resident care. Eye protection should be worn during resident care encounters.

Evan Shulman and Holly Norelli with CMS were present during the entire call and provided clarifications, along with Dr. Kara Jacobs-Slifka from CDC, on the April 27 updated guidance that allows for less restrictions on fully vaccinated individuals, including residents, visitors, and HCP. The panelists noted that the following Q&A do not consider stricter guidance at the state level. LeadingAge Ohio continues to advocate for Ohio’s orders to be aligned with the information below.

Question: Do visitors need to be vaccinated to visit?
Answer: No, visitors do not need to be vaccinated but they do need to follow the core principles of infection control.

Question: When a resident and their visitors are fully vaccinated can they have touch and not wear source control?
Answer: Yes, the resident and visitors do not need to wear source control and can have touch. While alone in the patient/resident’s room or the designated visitation room, patients/residents and their visitor(s) can choose to have close contact (including touch) and to not wear source control. Visitors should wear source control and physically distance from other healthcare personnel and other patients/residents/visitors that are not part of their group at all other times while in the facility.

Question: If a resident is vaccinated but the visitor is not fully vaccinated, can they have touch?
Answer: Yes, the resident can choose to have touch, but CDC still recommends everyone is still wearing well-fitting source control.

Question: Can facilities separate fully vaccinated residents from unvaccinated resident into different activities and dining similar to cohorting?
Answer: CMS notes that cohorting strategies have been leveraged throughout this pandemic and those strategies are no different here. CMS does not prescribe how facilities conduct their activities with their residents and CMS encourages facilities to conduct lots of activities. CMS notes that If a facility feels they can allow more to participate in activities by cohorting fully vaccinated residents, allowing them to sit close together, then they can do that. If a facility wants to intermingle the residents, that is fine, they just need to adhere to physically distancing and wearing of source control.

Question: If a group activity includes all fully vaccinated residents but the HCP is not fully vaccinated, do the residents have to wear source control?
Answer: Yes, if anyone in the group is unvaccinated or if vaccination status is unknown then all individuals in the space need to physically distance and wear source control. CMS notes that COVID does not know who an individual is, whether they are a resident, visitor, or HCP. A facility should make determinations based on the individual’s vaccinated status. 

Question: If fully vaccinated residents are dining or visiting and if a visitor would walk into that room, are all residents expected to mask up at that time?
Answer: Yes, if the visitor would be entering the space to join the congregated group and the individual is unvaccinated or the vaccination status is unknown, then the individuals must go back to physical distancing and wearing source control. CMS went on to clarify that every scenario is different and if an individual happens to be walking by then they do not need to mask up but if they join the activity then they must go back to distancing and wearing source control.

Question: Does the visitor need to have proof of their vaccination status?
Answer: CMS does not feel the need for facilities to start collecting visitor’s vaccination cards.

Question: How will CMS survey for this guidance?
Answer: CMS expressed excitement about the updated guidance that brings more people together and that nothing can replace the physical contact loved ones can share. CMS is excited that this newest guidance allows fully vaccinated individuals to start to get back to normal. CMS is not expecting surveyors to walk around and look for people that are not six feet apart and then ask them if they are vaccinated. CMS is not asking surveyors to seek out people who are less than six feet or unmasked during standard surveys but will only be looking at this retrospectively after an outbreak. When there is an outbreak, then CMS will -- as part of their normal investigation --  work to determine what were the causes of the outbreak and will expect facilities to be able to demonstrate and explain how they assure fully vaccinated residents are only the ones interacting with each other without being physically distanced or wearing source control. Facilities will also be asked to explain how they assure that when unvaccinated staff are in the mix, then everyone is distancing and wearing source control.

Additional clarifications on testing and outbreaks were answered in the following Q&A:

Question: What does CDC mean when they say fully vaccinated HCP are exempt from expanded screening testing?
Answer: Expanded testing is also referenced as routine testing based on county positivity rate. If an HCP is fully vaccinated they would not need to have routine testing but only if they became symptomatic or the facility was in an outbreak and conducting outbreak testing. CMS revised the QSO-20-38-NH memo on April 27 to be in alignment with the updated CDC guidance on testing for fully vaccinated HCP. The CMS memo notes that routine testing of unvaccinated staff should be based on the extent of the virus in the community. Fully vaccinated staff do not have to be routinely tested. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency for unvaccinated staff as outlined in table 2 of the memo. LeadingAge Ohio reminds providers that Ohio has not updated their testing order for nursing homes.

Question: Must indoor visitation stop if there is a positive case in a HCP but no residents?
Answer: CMS does not differentiate between HCP or resident positive cases in determining when to pause visitation. If there is a new case, regardless of the positive case being a HCP or resident, then outbreak testing needs to occur and if no new cases are identified and it is isolated, then visitation can occur in all other areas of the facility.

A copy of yesterday’s CDC and CMS recording and transcript will be available today on the CMS transcripts page

Dr. Kara Jacobs-Slifka from CDC also joined the April 29, 2021 LeadingAge Coronavirus Update call. Questions and answers from that call can also be found on the LeadingAge coronavirus resources webpage.

Survey Tip of the Week: Weight loss

The National Institute of Health (NIH) studied the impact of the pandemic on residents and collected clinical evidence of a consistent weight loss trend in a SNF population during and after a COVID-19 infection. Weight loss related to restrictive infection control measures was also reviewed. Anorexia was the most common symptom during COVID-19 infection among patients at a long-term chronic care facility, with 70.8% of residents developing anorexia during the illness course. Weight loss was listed by CMS as an outcome example that would qualify for compassionate care visits.

During the Long-Term Care Survey Process (LTCSP), residents and/or the resident’s representative will be asked if they have had a weight loss and why. LeadingAge Ohio encourages providers to use the LTCSP Initial Pool Care Area survey pathway to conduct resident and resident representative interviews. Interviews will identify if the resident and/or representative have been part of identifying the root cause for the weight loss. Staff will be asked if they know if the resident has had a weight loss and what the care plan interventions include. Physician notification of weight loss is a consistent citation. Facilities should utilize the LTCSP nutrition pathway to assess the organization’s compliance. 

The survey pathways can be found on the CMS Nursing Home webpage, under the download section, and within the zip file called LTC Survey Pathways.

As the re-start of the annual surveys continues, LeadingAge Ohio is sharing tips each week to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.

LeadingAge Need to Know

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's Need to Know featured Lobby Day record-breaking numbers and Mother's Day celebrations.

Check out the full report here.


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Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook gro up to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information. 

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Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.