MDH Advances Work on Reopening Recommendations

Posted on July 8, 2020 by Jonathan Lips

The Minnesota Department of Health (MDH) continues to work on recommendations for nursing homes and housing with services/assisted living settings to modify general visitation, but there still is not a firm timeline for release of those recommendations. 

Late last week, MDH shared an initial draft of their proposed guidance for the modification of visitor restrictions, in the context of CMS’s blueprint for states to develop a reopening plan for long-term care. From our initial understanding, MDH intends to issue recommendations, not strict regulatory mandates.

The current draft sets forth considerations and risk factors for providers to apply, and key elements of the draft framework include the following:

• MDH would identify two stages: Stage 1, in which facilities should not modify current visitor restrictions beyond what is currently allowed (essential healthcare personnel, compassionate care, window visits and outdoor visits), and Stage 2, in which facilities could modify current restrictions. Facilities could move forward and backward between the stages as conditions change.
• MDH would identify factors that facilities should assess before determining whether to move from Stage 1 to Stage 2, including testing capacity and other facility-specific information, as well as county-level COVID-19 transmission status.
• MDH would provide guidance on specific topics (such as screening, visitation modifications, and certain infection control practices) for each Stage, reflecting CMS, CDC and MDH guidance.

LeadingAge Minnesota and our Long-Term Care Imperative partner were invited to submit written comments prior to the July 4th holiday. We had the opportunity to discuss our written input with MDH staff on Monday, July 6.

While MDH did incorporate into this preliminary document some of the reopening concepts we had forwarded to them several weeks ago, we expressed our overall concern over a lack of specificity in the guidance in some areas:

• clear criteria for determining the risk of community transmission in a given county,
• lack of a clear link between baseline testing and any relaxation of visitor restrictions, as CMS recommends in its CMS blueprint for re-opening.
• lack of a clear and comprehensive testing strategy and a turn-key approach to testing and payment beyond the National Guard, which remains one of our primary concerns.
• how “guidance” will be interpreted in any future enforcement actions.

Consumer advocacy organizations have been eager to ease visitor restrictions and have brought considerable pressure on the Walz Administration to move forward with modifications. We share the desire to reunite families and residents and combat the impact of physical isolation, but also underscored that we will be held responsible by our constituents to ensure a safe and careful easing of restrictions.

Because of the need to address social isolation within our settings, we also introduced the concept of an Essential Caregiver designation.  The Essential Caregiver would be an expansion of compassionate care visits where those designated persons can continue to provide care and supports to residents under certain circumstances and with specific safety measures. This designation would apply to persons who provided care and support to residents before the pandemic began. 

Next Steps

MDH staff noted they would be working with Commissioner Malcolm and Governor Walz to finalize the recommendations, and that they continue to work diligently on resolution of testing issues, but they did not identify a clear timeline for completion of the work.

We urged MDH to give providers meaningful lead time, suggesting at least two weeks, between the release of the recommendations and their effective date, so that providers can analyze and plan for implementation of any appropriate modifications from current restrictions.

We will continue to work closely with the Department on these critical issues, advocating for recommendations that strike the right balance between relaxation of current visitor restrictions and remaining vigilant against the risks of COVID in our settings, and that give providers clear information and guidance to inform your decisions about transitioning to a less restricted stage of operation.