June 10, 2020

Featured News

Facts Not Fear: COVID Data Demands Vigilance

On June 10, 2020 by Jonathan Lips

Events of the past week illustrate the power of data to shape the public’s understanding of COVID-19 and how the virus impacts aging services providers and the people you serve.  Unfortunately, these examples are a powerful reminder that inaccurate data or inaccurate reporting can distort that understanding.  

What Happened

Two sets of data on positive cases and deaths in specific settings became available for public review and study became available on June 4 and June 5.

• Federal: CMS publicly released data that nursing homes have reported to the CDC National Healthcare Safety Network (NHSN) for the weeks ending May 24 and 31, including total cases and deaths among residents and staff, access to supplies and testing, and the other required data elements.  As CMS itself explains, this is preliminary data and will be subject to fluctuations as facilities are given the opportunity to submit and correct their data on the NHSN website. CMS cautions that data reported over the first few weeks should not be used to perform trend analysis, but we believe it will provide a useful foundation for national benchmarking once the data stabilizes.
• State: In response to a formal request from Senator Karin Housley, the Minnesota Department of Health (MDH) provided a variety of information on the status of COVID-19 in nursing homes and assisted living, including a list of cases and deaths in settings with more than 10 residents.

Media outlets moved quickly to publish stories based on this data, which we fully support. The steps MDH has taken toward transparency during the COVID crisis are important, and we will continue to support CMS and MDH efforts to gather and share public health data in ways that better inform surveillance, prevention and treatment. Unfortunately, however, inaccuracies have us working overtime to correct the facts and public perception.

Relying on a flawed understanding of the CMS data, the Star Tribune printed an article (Saturday, June 6) entitled “Feds Outline Care Crisis” that featured inaccurate information about COVID-19 cases in Minnesota nursing homes. The Star Tribune grossly exaggerated the number of deaths in 10 nursing homes and even spotlighted a nursing home for having 33 COVID-related deaths when actually no one has died from the virus there.

Meanwhile, following MDH’s release of data to Sen. Housley, MINNPOST reported a summary of the information and posted a link to the data within its story. The problem here was not with the reporting but with the accuracy of the MDH data. Shortly after the data was posted, LeadingAge Minnesota members began finding errors - including sites listed with confirmed positive resident cases where in fact there are none.

We also identified another problem: The cases and deaths in long-term care settings as published by MDH is generally accurate in aggregate. However, detailed review shows that the agency is displaying data for campuses as a single line item – listing them as either skilled nursing or assisted living and not tracking the setting types separately if a campus has both. This treatment of campuses means the breakdown-by-setting of confirmed resident cases and deaths is inaccurate and may cause other problems (i.e., determining qualification for higher EW rates).

Our Response

On the State front, we notified MDH of our concerns about the list and will continue to push the agency to correct and refine the data so it portrays an accurate picture.  In this work, your efforts will be critical. We urge all members to review the list of confirmed resident cases and deaths and determine if there are any errors in what you see.  If yes, please notify Jeff Bostic on our team, and we will relay those to MDH.

Please know that we stepped into immediate action to correct the inaccuracies and misrepresentations caused by the Star Tribune’s egregious reporting on the CMS data.

We immediately contacted the Star Tribune to seek a correction on this story when we saw it posted online. While the story was revised in its online version, it was too late to correct the error for the print edition. The Star Tribune noted the error in a brief correction in the Sunday, June 7 newspaper. While the corrections were needed, the damage was already done. LeadingAge Minnesota and Care Providers of Minnesota also requested a meeting with representatives from the Star Tribune’s editorial team to discuss this error and also the serious double-standard in the newspaper’s coverage of the health care sector’s response to COVID-19 and the consistent misrepresentation of the voice of senior care providers as well as the quality of services provided. The Star Tribune has agreed to meet.

In addition, the Long-Term Care Imperative distributed a letter to lawmakers to notify them of the inaccurate reporting in the Star Tribune in case they were alarmed by the story and provide them with context in case they heard from their constituents.

Two Steps Providers Should Take

If you have/had positive cases in your setting and/or experienced loss of life due to COVID-19, you should prepare to respond to questions or consider sharing this information more broadly before being asked – particularly if you have not previously informed residents and families of positive cases and deaths in your setting. We have prepared some key messages on how to respond to questions and concerns that you may get as well as provided links to three communication toolkits that can help you respond. Once we review the data in more detail, we will update these resources. Download the Messaging Resource.

We also recommend that you review and monitor public-facing data about your setting, including these:

• All care centers and housing/assisted living providers should check the list of confirmed cases MDH provided to Sen. Housley (see link above).
• All care centers and housing/assisted living providers should review the roster of Congregate Care Facilities with Exposures by County that MDH posts to its COVID-19 Situation Update webpage.  This list will grow over time, and it’s possible errors will occur.  As one example, the list should not contain settings with 10 or fewer residents (for data privacy reasons), but we are aware of at least one case where such a setting was identified.
• Care centers should monitor the CMS National Healthcare Safety Network data for accuracy, and remember that this data will be updated weekly.
• Care centers should also monitor the Nursing Home Compare site, and your facility’s individual profile to gain insight into the infection control focused survey data that CMS is spotlighting there (see our separate story in this week’s Advantage newsletter).

Best Practice: Transparency Builds Trust & Cooperation

The best way to counter inaccurate media stories and misperception is through transparency. Please see our COVID-19 Resource Round-up story this week for a best practice that will help you share information directly with residents and families -- and the -- public. 

Please do not hesitate to reach out to us on any of these issues. We are here for you. To support you, to counter false narratives, and to advocate for you and the people you serve.

Nursing Home Survey Results: What You Need to Know and Do

On June 10, 2020 by Jonathan Lips

The Centers for Medicare and Medicaid Services (CMS) is spotlighting COVID-19 survey results on the Nursing Home Compare home page. The results of surveys conducted since March 4 (complaints and infection control focused surveys) will be listed and available for the public to download, including a spreadsheet summarizing the findings from each inspection.  

CMS has always posted state survey reports on Nursing Home Compare, but it’s notable that the agency is specifically drawing the public’s attention to them in this way. The Minnesota Department of Health (MDH) has conducted an onsite infection control focused survey for 100% of our nursing homes, but the information available from CMS is significantly incomplete at this stage, due to a time lag in surveys being entered into ASPEN.

Minnesota’s Infection Control Focus Survey Results

Last week we obtained data from MDH for the Infection Control Focused Surveys and here is a summary of what we’ve learned so far.

• Surveys Conducted: 367
• Cited: 33% of facilities (120) were cited for deficient practice(s), and all of those at F880
• Not cited: 66% were deficiency free.
• Scope & severity of tags issued:
  • Level D: 7%
  • Level E: 17%
  • Level F: 73%
  • Levels G-I: 0%
  • Levels J-L: 3%
• Emergency Preparedness:  MDH also inspected all nursing homes for compliance with Emergency Preparedness requirements, and only 2 facilities received an E-tag.

Our review of the 120 survey findings revealed the issues most commonly cited (number of findings, not number of surveys), with staff screening leading the list:

We are now deep-diving into the findings to identify practice tips and opportunities for improvement, and we will provide a topic-by-topic look at those beginning next week.

State Posts Backlog of Survey Findings

The MDH webpages Search for Minnesota Health Care Provider Complaints and View Facility and Provider Complaint and Survey Findings have been updated with a significant number of complaint survey findings for nursing facilities and all other federally-certified provider types. 

As we understand it, these are findings from the licensing and certification survey team, not the state vulnerable adults act maltreatment determinations, which have consistently been posted. The batch includes both substantiated and unsubstantiated survey findings. For quite some time, MDH has been unable to post these survey findings for technical reasons (we aren’t certain what the issues were).  You, the providers, have been receiving these survey reports along the way, but the public has not been able to access them through the MDH search engines.

The MDH announcement of this action offers these notes:

• What you need to do: Nothing is required of health care providers. This is to inform you of these changes, which will be available to members of the public via MDH’s website.
• How will this affect me? As a health care provider, you are already subject to regular surveys and complaint investigations. With increased numbers of trained complaint investigators, complaints will be investigated quickly and will be communicated to MDH’s surveyors to ensure an efficient, transparent, and accurate inspection process. This will lead to clearer understanding about potential violations and more frequent communication about remedies needed to ensure health care standards are maintained at required levels for the safety and well-being of residents.
• What if I have questions about a complaint?  Email health.fpc-web@state.mn.us or call 651-201-4101.

We have asked MDH for the number of survey reports that have been posted, and covering what period of time, but have not yet heard back.  We recommend that you search one or both of the sites linked above, to gain insight into what information is now posted for your facility, as it’s possible that community members, or media, may be mining this information.

Expedited Feeding Assistant Curriculum is Available!

On June 10, 2020 by Jenna Kellerman

The Minnesota Department of Health recently agreed to waive the 8-hour training requirement for Paid Feeding Assistants, in accordance with a waiver from the Centers for Medicare & Medicaid Services. Our partners at EduCare have released the only MDH approved expedited curriculum in Minnesota, which is a 2.5 hour course with competencies. There is no cost to this program. 

Registration: For EduCare Users

Organizations who are users of EduCare trainings have access to the Paid Feeding Assistant curriculum through their EduCare library. Please contact Jennifer Anderson, President/CEO of EduCare, if you have questions on how to access.

Registration: For non-EduCare Users

Registration coming soon!

Please note that the only component of Paid Feeding Assistant regulation that was waived is the length of training required. Other language, such as the exception language in 144A.62 Subdivision 8 remains. The exceptions to the use of a Paid Feeding Assistant include:

A resident attendant may not be assigned to feed any resident who: is:

1) is at risk of choking while eating or drinking;

2) presents significant behavior management challenges while eating or drinking; or

3) presents other risk factors that may require emergency intervention.

Contact Jenna Kellerman with questions.

State News

Disability Services Providers: Can You Engage in Waiver Reimagine?

On June 10, 2020 by Bobbie Guidry

The Minnesota Department of Human Services (DHS) is considering how best to move forward with previously planned work, including Waiver Reimagine, during COVID-19. DHS is seeking input from disability services providers in their availability to participate in this project.  

Survey

If you are a provider of waiver disability services, complete this short, five-minute survey about your current and anticipated availability. DHS will use the results to plan what happens next with the project. Survey deadline: Thursday, June 18

Waiver Reimagine

The Waiver Reimagine project is designed to:

• Ensure equal access and benefits across disability waiver programs. The programs will be responsive to a person’s needs, circumstances and preferences.
• Align benefits across waiver programs for people with disabilities, including consistent limits and allowable services
• Provide flexible and predictable benefit changes that recognize life changes and an increased use of technology
• Allow simplified administration that make waivers easier to understand for people who receive services, county and tribal administrators and service providers.

Read more on the Waiver Reimagine webpage.

Apply for 5310 Vehicle Grants through MnDOT

On June 10, 2020 by Terri Foley

The 5310-program vehicle grant application process is open for fiscal year 2022 and 2023. Grant awards fund 80% of vehicle purchase cost with the 20% match required from non-Department of Transportation (MnDOT) sources. The program only includes lift-equipped buses.  

A letter of intent is due by June 15. Applications are due August 31.

Questions? Contact Sue Siemers, MnDOT Program Coordinator, at susan.siemers@state.mn.us. Learn More at: MnDOT Transit Grants

Federal News

Medicaid Providers: Apply for Provider Relief Funds, Application Portal Opens Today

On June 10, 2020 by Jeff Bostic

The U.S. Department of Health and Human Services (HHS) announced it will distribute funds to Medicaid providers who do not participate in Medicare, including Assisted Living and Adult Day, through the Provider Relief Fund through a time-limited  application process vs. automatic payment. The application portal opens June 10 (today). Here’s what we know so far: 

Who is eligible?

Providers who:

• did NOT receive a General Distribution payment (these went to Medicare providers who may also provide Medicaid) AND
• participate in Medicaid and/or CHIP programs AND billed Medicaid FFS or Medicaid Managed care between Jan. 1, 2018 and May 31, 2020.

 How will providers get the payment?

Unlike prior Provider Relief Fund distributions, for this distribution, providers must apply by submitting required information through a new enhanced Provider Relief Fund Payment Portal that will go live June 10). HHS has said providers will need to submit annual patient revenue and # of Medicaid patients/beneficiaries served (not sure for what year)

How much will a provider receive?

Providers will be eligible to receive payments of at least 2% of reported gross revenue from patient care. 

How long is the application process?

The portal will remain open for applications until July 3. 

Read more: Provider Relief Fund – Medicaid Distribution.

Notable News

New Basic Care Aide Registration Website

On June 10, 2020 by Jenna Kellerman

LeadingAge National is hosting the Basic Care Aide through its Learning. All non-EduCare users should have new students login through this portal beginning June 15. EduCare users should continue to access the training through their own EduCare library.  

Non-EduCare Users

Beginning on Monday, June 15, please have ALL new Basic Care aide students login here. The course is still free, and the new site allows for immediate course access. Staff Educators/RN Trainers have access to the Course Syllabus and Competency tools through this portal as well. 

For EduCare Users

Any organizations accessing this training through their own EduCare Library should continue to do so. The new registration portal only applies to non-EduCare users. 

Contact Jenna Kellerman with questions.

Member News

COVID-19 Resource Round-Up: Transparency Builds and Cooperation

On June 10, 2020 by Jodi Boyne

If we know one thing to be true during this global pandemic, the media and public will continue to focus on the number of positive COVID-19 cases and deaths related to the virus in long-term care settings. The best way to counter inaccurate media stories and public perception is with consistent transparency of your COVID-19 responsem, including the number of people who have been afflicted by the virus or died from it in your setting.  

Below is a best practice from two LeadingAge MN members – Jones-Harrison and Sholom – who are sharing COVID-19 status in their settings with residents, families, staff and the public by featuring a link from their home page on their website. Sholom also shares this information via a Hotline for those who do not have access to a computer.

• Jones Harrison: Latest COVID-19 Numbers  
• Sholom: Sholom’s COVID-19 Numbers

For support in communicating or deveeloping your own dashboard, see our Communication – Surge of COVID-19 Cases toolkit. We also encourage you to review our COVID-19 Notification Guidance.