• Recommendations for State and Local Officials: CMS is providing recommendations to help determine the level of mitigation needed to prevent the transmission of COVID19 in nursing homes. The recommendations cover the following items:

o Criteria for relaxing certain restrictions and mitigating the risk of resurgence: Factors to inform decisions for relaxing nursing home restrictions through a phased approach.

o Visitation and Service Considerations: Considerations allowing visitation and services in each phase.

o Restoration of Survey Activities: Recommendations for restarting certain surveys in each phase.

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. 

The Occupational Safety and Health Administration (OSHA) is committed to protecting the health and safety of America’s workers and workplaces during these unprecedented times. The agency will be issuing a series of alerts designed to keep workers safe. In a nursing home or long-term care facility, the following tips can help reduce the risk of exposure to the coronavirus.

Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes

Summary of Changes to the Guidance:

Updated guidance to recommend that nursing homes:

• Act now to implement ALL COVID-19 preparedness recommendations, even before cases are identified in their community
• Address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.
• Dedicate an area of the facility to care for residents with suspected or confirmed COVID-19; consider creating a staffing plan for that specific location

COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings

Nursing homes and other long-term care facilities can take steps to assess and improve their preparedness for responding to coronavirus disease 2019 (COVID-19). This checklist should be used as one tool to develop a comprehensive COVID-19 response plan, including plans for:

• Rapid identification and management of ill residents
• Considerations for visitors
• Supplies and resources
• Sick leave policies and other occupational health considerations
• Education and training
• Surge capacity for staffing, equipment and supplies, and postmortem care

The checklist identifies key areas that long-term care facilities should consider in their COVID-19 planning. Long-term care facilities can use this tool to self-assess the strengths and weaknesses of current preparedness efforts. This checklist does not describe mandatory requirements or standards; rather, it highlights important areas to review to prepare for the possibility of residents with COVID-19.

Additional pages: 

• Considerations for Memory Care Units in Long-term Care Facilities
• Key Strategies for Long-term Care Facilities
• Responding to Coronavirus (COVID-19) in Nursing Homes
• Testing for Coronavirus (COVID-19) in Nursing Homes
• Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19

CDC’s NHSN provides healthcare facilities, such as long term care facilities (LTCF) with a customized system to track infections and prevention process measures in a systematic way.

Tracking this information allows facilities to identify problems, improve care, and determine progress toward facility and national healthcare-associated infection goals.

The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response by introducing a new COVID-19 Module for Long Term Care Facilities. Facilities eligible to report into the COVID-19 Module include nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities.

The COVID-19 Module for LTCFs consists of four pathways within NHSN’s Long-term Care Facility Component:

• Resident Impact and Facility Capacity
• Staff and Personnel Impact
• Supplies and Personal Protective Equipment
• Ventilator Capacity and Supplies

The Module enables an assessment of the impact of COVID-19 in LTCFs through facility reported information, including: 1) counts of residents and facility personnel with suspected and laboratory positive COVID-19; 2) counts of suspected and laboratory positive COVID-19 related deaths among residents and facility personnel; 3) staffing shortages; 3) status of personal protective equipment (PPE) supplies; and 4) ventilator capacity and supplies for facilities with ventilator dependent units.  The Module does not collect staff or resident-level information.

Participation in the COVID-19 Module for LTCFs requires facilities to be actively enrolled in NHSN. LTCFs that are currently enrolled in NHSN’s LTCF Component have immediate access to the new module and may begin reporting. If your facility previously enrolled, but is no longer able to gain access, contact NHSN user support at nhsn@cdc.gov for assistance. Please do not re-enroll a previously enrolled facility.

LTCFs that are not enrolled in NHSN may gain access to the COVID-19 Module by completing the enrollment process outlined in the Enrollment section of this page. Upon completion, the facility will gain same-day access to NHSN.

While daily reporting will provide the timeliest data for response purposes, retrospective reporting of prior day(s) is encouraged if daily reporting is not feasible. LTCF data submission options include manual entry, CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities.  NHSN, in turn, will enable state and local health departments and the Centers for Medicare and Medicaid Services (CMS) to gain immediate access to the COVID-19 data for LTCFs in their jurisdictions. COVID-19 data submitted to NHSN also will be used by CDC’s emergency COVID-19 response and by the U.S. Department of Health and Human Services’ (HHS’) COVID-19 tracking system maintained in the Office of the Assistant Secretary of Preparedness and Response.

Title Fiscal Year 2020 CARES Act Information

Memo # 20-07-ALL

Posting Date 2020-04-30

Fiscal Year 2020

Summary

•CARES Act Funding: Congress appropriated no less than $100 million in supplemental funds to offset the costs associated with COVID-19 survey activities. This memorandum provides guidance to State Survey Agencies and Centers for Medicare & Medicaid Services (CMS) personnel in requesting, executing and reporting the supplemental funding.

•Medicare Budget, Execution and Reporting: Per DHHS guidance, COVID-19 funding and expenditures must be tracked, executed and reported separately. CMS intends to implement these functions in a manner similar to existing IMPACT Act hospice funding. Cost sharing will continue according to existing State practice.

•Medicaid Budget, Execution and Reporting: COVID-19 expenditures will be tracked and reported separately; however, funding will continue to be provided via traditional means in accordance with Medicaid rules. Cost sharing will continue according to existing State practice.

Note that the COVID-19 reporting and SNF QRP reporting changes both will go into effect on May 8 since the effective date is the publication date.

Medicare and Medicaid Programs, Basic Health Program, and Exchanges: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program

ACTION: Interim final rule with comment period.

Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

SNF QRP

We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

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.

Emerging Infectious Diseases

Volume 26, Number 5—May 2020

Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand

Abstract

A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.

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.