• FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    Monday, August 10, 2020 | CMS

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

    16. Are nursing homes required to report results of any COVID-19 tests?

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (7/20)

    Monday, July 20, 2020 | CMS

    New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

    CMS has released a new toolkit (updated 7/15/20) developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

    “The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

    The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

    Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (7/20)

    Wednesday, July 15, 2020 | CDC

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

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  • OIG to Assess Trends Re: the Use of Psychotropic Drugs in Nursing Homes (7/20)

    Wednesday, July 15, 2020 | OIG

    Assessing Trends Related to the Use of Psychotropic Drugs

    Previous OIG work found that elderly nursing home residents who were prescribed antipsychotic drugs—a type of psychotropic drug—were at risk for harm. CMS concurred with some OIG recommendations and developed new initiatives. However, policymakers continue to raise concerns about whether CMS has made sufficient progress in reducing the use of antipsychotic drugs to care for the elderly. We will report the changes over time for the following: (1) the use of psychotropic drugs for elderly nursing home residents; (2) citations and civil monetary penalties assessed to nursing homes regarding psychotropic drugs; and (3) the presence of diagnoses that exclude nursing home residents from CMS's measure of the use of antipsychotic drugs.

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  • CMS Will Increase Use of QIOs to Fight COVID-19 Hot Spots (7/20)

    Monday, July 13, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

    Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

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  • COVID-19 Testing: CDC Says Repeated Point Prevalence Surveys Can ID Asymptomatic Cases in SNFs (7/20)

    Wednesday, July 1, 2020 | CDC

    Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

    Early Release / July 1, 2020 / 69

    Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

    What is added by this report?

    Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

    What are the implications for public health practice?

    Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

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  • CDC Long-term Care COVID-19 Resources Updated (6/20)

    Monday, June 22, 2020 | CDC

    Preparing for COVID-19 in Nursing Homes

    Updated June 25, 2020

    Summary of Changes to the Guidance:

    • Tiered recommendations to address nursing homes in different phases of COVID-19 response
    • Added a recommendation to assign an individual to manage the facility’s infection control program
    • Added guidance about new requirements for nursing homes to report to the National Healthcare Safety Network (NHSN)
    • Added a recommendation to create a plan for testing residents and healthcare personnel for SARS-CoV-2

    Related Pages

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  • Coronavirus Commission for Safety and Quality in Nursing Homes to Focus on Identifying Best Practices, Strengthening Regulations and Enforcement (4/20)

    Thursday, April 30, 2020 | CMS

    On April 30, the Centers for Medicare & Medicaid Services (CMS) announced that an independent Commission will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will be convened and lead by a CMS contractor and will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. 

    The convening of the Commission is the next step in improving quality and safety within nursing homes. The Commission will help inform efforts to safeguard the health and quality of life of vulnerable Americans as CMS continues to battle COVID-19. The Commission will include residents, families, resident/patient advocates, leading industry experts, clinicians, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other experts selected through a nomination process.

    It is expected to convene in May and develop recommendations on three key tasks: 

    • Putting nursing home residents first by ensuring they are protected from COVID-19 and improving the responsiveness of care delivery to meet the needs of all residents to maximize quality of life for residents.

    • Strengthen regulations to enable rapid and effective identification and mitigation of COVID-19 transmission in nursing homes; and 

    • Enhance federal and state enforcement strategies to improve compliance with infection control policies in response to COVID-19. 

    Additionally, the Commission will focus on identifying potentially innovative approaches for using existing and newly available nursing home (and other) data to enable better coordination between federal surveyors and state and local entities to address the current spread of COVID-19 within nursing homes as well as to analyze the impact of efforts to stop or contain the virus within these facilities. 

    Participants will help to identify best practices to address COVID-19, which CMS or states may incorporate into a larger regulatory framework for effective oversight to better inform federal and state officials as well as nursing homes across the country, to better achieve compliance through improved enforcement solutions, and to improve the quality of life and overall health status of nursing home residents during the pandemic. 

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  • AHRQ COVID-19 Articles: Peer Support/Crisis Communications and Helping LTC Settings Deal With the Pandemic (4/20)

    Tuesday, April 28, 2020 | AHRQ

    COVID-19: Peer support and crisis communication strategies to promote institutional resilience.

    Wu AW, Connors C, Everly Jr GS. Ann Intern Med. 2020

    To address the negative psychological impacts faced by healthcare workers during the COVID-19 crisis, the authors of this commentary recommend three strategic principles for healthcare institutions responding to the pandemic:

    ·  Encourage leadership to focus on resilience

    ·  Ensure that crisis communication provides both information and empowerment

    ·  Create a continuum of staff support within the organization to address a surge in mental health concerns among healthcare workers.

     

    Unprecedented solutions for extraordinary times: helping long-term care settings deal with the COVID-19 pandemic.

    Gaur S, Dumyati G, Nace DA, et al.  Infect Control Hosp Epidemiol. 2020

    This commentary discusses the provision of safe care in long-term care settings during the COVID-19 pandemic. The authors propose the following measures to ensure the safety of long-term care patients:

    ·  facilities should only accept patients with COVID-19 infections if they can provide effective airborne isolation;

    ·  patients recovering from COVID-19 need to have 2 negative tests on 2 consecutive days, as well as remain fever-free without mediation for at least 48 hours and not require ventilatory support that generates aerosols;

    ·  facilities should screen potential admissions for typical and atypical signs and symptoms of COVID-19, and;

    ·  facilities that are currently COVID-19 naïve should not accept any new admissions for whom there may be a concern for COVID-19.

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  • COVID-19 Notification/Reporting Requirements Addressed in CMS QSO Memo (4/20)

    Sunday, April 19, 2020 | CMS

    DATE: April 19, 2020

    TO: State Survey Agency Directors

    FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID19 Persons under Investigation) Among Residents and Staff in Nursing Homes

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s health care facilities are prepared to respond to the 2019 Novel Coronavirus (COVID-19) Public Health Emergency (PHE).

    • Communicable Disease Reporting Requirements: To ensure appropriate tracking, response, and mitigation of COVID-19 in nursing homes, CMS is reinforcing an existing requirement that nursing homes must report communicable diseases, healthcare-associated infections, and potential outbreaks to State and Local health departments. In rulemaking that will follow, CMS is requiring facilities to report this data to the Centers for Disease Control and Prevention (CDC) in a standardized format and frequency defined by CMS and CDC. Failure to report cases of residents or staff who have confirmed COVID -19 and Persons under Investigation (PUI) could result in an enforcement action. This memorandum summarizes new requirements which will be put in place very soon.

    • Transparency: CMS will also be previewing a new requirement for facilities to notify residents’ and their representatives to keep them up to date on the conditions inside the facility, such as when new cases of COVID-19 occur.

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