Risk Management

In a SNF, there are a lot of moving pieces, a lot to manage, and a lot can go wrong. Mitigating the risk of adverse events is a daily task. From care systems review and root cause analysis to anticipatory management, the resources below are designed to help you do just that. Protect your staff and residents now before you have to pick up the pieces after the fact. 

  • CDC Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (11/20)

    By CDC - November 23, 2020

    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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  • Residents With Acute Respiratory Symptoms? CDC Testing and Management Considerations When SARS-COV-2 and Influenza Co-Circulate (11/20)

    By CDC - November 23, 2020
    This document contains practices that should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities.
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  • CMS Podcast: Nursing Home Series for Front Line Clinicians and Staff (11/20)

    By CMS - November 19, 2020

    The Centers for Medicare & Medicaid Services (CMS) is releasing the first episode in a series of short podcasts for frontline nursing home staff “CMS Beyond the Policy”.

    This edition is titled “Nursing Home Series for Front Line Clinicians and Staff.” Dr. Shari Ling, Deputy Chief Medical Office for The Centers for Medicare and Medicaid Services and geriatrician is joined by David Wright, Director of the Quality Safety & Oversight Group to discuss training and infection control practices in nursing homes to help combat the spread of coronavirus disease 2019 (COVID-19).

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  • CMS Urgent Call to Action: Staff, Managers Should Complete QSEP Nursing Home COVID-19 Training (11/20)

    By CMS - November 17, 2020

    Agency thanks nursing homes whose staff have completed free CMS training, but urges remaining homes to take advantage of this resource

    The Centers for Medicare & Medicaid Services (CMS) is publicly recognizing the 1,092 nursing homes at which 50% or more of their staff have completed CMS training designed to help staff combat the spread of coronavirus disease 2019 (COVID-19) in nursing homes. CMS applauds these facilities for taking this critical step to equip their staff with the latest information regarding infection control, vaccine distribution, and other topics.

    There are 125,506 individuals from 7,313 nursing homes who have completed the training. This represents approximately 12.5% of the approximately one million nursing home staff in the country. With today’s announcement, CMS is calling on nursing homes to take action, urging them to require their staff to take this free training, as part of the Trump Administration’s continued efforts to keep nursing home residents safe.

    “We’ve provided nursing homes with $20 billion in federal funding, millions of pieces of PPE, free testing machines and supplies, and significant technical assistance and on-the-ground support,” said CMS Administrator Seema Verma. “Ultimately, the ownership and management of every nursing must take it on themselves to ensure their staff is fully equipped to keep residents safe. With coronavirus cases increasing across the country and infection control identified as a major issue, we encourage all nursing homes to take advantage of this no-cost opportunity to train their staff.”

    The training includes multiple modules, with emphases on topics such as infection control, screening and surveillance, personal protective equipment (PPE) usage, disinfection of the nursing home, cohorting and caring for individuals with dementia during a pandemic. CMS developed this training in consultation with the Centers for Disease Control and Prevention (CDC) and expert stakeholders, and announced the training on August 25, 2020. For anyone interested, the training is free to access on a public CMS website; instructions on how to create an account and take the training are available at qsep.cms.gov/welcome.aspx.

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  • CMS Alert Addressing Holiday Celebrations (11/20)

    By CMS - November 17, 2020

    In advance of the approaching holiday season, the Centers for Medicare & Medicaid Services (CMS) is urging nursing home staff, residents and visitors to follow established guidelines for visitation and adherence to the core principles of infection prevention. These guidelines include remaining six feet apart from individuals, wearing a face covering, and limiting the number of visitors in the nursing home at any one time. Adherence to these principles is critical in preventing the spread of the coronavirus disease 2019 (COVID-19) in America’s nursing homes. While the holiday season is typically a time for family and friends to gather, CMS implores staff, residents and visitors to exercise extreme caution this year. 

    “The approaching holiday season remains fraught with danger for the vulnerable residents of America’s nursing homes,” said Administrator Seema Verma. “They have already endured loss and loneliness to a degree that would have been unthinkable before this year began, but they and their families – along with facilities themselves – must not let their guard down over the holiday season, especially with a safe and effective vaccine so close to reality.”

    The agency understands the emotional and mental health impact that separation from loved ones during the pandemic has caused. In September, CMS provided guidance for how residents can safely receive visitors in the nursing home. With the holiday season approaching, residents will want to spend more time with their loved ones, and CMS is recommending that facilities find innovative ways of recognizing the holidays without having parties or gatherings that could increase the risk of COVID-19 transmission (e.g., virtual parties or visits).

    CMS also acknowledges that some residents may want to leave the nursing home temporarily to visit with family and friends for the holidays, or for other outings.  A resident has the right to leave the nursing home, and CMS urges that extra precautions be taken to help reduce the spread of COVID-19, which poses an elevated danger to the health of nursing home residents.  Nursing homes should double down on infection control and adhere to testing requirements.

    Extra precautions taken now will help to ensure that our loved ones stay healthy and safe for the short amount of time remaining until a safe and effective vaccine becomes available.  Leaving the nursing home could increase a resident’s risk for exposure to COVID-19. The risk may be further increased by factors such as a resident’s health status, the level of COVID-19 in the community (e.g., cases or positivity rate), or attendance at large gatherings. Residents are encouraged to discuss these and other risks with their family and nursing home staff.  Nursing homes should educate residents and families of the risks of leaving the facility, the steps they should take to reduce the risk of contracting COVID-19, and encourage residents can stay connected with loved ones through alternative means of communication, such as phone and video communication. 

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  • Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes (10/20)

    By CDC - November 17, 2020
    This document provides a summary of considerations for use of SARS-CoV-2 (the virus that causes COVID-19) antigen testing in nursing homes and is intended for nursing home providers and state and local public health departments.

    Also see: Guidance for SARS-CoV-2 Point-of-Care Testing

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  • CDC Long-term Care COVID-19 Resources Updated (11/20)

    By CDC - November 15, 2020

    Preparing for COVID-19 in Nursing Homes

    Updated Nov. 20, 2020

    New Resources: 

    CMS Alert Addressing Holiday Celebrations

    pdf

    Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating

    Read the complete guidance here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html


    Related Documents and Resources

    • Considerations for the Public Health Response to COVID-19 in Nursing Homes
    • Interim Testing in Response to Suspected or Confirmed COVID-19 in Nursing Home Residents and Healthcare Personnel
    • Considerations for Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes
    • Considerations for Memory Care Units in Long-Term Care Facilities
    • Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19
    • CDC Strategy for COVID-19 Testing Nursing Homes.
    • Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)
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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (11/20)

    By CMS - November 15, 2020

    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 11/22/20) 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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  • Vaccinate Your Staff: CDC LTC Toolkit for Staff Influenza (Flu) Vaccination (11/20)

    By CDC - November 14, 2020
    Post-acute and Long-term Care Facility Toolkit: Influenza Vaccination among Healthcare Personnel: Increasing Influenza Vaccination among Health Care Personnel in Long-term Care Settings

     

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  • OSHA COVID-19 Citations: Lessons Learned (11/20)

    By OSHA - November 13, 2020

    The Occupational Safety and Health Administration cites lessons learned from its COVID-19 inspections and citations, as well as noting nursing homes and other companies that have been fined since the COVID-19 pandemic began.

     Lessons Learned: Frequently Cited Standards Related to COVID-19 Inspections.(November 6, 2020).

    Common COVID-19 Citations: Helping Employers Better Protect Workers and Comply with OSHA Regulations. (November 6, 2020).

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  • CDC Study Shows How Community Transmission Can Impact Nursing Homes Miles Away (11/20)

    By CDC - November 10, 2020

    Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine — August 7–September 14, 2020

    Weekly / November 13, 2020 / 69(45);1686–1690

    Parag Mahale, MBBS, PhD1,2; Craig Rothfuss, MPA, MPH1,3; Sarah Bly1,3; Megan Kelley1,3; Siiri Bennett, MD1; Sara L. Huston, PhD1,3; Sara Robinson, MPH1 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Large gatherings pose a high risk for SARS-CoV-2 transmission.

    What is added by this report?

    A wedding reception with 55 persons in a rural Maine town led to COVID-19 outbreaks in the local community, as well as at a long-term care facility and a correctional facility in other counties. Overall, 177 COVID-19 cases were linked to the event, including seven hospitalizations and seven deaths (four in hospitalized persons). Investigation revealed noncompliance with CDC’s recommended mitigation measures.

    What are the implications for public health practice?

    To mitigate transmission, persons should avoid large gatherings, practice physical distancing, wear masks, stay home when ill, and self-quarantine after exposure to a person with confirmed SARS-CoV-2 infection.

     

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  • OSHA Respiratory Protection Guidance for Nursing Homes (11/20)

    By Occupational Safety and Health Administration - November 03, 2020

    Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and Other Long-Term Care Facilities During the COVID-19 Pandemic

    This guidance is designed specifically for nursing homes, assisted living, and other long-term care facilities (LTCFs) (e.g., skilled nursing facilities, inpatient hospice, convalescent homes, and group homes with nursing care). While this guidance focuses on protecting workers from occupational exposure to SARS-CoV-2 (the virus that causes COVID-19 disease) by the use of respirators, primary reliance on engineering and administrative controls for controlling exposure is consistent with good industrial hygiene practice and with OSHA’s traditional adherence to a “hierarchy of controls.”

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  • Cybersecurity Alert: Ransomware Activity Targeting the Healthcare and Public Health Sector (10/20)

    By ASPR TRACIE - October 30, 2020
    The U.S. Department of Health and Human Services (HHS), the Cybersecurity and Infrastructure Security Agency (CISA), and the Federal Bureau of Investigation (FBI) have developed a cybersecurity alert related to an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers: "Alert (AA20-302A) Ransomware Activity Targeting the Healthcare and Public Health Sector." This advisory describes the tactics, techniques, and procedures (TTPs) used by cybercriminals against targets in the Healthcare and Public Health Sector (HPH) to infect systems with Ryuk ransomware for financial gain. CISA, FBI, and HHS are sharing this information to provide warning to healthcare providers to ensure that they take timely and reasonable precautions to protect their networks from these threats.
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  • SNF QRP October Refresh 2020: Six New Measures Publicly Reported (10/20)

    By CMS - October 29, 2020

    The October 2020 refresh of SNF QRP data is now available on Nursing Home Compare (NHC), as well as the Nursing homes including rehab services web pages within Care Compare (CCXP) and Provider Data Catalog (PDC).

    The data are based on quality assessment data submitted by SNFs to CMS from Quarter 1 2019 through Quarter 4 2019 (01/01/2019 –12/31/2019); and the annual update of the claims-based measures data from Quarter 4 2017 – Quarter 3 2019 (10/01/2017 – 9/30/2019).

    Starting in October 2020, six additional SNF QRP measures will be publicly reported on NHC, CCXP and PDC:

    ·  Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury,

    ·  Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC SNF QRP,

    ·  Application of IRF Functional Outcome Measure: Change in Self-Care (NQF #2633),

    ·  Application of IRF Functional Outcome Measure: Change in Mobility (NQF #2634),

    ·  Application of IRF Functional Outcome Measure: Discharge Self-Care Score (NQF #2635), and

    ·  Application of IRF Functional Outcome Measure: Discharge Mobility Score (NQF #2636).


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  • SARS-CoV-2 Exposure and Infection Among Health Care Personnel: LTC Staff More Likely to Work With Symptoms (10/20)

    By CDC - October 28, 2020

    SARS-CoV-2 Exposure and Infection Among Health Care Personnel — Minnesota, March 6–July 11, 2020

    Weekly / October 30, 2020 / 69(43);1605–1610

    Summary

    What is already known about this topic?

    Health care personnel (HCP) are at increased risk for COVID-19 from workplace exposures.

    What is added by this report?

    Among 21,406 Minnesota SARS-CoV-2 HCP exposures, 5,374 (25%) were higher-risk (within 6 feet, ≥15 minutes, or during an aerosol-generating procedure); exposures involved patient care (66%) and nonpatient contacts (34%). Compared with HCP working in acute care settings, those working in congregate living and long-term care more often worked while symptomatic and received positive SARS-CoV-2 test results.

    What are the implications for public health practice?

    HCP should recognize potential exposures unrelated to patient care and use prevention measures, including masks. HCP in congregate living and long-term care settings experience considerable risk and pose a transmission risk to residents. Improved access to personal protective equipment, flexible medical leave, and testing is needed.

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