November 11, 2021
Featured News
MDH, DHS, CMS Clarify, Add Detail to Vaccination Rules
On November 11, 2021 by Jonathan Lips
State and federal regulators have added clarifying information to the conversation about how vaccine rules will be implemented and enforced in long-term care settings.
On its Nov. 10 long-term care COVID-19 call, the Minnesota Department of Health confirmed that the CMS requirements do not apply to assisted living settings, licensed-only group homes, or Home and Community-Based Services. MDH has not signaled an intention to create a state-level vaccination requirement.
As we have shared previously, CMS has stated that the rule does not apply to Home and Community-Based services providers, which provides a clear picture of where we stand today. However, we also asked the Minnesota Department of Human Services (DHS) if CMS had communicated anything to state Medicaid agencies about vaccination of employees of Home and Community-Based services providers that might be coming in the future. DHS replied that CMS had not communicated anything to states about potential vaccine requirements for HCBS waiver providers. At this time, they are not aware of anything on the horizon about this.
CMS held a second national stakeholder call regarding the newly-issued rule on Nov. 10. We will provide a link to a recording of this call as soon as CMS posts it, but here are a few clarifying points made by CMS during the question and answer portion:
- How does CMS intend to address surveyor vaccinations? CMS recognizes the importance of ensuring that surveyors are themselves mitigating the risk of COVID-19. CMS will develop additional guidance for federal, state and CMS-contracted surveyors commensurate with the regulatory expectations for healthcare staff in CMS-certified facilities.
- What specific types of accommodations should a facility provide to an unvaccinated staff member with an exemption? CMS encourages providers to review the EEOC website for additional information about situations that may warrant an exemption. CMS is leaving this in the hands of facilities, and that some examples "could include but are not limited to testing, physical distancing, source control, or assigning unvaccinated individuals to non-patient care areas with low risk whenever possible. CMS will allow a facility to develop a plan and process for providing exemptions and accommodations.
- Does the requirement apply to pharmacies that go on-site to a facility? Yes, the vaccination requirement includes individuals that provide care or services to the facility or its residents under contract or other arrangements.
- Are EMS providers subject to the vaccine rule? EMS providers are not directly subject to these requirements. However, some EMS providers may be covered because of their relationship with a CMS-regulated healthcare provider. For example, a hospital may contract with EMS providers, in which case the CMS rule would apply to these staff. Also, an EMS provider may provide non-emergency transport for long-term care facility residents under contract. In that case, EMS staff would be subject to the requirements as applied to long-term care facility staff.
On Nov. 9, LeadingAge CEO Katie Sloan sent a letter to CMS Administrator Chiquita Brooks-LaSure seeking answers to members' questions concerning the Interim Final Rule on vaccinations. Among the questions are:
- whether the rule applies to entire entities or just the CMS certified parts;
- the definition of "additional precautions" for unvaccinated staff;
- timing of contingency plans;
- requirements for new hires after Jan. 4;
- more clarity on medical exemptions;
- how to handle vaccinating staff under the age of 18 whose parents or guardians won't consent;
- types of contractors/services that might be eligible for an exception; and
- clarity on applicability to Medicaid home care services.
At the Capitol: Senate Holds Hearing on Vaccine Mandate and Long-Term Care Workforce Crisis
On November 11, 2021 by Matt Steele
The Senate Human Services Reform Finance and Policy Committee met on Wednesday, Nov. 10 to discuss the recently-released rules surrounding the federal vaccine mandate for long-term care workers and the broader workforce emergency occurring in the long-term care sector.
While providers anticipated the Centers for Medicaid and Medicare Services (CMS) and the Occupational Safety and Health Administration (OSHA) vaccination and testing rules, there are no concrete solutions in place – either at the state or federal levels – to address potential emergency workforce shortages that the mandate may create.
LeadingAge Minnesota's Senior Vice President of Advocacy, Kari Thurlow, made it clear to committee members that the state is ill-prepared to address the workforce consequences from the vaccine mandate. On behalf of senior services providers, she pushed for approval of immediate wage increases for long-term care workers through the spending of federal money, technical fixes in language related to the Payment Protection Program and Provider Relief Fund, and emergency staffing support.
In response, MDH agreed with the seriousness of the workforce crisis and said that they were looking at all possible solutions, including the ability to leverage federal money and implement rate increases, amongst other solutions. In addition, DHS mentioned that a need for legislative approval limits the agency's actions. The agency urged lawmakers to seek bicameral, bipartisan support for policy proposals.
Thanks to Deb Barnes, administrator at Lakeview Methodist, for testifying at the hearing and sharing a clear picture of the impact of the DHS's interpretation of the PPP and PRF offset in nursing home rates.
Senate Human Services Finance and Policy Reform committee members agreed to continue the discussion on solutions with MDH and are eager to find a fix to the workforce emergency as soon as possible. Any immediate solution that is presented will likely require Gov. Walz to call a special session for approval. LeadingAge Minnesota advocacy staff will be closely working with lawmakers and the Walz administration to help get solutions approved by all stakeholders quickly and urge the Governor at that point to hold a special session to pass them into law.
We hope you consider hosting a lawmaker at your site to help them better understand the impact of workforce shortages and see the quality care you provide to the seniors living in your community. Feel free to reach out to Matt Steele, Director of Government Affairs, to get a visit with your lawmaker scheduled soon!
Connect with Students and Interns at the University of Minnesota
On November 11, 2021 by Jenna Kellerman
Looking to recruit staff, build the pipeline, or increase engagement with students? The most effective way to reach University of Minnesota (U of M) students and alumni is through a no-charge job, internship, and volunteer database called Handshake.
This site is intended for career-focused opportunities that align with the majors offered at the university, and it is the easiest way for you to reach U of M students and alumni from all five campuses. By using this registration link, you will connect your organization with Handshake for your recruiting purposes. A training video for recruiting U of M students is also available.
For additional information, reach out to the University of Minnesota Career Services at handshake@umn.edu.
COVID-19
CMS Vaccination Rule Challenged by 10-State Coalition
On November 11, 2021 by Jonathan Lips
The Associated Press has reported that a coalition of 10 states sued the federal government on Nov. 10 to block the CMS COVID-19 vaccine requirement for health care workers. The CMS rule remains in full effect, and the filing of this suit has no impact unless and until the court issues a ruling. We will follow this breaking story closely, but long-term care providers should continue working to implement the CMS vaccine rules.
According to the story, the lawsuit “contends that the vaccine requirement threatens the jobs of millions of health care workers and could ‘exacerbate an alarming shortage’ in health care fields, particularly in rural areas.” CMS declined to comment.
What is the OSHA Emergency Temporary Standard for Healthcare?
On November 11, 2021 by Jonathan Lips
When OSHA’s Nov. 5 COVID-19 Vaccine and Testing Emergency Temporary Standard (the “Vaccine ETS”) indicates that it does not apply to workplaces that are subject to the requirements of a broader COVID-19 Healthcare Emergency Temporary Standard (the “Healthcare ETS”) that OHSA released in June 2021.
The Healthcare ETS applies to workplace settings where any employee provides healthcare services or healthcare support services, including employees in hospitals, nursing homes, assisted living facilities, among others.
As we wrote earlier this week, the Healthcare ETS will expire on Dec. 21, unless OSHA takes action to extend it. But the standard is still in effect now, and we have received member requests for more information about it.
What does the Healthcare ETS require?
OHSA has developed a summary of the Healthcare ETS, which provides a good overview. The standards fall into several different categories:
- Administrative requirements, including the development of a written COVID-19 plan that is based on a workplace hazard assessment and designation of workplace safety coordinator(s);
- Core infection control practices, including patient screening and management, standard and transmission-based precautions, use of personal protective equipment (PPE), and physical distancing;
- Respiratory protection standards;
- Physical environment standards, including cleaning and disinfection, use of physical barriers in some situations where distancing is not possible, and ventilation;
- Health screening and medical management of staff cases and exposures, including screening, notification of exposures, and removing employees with suspected or confirmed cases, or who have had a high-risk exposure; and
- Employment policies, including providing reasonable time and paid leave for vaccinations and vaccine side effects and continuing to pay employees in most circumstances when they are restricted from work due to COVID.
Many of the ETS requirements are closely aligned to the infection prevention, and control standards providers have been implementing throughout the pandemic, based on CDC and MDH guidance. However, there are requirements in the ETS that go beyond those practices and may be new for some providers, such as the employment policies noted above.
Resources
OSHA has posted several tools on its resources page to assist employers in compliance, including a sample plan, a sample workplace risk assessment, an OHSA overview webinar, and more. And LeadingAge has posted a webinar update on the Healthcare ETS to its Learning Hub, which is available at no cost to members of LeadingAge, our national affiliate.
Vaccine FAQs Revisited: Which Vaccine Rules Applies to Your Setting?
On November 11, 2021 by Kari Everson
Alongside our members, LeadingAge Minnesota is working to answer questions regarding both the OSHA and CMS Vaccine and Testing Emergency Temporary Standards. We have shared answers each day as quickly as possible, but we would like to summarize some of the frequently asked questions we are getting from members across the state.
Does OSHA’s Vaccine and Testing Emergency Temporary Standard apply to assisted living settings with 100+ employees? It appears OSHA’s Vaccine & Testing ETS does not apply to those organizations subject to OSHA's Healthcare ETS requirements released in June. Assisted living providers are among the long-list providers subject to the June Healthcare ETS, which expires on Dec. 21. At that time, assisted living employers with 100+ employees may be subject to the Vaccine ETS once the June Healthcare ETS expires. LeadingAge Minnesota is seeking clarification from OSHA, MN OSHA and other agencies on this question and many others. We will continue to communicate updates to members as soon as possible. In the meantime, some organizations may choose to proactively plan for compliance with the Vaccine and Testing ETS in case assisted living settings are subject to it in the future.
Do SNFs have a choice between CMS and OSHA ETS? Nursing homes do not have a choice between the two. It is clear nursing homes must follow the CMS rule and do not have an option to adopt the OSHA ETS instead.
Does the CMS Rule apply to assisted living settings that receive Medicaid waiver payments like Elderly Waiver or CADI? Our understanding is that the CMS rule does not apply to assisted living facilities that accept Elderly Waiver or CADI. This is based on our review of the specific sections of federal regulation that CMS is amending under the rule, and on a CMS FAQ document stating that CMS does not have regulatory authority over assisted living, and that its regulations do not cover providers of Home and Community-Based services that receive Medicaid funding but are not regulated as certified facilities. On its Nov. 10 long-term care COVID-19 call, the Minnesota Department of Health confirmed that the CMS requirements do not apply to assisted living settings, licensed-only group homes, or Home and Community-Based services. MDH has not signaled an intention to create a state-level vaccination requirement. We also asked the Minnesota Department of Human Services (DHS) if CMS had communicated anything to state Medicaid agencies about vaccination of employees of Home and Community-Based services providers that might be coming in the future. DHS replied that CMS has not communicated anything to states about potential vaccine requirements for HCBS waiver providers, and at this time they are not aware of anything on the horizon about this.
Does the CMS Rule apply to assisted living settings attached to a nursing home? At this time, we do not believe an assisted living setting attached to a nursing home will have to abide by the CMS rule where there are clearly delineated staff. However, staff who work in both settings will be subject to the CMS Rule. The LeadingAge national team has asked CMS to confirm how the rule applies when there are multiple service lines, and we will share with members any information we receive. There continues to be some question about whether being in the same space for a minimal amount of time, e.g., punching in by the timeclock, is enough to subject employees of the assisted living to the CMS rule. Currently, we do not believe so; however, we are continuing to reach out for clarification. If this changes, we will get information out to members as quickly as possible. In the meantime, it may be a good idea to consider separating break rooms until we’re able to receive clarification.
Does the CMS or OSHA ETS impact residents or their families? No, these rules have no impact on family visits and do not apply to residents. The vaccine rules apply only to employees and contractors working in our settings. Members should continue to follow visitation, screen, and testing guidance from MDH and CDC.
If you have questions, we invite you to reach out to either Jonathan Lips or Kari Everson, both staff members on the technical assistance team at LeadingAge Minnesota.
Resilience Tip: Avoid Filling the Space
On November 11, 2021 by LeadingAge
Featuring Dr. Alyson VanAhn from Associated Clinic of Psychology
These days, we have better knowledge and skills about managing big problems that seemed unimaginable before COVID. However, many of us are at the point now when even hearing the word "resilience" has become tiresome.
For well over a year, we've experienced fatigue, frustration, sadness and even burnout as we see residents struggle, colleagues leave and new stressors and mandates that seem impossible to manage at the outset. We have little rest, it seems.
So, let’s talk about capturing whatever “space” you have in your life (even if it’s a few seconds) and taking it for what it is: empty space.
The busier we are, the more need we feel to fill this space with tasks or “just one more thing.” Ironically, this can ultimately leave us feeling overloaded rather than relieved.
The hopeful side is that the space is there. Our challenge is to identify it and simply not to fill it with more “stuff.”
How to enjoy small empty moments in your day:
- In your schedule: When there is a moment of downtime (e.g., between meetings, after you arrive at your next destination), see it as time to "rest" and pause before rushing to the next thing.
- In your head: When you notice you are not worrying or solving problems for a minute, try to extend that to a few more minutes before tackling the next task.
- When you wonder how best to use the next ten minutes to "get it all done:" Realize that you can be quite productive if you just leave those ten minutes empty. Resist the urge to multi-task in exchange for the short rest that will propel you to be a better multitasker in a few minutes.
For more information about stress relief during COVID-19, go to www.leadingagemncoaching.com.
You can arrange virtual staff support groups through LeadingAge Minnesota Foundation's COVID-19 Staff Coping & Support Line project at no charge. Contact Terri Foley at tfoley@leadingagemn.org or 651-815-8137.
State News
DHS Delays Transition to Fingerprint-Based Background Studies for MDH-Licensed Providers
On November 11, 2021 by Jonathan Lips
This week, the Minnesota Department of Human Services (DHS) announced that MDH-licensed providers, including home care, assisted living facilities, and nursing homes, will not transition back to fingerprint-based background studies until Jan. 5, 2022. Until the transition occurs, these providers will continue to submit emergency studies, as we have been doing throughout the pandemic.
Other groups, including DHS-licensed providers who have already transitioned to fingerprint-based studies, will continue submitting those studies and not revert to emergency studies.
DHS had planned to transition MDH-licensed providers on Nov. 17 but has delayed the transition to allow additional time for IDEMIA, the new fingerprinting vendor, to open service locations across the state. The vendor must have eighty-three sites open by Jan. 5; as of Nov. 10, seventy-six sites are in place, and three more are expected next week.
The state has also changed the plan for resubmission of emergency studies. Individuals who received emergency studies will also need to have a fully compliant study by July 2, 2022 to continue working. Initially, DHS planned to begin all resubmissions on Dec. 1, but the new plan is to stagger this process by provider type. The target dates are February-March for DHS-licensed providers and April-May for MDH-licensed providers.
The DHS also indicates that this delayed transition provides additional time for providers to explore the purchase of a fingerprinting system for use within their organizations. Based on the available information, this opportunity has been viable only for very large organizations, given that an organization must submit 100 or more studies per month. We are continuing to work with DHS to determine if this option could be made more widely available, knowing that we must eliminate as many barriers to onboarding new staff as possible.
We will continue to follow the transition process and share any updates with members as we receive them.
Bed Rail Safety and Assisted Living Surveys
On November 11, 2021 by Bobbie Guidry
The Minnesota Department of Health (MDH) frequently cites the following in assisted living surveys: “The licensee failed to ensure a side rail was assessed for appropriateness and safety.”
Although bed rail monitoring is not a specific requirement within assisted living licensure or rules, it is cited under the Bill of Rights and the Right to Appropriate Care and Services, 144G.91, Subd. 4. This has been similarly addressed during Home Care surveys for several years.
We recommend that staff are trained to watch for and report to the CNS or LALD if a side rail is observed in a resident's apartment. The nurse can then assess the side rail for safety and advise the resident or their representative related to safety concerns, alternative approaches to meeting the resident's needs, and suggest a therapy evaluation to assist in planning safer practices.
Deaths have occurred related to side rails in Minnesota in recent years. A detailed document on side rails is available for the US Food and Drug Administration (FDA). Staff should utilize the guidance below to assess side rails for safety and attempt alternative approaches to meet the needs if possible. Some side rails are devices that are put on a regular bed and, for example, may slip under the mattress for attachment. These devices may not be stable or may have openings that can also cause entrapment. You should assess any side rail or transfer bar for safety.
Information from FDA Regarding Side Rails:
In 2006, the Food and Drug Administration (FDA) released its recommendations for reducing entrapments. The FDA identified seven “zones of entrapment” and recommended maximum dimensions for four of the zones.
In the diagram, zones 1, 2, and 3 are areas where a person’s head can be caught within the side rail or between the side rail and the mattress. Zone 4 is an area where a person’s neck can be caught between the side rail and the mattress.
The FDA recommends that the dimensions in Zones 1-4 be less than:
- Zone 1: Within the Rail (4.75”)
- Zone 2: Under the Rail, Between the Rail Supports or Next to a Single Rail Support (4.75”)
- Zone 3: Between the Rail and the Mattress (4.75”)
- Zone 4: Under the Rail, at the Ends of the Rail (2 and 3/8” and greater than 60° angle)
The FDA has not established recommended maximum dimensions for Zones 5-7:
- Zone 5: Between Split Bed Rails
- Zone 6: Between the End of the Rail and the Side Edge of the Head or Foot Board
- Zone 7: Between the Head or Foot Board and the Mattress End
Side rails can be very helpful in assisting individuals in transferring out of bed or repositioning in bed. It is essential to recognize that the dangers exist regardless of the purpose of using the side rails. Nursing staff should assess an individual's capabilities for using side rails safely.
In care centers, the facility is responsible for the bed, side rails, and mattress and complying with the FDA recommended dimensional limits. A mattress that does not fit properly against the side rails poses a risk (Zone 3 in the diagram), and loose side rails make the zones more dangerous because they increase the distances.
In assisted living, the property will belong to the resident, but the provider must assess its safety and advise the resident or their representative.
Ending Soon: Nov. 23 Deadline for CMP Grant Application to Retain Staff
On November 11, 2021 by Jenna Kellerman
Care centers have access to an engagement, retention, and leadership building platform for free through a grant for Align’s Employee Engagement Solution. The current grant window closes on Nov. 23. Previous messages indicated that subsequent grant cycles would open over the next two years; however, applications cycles will be limited and will likely end in early 2022. If you plan to apply in future application cycles, please plan accordingly.
This initiative will fully fund:
- A comprehensive employee engagement process, complete with evidence-based retention resources
- Data collection and analysis through surveys across the entire employee life cycle — new hires, current staff and exiting employees — to help you make informed improvement decisions
- Staff and customer communication tools to boost participation, trust and transparency
- Leadership training for managers and supervisors — because employee engagement is highly influenced by the behaviors and actions of your frontline leaders
- Benchmarking on multiple data points compared to participating facilities in Minnesota.
The grant is limited to 150 skilled nursing facilities.
LeadingAge Minnesota and Care Providers of Minnesota collaboratively led this two-year initiative through the civil money penalty (CMP) grants to address employee turnover and its impact on the resident experience and quality of life in Minnesota skilled nursing facilities. Questions can be directed to Jenna Kellerman, Director of Workforce Solutions.
Nurse Loan Forgiveness Program Informational Application Webinar
On November 11, 2021 by Jenna Kellerman
The Minnesota Health Care Loan Forgiveness program cycle is accepting applications through Jan. 17, 2022. The Loan Forgiveness program is available for various health care professionals serving in high-need areas, including nurses in nursing homes, assisted living, and home care settings. Please join the Minnesota Department of Health (MDH) team for a webinar to learn more about this program on Wednesday, Dec. 8 from 9-10 a.m. Register here.
You can find general program information for long-term care on the MDH website.
Previous grants have included repayment for loans, tuition, and reasonable educational or living expenses for past graduate or undergraduate education. Individual applicants must apply (not organizations). Please encourage nurses in your organization to apply.
Contact Elizabeth Fenske, the MDH program administrator, with questions. Members can also contact Jenna Kellerman, LeadingAge Minnesota’s Director of Workforce Solutions.
Federal News
Critical LTC Investment in Moving in Congress
On November 11, 2021 by Jeff Bostic
Congress is currently working on the Build Back Better Act, the second part of President Biden's infrastructure improvement effort. The BBB is a $1.75 trillion proposal to enhance and improve "social" infrastructure, including services to older adults. It is currently being finalized in the House. Then it will head to the Senate and, once both houses agree, to the President. The current version of the bill includes the following investments in programs for older adults-
- $500 million for HUD’s Section 202 Supportive Housing for the Elderly funding program. More Section 202 housing, the bill's Home and Community Based Services and Money Follows the Person investments are vital to keeping low-income older adults from continuing to languish on the growing waiting lists for service-connected, affordable housing.
- $150 billion for Home and Community Based Services Expansion. Older adults want to get help to age in place wherever they call home. This investment will help ensure access to services and bolster wages of the direct care professionals who deliver that care.
- Critical LTC Workforce Investments:
- $150 billion Medicaid HCBS Expansion
- $1.6 billion for Nursing Home Workforce Training Grants.
- $1 billion for grants to support the Direct Care Workforce
- $425 million to expand the Health Profession Opportunity Grants
- $20 million for Technical Assistance Centers for Supporting Direct Care and Caregiving.
- $40 million in Funding to Support Unpaid Caregivers Behavioral Health Needs
- $30 million in funding for Palliative Care and Hospice Education and Training
- $20 million for Hospice and Palliative Nursing
- $350 million for individuals to carry out nontraditional apprenticeship programs
LeadingAge continues to advocate for as much investment in older adult services as possible in the BBB. Members are encouraged to send a message to their Representatives and Senators in support of more funding.
Notable News
Build Three Good Things into Your Workplace
On November 11, 2021 by Julie Apold
Last week we talked about bringing more joy to your workplace by starting your meetings by sharing one good thing. Another simple way to share good things and boost positive emotions in the workplace is to hang posters on the walls around the campus or in the breakroom to record and share good things visually. Get the list started and encourage others to add their own good things.
Happiness is contagious; pass it on!
Visit the Self Care for Safe Care site to find all the resources and tools for bringing Three Good Things to your community in November and December. This is the second of six Self Care for Safe Care activities designed to build our resilience and increase our sense of happiness and well-being.
For more information on Self Care for Safe Care or our other resiliency and mental health support resources, reach out to Jenna Kellerman or Julie Apold.
New Manual Available on Serving Older Adults with Serious Mental Illness
On November 11, 2021 by Bobbie Guidry
The US Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA) has released a free downloadable manual, Psychosocial Interventions for Older Adults with Serious Mental Illness.
The guide provides considerations and strategies for interdisciplinary teams, peer specialists, clinicians, registered nurses, behavioral health organizations, and policymakers in understanding, selecting, and implementing evidence-based interventions that support older adults with serious mental illness.
Member News
Share Your Voice! Join a LeadingAge Minnesota Committee
On November 11, 2021 by Lori Meyer
As we approach the new year, we invite all members to get involved in LeadingAge Minnesota committees in 2022. We are tackling the challenges you face on numerous fronts, and we need you to help shape the critical work ahead.
Pushing for adequate, timely and sustainable funding; reforming the regulatory system to be fair, consistent, and collaborative; guiding ongoing COVID-19 response and recovery; addressing issues in the new assisted living requirements—just a few of the impactful issues facing senior care in the coming year. Through it all, we have a tremendous opportunity to improve the aging experience for those we serve.
Getting involved is easy!
Simply sign up online by clicking here. Our committee rosters are being completely refreshed, so whether you have been involved in committees this year or not, you will need to sign up to participate in 2022.
Not sure where to get involved?
Click here for a description of each committee and the work they will tackle in the coming year.
Thank you for being part of our collective efforts. We are excited to work alongside you as we move forward!
For Veterans and their Caregivers, We Are Thankful
On November 11, 2021 by LeadingAge
On this Veteran’s Day, LeadingAge Minnesota and our members join those throughout our country honoring veterans who have served and sacrificed.
To our members: Thank you to all those who are serving or have served our nation. Our country is built on the foundation of your courage. To those of you who care for our veterans, we are incredibly thankful for you and your work to support those in your care.
If you would like to join us in celebrating those who have served and those who care for them, we invite you to share and like LeadingAge Minnesota on Facebook and Twitter. We also invite you to create your own post with the following images: