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Centers for Medicare and Medicaid Services (CMS) modified how surveyors should look at staff screening procedures and they have removed the requirement for active screening. Requirements for the organization in reference to staff screening include the need for a screening process that all staff must complete prior to or at the beginning of their shift.

First Phase to Include Healthcare Personnel and LTC Residents

The Minnesota Department of Health (MDH) issued two documents on Tuesday, Dec. 8, 2020 discussing several topics regarding vaccines.  Recommendations for initial Phase 1a vaccination include healthcare personnel and residents of long-term care facilities.

If ever there were a time to develop and support nurse leaders in our field, this is it. They are looked upon to deliver best in class service, meet stringent regulatory requirements, develop an effective quality process, navigate the evolving challenges of a pandemic, lead and motivate a staff team that is stretched to capacity – and so much more.

Appropriate use of gloves and hand hygiene practices related to glove use is an important component of effective infection prevention practices and is a practice that is frequently cited during infection control surveys.

Join Your Colleagues in Creating Safe Hand Hygiene and Glove Use Habits across our communities. The Living the Pledge Campaign monthly infection prevention campaign is now entering its second full month to help keep residents and fellow team members safe from harm.

DHS recently posted 2021 calendar year Medicaid rate notices for almost all care centers in the Nursing Facility Provider Portal. These rates are based on the cost reports for the year ended September 30, 2019 and will not reflect any COVID-19 related cost increases.

The Minnesota Board of Executives for Long Term Services and Supports (BELTSS) has published the draft rules for the licensure of assisted living directors and has reached the hearing process. Included in the draft rules (pages 515-539) are requirements for licensure, courses, the director in residence requirements, course provider program review and continuing education. The draft rules and Statement of Need and Reasonableness (SONAR) for the Licensed Assisted Living Directors (LALDs) can be accessed on the BELTSS website.

In a special “Home Care Matters” call this week, the Minnesota Department of Health (MDH) provided basic information on assisted living licensure and the transition for settings currently registered as Housing with Services Establishments with “arranged home care providers” to licensure as assisted living facilities.

CMS last week posted updates to several nursing home survey tools and documents:

Information is circulating that the Centers for Disease Control and Prevention (CDC) is updating its quarantine guidance to say quarantine can be shortened to 7 days if the individual is asymptomatic and has a COVID negative test.

Long-term care providers were asked to sign up with a pharmacy partner to administer vaccines to residents when a COVID-19 vaccine becomes available. The PPP program sign-up deadline has passed and LeadingAge Minnesota recently received several questions about what to do if an organization was unable to sign up for the PPP program within previous deadline.

If you have not signed up with a pharmacy vaccine partner and would still like to, please email MDH at health.covid.vaccine@state.mn.us as soon as possible.  MDH and CDC would like this finalized by the end of day on Friday, Dec. 4, 2020.

Due to the overlapping mandates for testing of staff and residents during outbreaks and of staff based on the positivity rate in the county, the Long-term Care Imperative has been working with the Minnesota Department of Health (MDH) and the Department of Human Services (DHS) on clarifying how staff testing should be billed when both requirements apply.

The Minnesota Department of Health (MDH) shared updated information this week on the issue of whether a healthcare worker who experiences a high risk exposure to COVID-19, but who is asymptomatic and has not tested positive for the virus, may return to work prior to the end of his or her 14-day quarantine if staffing needs are acute. The information is consistent with prior guidance from MDH, but we want to be sure members have access to the latest published standards on this and on the related issue of asymptomatic staff who have tested positive.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) held an emergency meeting on Dec. 1 to review allocation recommendations for vaccines in phase 1 distribution. The advisory committee voted to include resident’s of long-term care communities in Phase 1A of vaccination. Long-term care residents now join healthcare workers in Phase 1A vaccination recommendations. For more information on ACIP you can visit the CDC’s Advisory Committee on Immunization Practices website.

Earlier this year, the state produced two special budget updates to look at the impact of the COVID-19 pandemic on the state’s economy. Those updates showed disturbing projected budget shortfalls of $2.4 billion for the current biennium and $4.7 billion for the biennium starting July 1, 2021. Since that time, state revenue collections have exceeded expectations and the budget looks more positive.

Today the Minnesota Department of Health published guidance entitled “Long-term Care Guidance Under Executive Order 20-99” specific to residents who leave a long-term care building for reasons other than essential medical appointments. The document references the Governor’s executive order 20-99 and makes the following points:

Registration just opened for one of the hottest tickets in the field of aging. Each year, the Minnesota Leadership Council on Aging (MLCOA) gathers the state’s leading minds for a Summit to discuss the policies and practices needed to create communities and systems that support aging with dignity and a spirit of well-being in Minnesota. Last year at the Summit, Governor Walz signed an executive order to establish the Council for an Age-Friendly Minnesota that recently submitted their recommendations.

Nurse leaders in aging services settings must possess the leadership and operational skills to provide best in class care and effectively support their staff and residents. This year, when the COVID-19 pandemic has staff teams stretched to capacity, the need is even more urgent.

Members interested in submitting one or more proposals for the May 19-21 LeadingAge Minnesota Institute have until 5 pm on Tuesday, December 1, 2020 to respond. Proposals can be sent using this link. Questions may be directed to Heidi Simpson at hsimpson@leadingagemn.org. Individuals and companies who submitted proposals in the summer 2020 CFP round have been contacted and asked to make a choice about how they would like their original proposal(s) handled. Copies of original proposal submissions may be requested by contacting Terri Foley tfoley@leadingagemn.org.

On November 23^rd, HUD announced the continued availability of supplemental funds for HUD-assisted multifamily housing providers responding to COVID-19. In July, HUD announced the initial request period for COVID-19 Supplemental Payments. The new HUD notice establishes a second request window and updates the submission requirements.

As reported in last week’s Advantage, a special “Home Care Matters Call” will be held Monday, November 30, from 11:00 am to 12:00 pm. On the call MDH will cover Assisted Living Licensure topics and discussion. 

Our focus this week is on “Recognizing Wins” via complimenting and expressing appreciation. During a time when the “right” course is often illusive even when working hard to avoid making mistakes, people need to be reminded when they are doing well. More importantly, people need to hear they are a valuable member of your team. This helps us all keep going despite the significant stress.

The recent surge of COVID-19 cases in Minnesota has had a significant impact on long-term care, after many months of reduced cases and deaths after the spring wave. The new wave has created unprecedented staffing challenges for providers due to infected and exposed staff needing to miss work, and the impact is being felt throughout the state as opposed to the mostly Twin Cities-based outbreaks in the spring. Deaths in long-term care have risen in recent months after being at very low levels for months.

Minnesota nursing homes may be receiving calls with questions and offers of assistance from CMS, CDC, or Superior Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Minnesota. The LeadingAge national team recently passed along this information from CMS about non-regulatory outreach currently underway:

In recognition of severe staffing shortages facing assisted living providers and nursing homes in Minnesota, the Chief of Staff to Governor Walz yesterday sent a message to 36,000 state employees, asking them to consider volunteering for a potential redeployment to help long-term care residents and facilities at some point in the future. “We could need assistance in communities across the state, particularly in Greater Minnesota,” the message noted. “Facilities could make use of any RNs, LPNs, or Certified Nursing Assistants (CNAs). No prior experience is required. If needed, we will provide CNA training prior to deployment.”

Late yesterday, DHS released a memo that suspends the physician signature requirement for the single room rate differential. It also allows the charging of a differential to private pay without advance notice. The waiver applies only for the fourteen day quarantine period for new admissions or residents returning from leave, and it is in place through the end of the state public health emergency.

There have been many questions regarding quarantine periods in long-term care communities over the past several weeks. In order to clarify, here is information about the quarantine period for staff in various circumstances:

Receiving a vaccination is one of the most effective ways for people to protect themselves and those around them including residents. Development of a COVID-19 vaccination has been on a fast-track since the beginning of the pandemic in early 2020. Many teams working toward vaccines for the SARS-CoV-2 (COVID-19) virus previously worked on vaccines for similar viruses such as the original SARS virus, influenza, and other coronavirus pathogens contributing to the speed at which vaccines for COVID-19 are developing. On November 18, 2020 Pfizer applied for the first COVID-19 vaccination emergency use authorization (EUA) and will shortly be followed by other manufacturers such as Moderna, Astra-Zeneca, and others. Currently, vaccines are projected to be available the end of December 2020 or the beginning of January 2021.

On December 9-11, the Minnesota Leadership Council on Aging hosts its 2020 Virtual Summit Series, a forum to discuss the policies and practices needed to create communities and systems that support aging with dignity and a spirit of well-being in Minnesota. This year’s event will focus on improving health equity for older adults in our state.

Dealing with the various aspects of the current crisis brought about by the pandemic, nurse leaders in aging services settings are facing even more challenges and stressors than ever before. It is critical that they find ways to build up their strengths and their reserves so they can be present to support others—their staff, their residents and families—both now and as we look ahead to the future of aging services. LeadingAge Minnesota’s Nurse Leadership Certificate Program is designed to do just that and in a virtual environment. It builds on the solid program content and expert faculty that were formerly a part of the venerable Nursing Leadership Symposium and the Assisted Living Nurse Manager program – updated to address today’s challenges.