Oct. 23 Webinar, Strategies to Prevent the Spread of COVID-19

The first segment of this presentation will address key important and realistic approaches, consistent with current guidance, that health care workers can implement to mitigate the spread of COVID-19 for long-term care professionals.

The second segment will cover the multiple actions necessary for organizations to consider around PPE from planning, inventory, policies and procedures, types of PPE to use consistent with current guidelines, education, optimization, process surveillance, and follow up.

Friday, October 23, 2020

1:00-2:30 p.m. MT / 3 – 4:30 p.m. ET

Oct. 29 Webinar, COVID-19: Realistic and Quality Approach to Cohorting, Cleaning and Disinfection

The first segment of this presentation will discuss the guidance, planning, education, and prompt action approach to the very important mitigation step of cohorting during the COVID-19 pandemic. The second section will provide key strategies in both cleaning and disinfection to include the process, products, PPE, necessary and education of employees during the COVID-19 pandemic.

Thursday, October 29, 2020

10:30 a.m.-Noon MT / 12:30 p.m. – 2 p.m. ET

The Pharmacy Partnership for Long-Term Care Program provides complete management of the COVID-19 vaccination process. This means LTCF residents and staff across the country will be able to safely and efficiently get vaccinated once vaccines are available and recommended for them, if they have not been previously vaccinated. It will also minimize the burden on LTCF sites and jurisdictional health departments of vaccine handling, administration, and fulfilling reporting requirements.   

“Protecting the vulnerable has been the number one priority of the Trump Administration’s response to COVID-19, and that commitment will continue through distributing a safe and effective vaccine earliest to those who need it most,” said HHS Secretary Alex Azar. “Our unprecedented public-private partnership with CVS and Walgreens will provide convenient and free vaccination to residents of nursing homes across America, another historic achievement in our efforts to get a safe and effective vaccine to Americans as fast as possible.”

“Today’s historic pharmacy partnership will truly help jurisdictions solve a logistical hurdle and decrease the burden of distributing, administering, and reporting COVID-19 vaccination for both states and long-term care facilities,” said Centers for Disease Control and Prevention Director Dr. Robert Redfield. “CDC is proud to be a part of this public-private partnership that is advancing care for the Nation’s most vulnerable.”

“The pandemic has inflicted a devastating toll on America’s nursing home residents,” said Centers for Medicare and Medicaid Services Administrator Seema Verma. “That’s why the Trump Administration has taken unprecedented action to protect them in every possible way.  This effort will ensure they are at the front of the line for the COVID vaccine and will bring their grueling trial to a close as swiftly as possible.”

The program is:

• Free of charge to facilities.
• Available for residents in all long-term care settings, including skilled nursing facilities (SNF), nursing homes, assisted living facilities, residential care homes, and adult family homes.
• Available to all remaining LTCF staff members who have not been previously vaccinated for COVID-19 (e.g., through satellite, temporary, or off-site clinics).
• · Available in most rural areas that may not have an easily accessible pharmacy.

HHS is using multiple authorities to ensure appropriate reimbursement for these services and that no American being vaccinated for COVID-19 will have to pay out-of-pocket.

CVS and Walgreens will schedule and coordinate on-site clinic date(s) directly with each facility. It is anticipated that three total visits over approximately two months are likely to be needed to administer both doses of vaccine (if indicated) to residents and staff.  The pharmacies will also:

• Receive and manage vaccines and associated supplies (e.g., syringes, needles, and personal protective equipment).
• Ensure cold chain management for vaccine.
• Provide on-site administration of vaccine.
• Report required vaccination data (including who was vaccinated, with what vaccine, and where) to the state, local, or territorial, and federal public health authorities within 72 hours of administering each dose.
• Adhere to all applicable Centers for Medicare & Medicaid Services (CMS) requirements for COVID-19 testing for LTCF staff.

“Ensuring access to COVID-19 vaccines, particularly among our most vulnerable populations, will be critical to saving lives and helping our nation recover from the pandemic,” said John Standley, Walgreens president. “Since the onset of the pandemic, Walgreens has worked closely with the CDC, HHS and the Administration to help accelerate the availability of COVID tests, ensure access to essential medicines and products and serve as a safe and trusted source of information in our communities. We are proud of how our pharmacists have continued to serve our patients and look forward to leveraging our nationwide footprint, community presence and pharmacist expertise to help administer COVID-19 vaccines, once they become available.”

“CVS Health has been on the frontlines of the fight against COVID-19, working across the health care spectrum in all the communities we serve and that will continue to be the case when we have a vaccine to dispense,” said Troy Brennan, Chief Medical Officer, CVS Health.

Starting October 19, 2020, LTCFs will be able to opt in and indicate which pharmacy partner their facility prefers to have on-site. LTCFs are not mandated to participate in this program and can request to use their current pharmacy contracts to support COVID-19 vaccination. Nursing homes can sign up via the National Healthcare Safety Network and assisted living facilities can sign up via an online survey they will receive.  An alert has been incorporated into the NHSN LTC COVID-19 module to guide users to the form.

When completing the form, facilities will need to indicate participation in the Pharmacy Partnership for Long-term Care Program and their preferred retail provider (CVS or Walgreens).  If opting to not participate in the program, facilities must indicate their alternate plan for securing vaccine supply and vaccinating residents. 

The form will remain open for two weeks, this decision is not binding and can be changed during these two weeks. Once the forms close, a facility must coordinate directly with the selected pharmacy provider to change any requested vaccination supplies and services.  

Testing Guidelines for Nursing Homes FRIDAY, OCTOBER 16, 2020

Revisions were made on October 16, 2020, to reflect the following:

Updated link to Testing Resources for Nursing Homes one-pager for nursing home personnel with link to Guidance for SARS-CoV-2 Point-of-Care Testing.

CDC’s NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), 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 national healthcare-associated infection goals.

The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response through the COVID-19 Module for LTCFs. 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

Data submitted into the Module pathways enables an assessment of the impact of COVID-19 through facility reported information, including: 1) counts of residents and facility personnel with newly suspected and laboratory positive COVID-19; 2) death counts among residents and facility personnel with suspected and laboratory positive COVID-19; 3) staffing shortages; 4) availability of personal protective equipment (PPE) and supplies; and 5) ventilator capacity and supplies for facilities with ventilator dependent units.

In addition to the reporting pathways, the Point-of-Care (POC) Test Reporting Tool has been added to enable LTCFs to enter POC SARS-CoV-2 test results into the NHSN application.  NHSN will route the POC laboratory test data to the public health agency at the local or state level that has jurisdictional authority and responsibility to receive those data.  Health agencies, in turn, will use the data to fulfill their public health functions, which include reporting to the US Department of Health and Human Services, where the data will be used in the COVID-19 response. Participation in this pathway requires users to have secure access through Secure Access Management Services (SAMS), which includes having a SAMS grid card.

LTCF data submission options include manual entry and/or CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities. Note: CSV file submission is not currently available for the Point-of-Care (POC) Test Reporting Tool.

Memo # QSO-21-02-NH

Posting Date 2020-10-05

Fiscal Year 2021

CMS QSO Memo: Compliance with Residents’ Rights Requirement Related to Nursing Home Residents’ Right to Vote

Summary

• The Centers for Medicare & Medicaid Services (CMS) is affirming the continued right of nursing home residents to exercise their right to vote.

• While the COVID-19 Public Health Emergency has resulted in limitations for visitors to enter the facility to assist residents, nursing homes must still ensure residents are able to exercise their Constitutional right to vote.

• States, localities, and nursing home owners and administrators are encouraged to collaborate to ensure a resident’s right to vote is not impeded.

Press Release Date: September 29, 2020

The Agency for Healthcare Research and Quality (AHRQ) is partnering with the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston to establish a National Nursing Home COVID Action Network. The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff.

Nursing home residents are especially vulnerable to SARS-COV-2 (COVID-19) due to their age, their underlying frailty, and their communal living conditions. And nursing home staff who care for them are among the most needed and most at-risk essential workers. It is estimated that almost 56,000 nursing home residents and staff have died from COVID-19, representing more than one-quarter of the nation’s known COVID-19 deaths.

"Protecting vulnerable older Americans in nursing homes is a central part of our fight against COVID-19, and we’ve learned that improving infection control in many nursing homes is not a matter of will but of skill," said HHS Secretary Alex Azar. "AHRQ is deploying its unique expertise in partnership with Project ECHO and IHI to help nursing homes protect both their residents and staff from the virus, slowing the spread and saving lives."

"Expanding the use of proven safety practices will directly benefit nursing home residents and staff members and help save lives," said AHRQ Director Gopal Khanna, M.B.A. "AHRQ has a proven track record of producing science and research to address critical needs such as responding to COVID-19 and achieving 21st century care for all Americans. We are pleased to be working with the ECHO Institute and IHI on this new initiative."

The new network is being created under an AHRQ contract worth up to $237 million that is part of the nearly $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. While $2.5 billion has already been distributed to help fund testing, personal protective equipment, and other supplies, another $2 billion is available for Medicare and Medicaid-certified nursing homes that show improvement in infection control.

The ECHO Institute is recruiting academic medical centers and large health centers across the country to serve as training centers for local nursing homes. Over 15,000 nursing homes that are certified to participate in the Medicare and Medicaid programs will be able to participate in a 16-week training program using a standardized curriculum developed by the IHI. Nursing homes that actively participate are eligible to receive $6,000 in compensation to cover staff training time.

While the curriculum will continue to be refined as new evidence emerges and the pandemic evolves, topics to be covered in the early weeks include:

• Best Practices in the Use of Personal Protective Equipment for COVID-19.
• Making the Environment Safe during COVID-19 through Infection Control Practices.
• Minimizing the Spread of COVID-19.
• COVID-19 Testing.
• Clinical Management of Asymptomatic and Mild Cases of COVID-19.
• Managing Social Isolation during COVID.

Weekly virtual training sessions will be facilitated by small multidisciplinary teams of subject matter and quality improvement experts. Sessions will combine short lectures that provide immediately usable best practices with case-based group learning. Between sessions, a robust community of practice will foster peer-to-peer learning supported by additional expert consultation.

"Collaborative education and shared learning is critical for our nonprofit nursing home members on the front line of this pandemic, under often challenging conditions," said Katie Smith Sloan, president and CEO of LeadingAge. "Access to mentors, local experts, community peers, and resources, with a focus on continuous improvement, will go a long way to help mitigate the virus’ spread and ensure the health and safety of older adults."

Sanjeev Arora, M.D., Project ECHO’s director and founder, said he looks forward to leading the initiative in partnership with AHRQ. "At a time when the dissemination of best practices in health care is more critical than ever, we are honored to help address this urgent need for nursing homes," he said.

Project ECHO (Extension for Community Healthcare Outcomes) was established to provide training and telementoring for health care professionals and staff across the nation and around the world. It includes over 250 training partners across the United States. AHRQ funded the initial establishment and evaluation of Project ECHO beginning in 2004. The new network’s training program will use the evidence-based process pioneered by Project ECHO and referred to as the ECHO Model, which is an interactive, case-based approach based on adult learning principles.

"The ECHO model is a proven approach that brings experts and providers together to learn and solve clinical and operational challenges," said Mark Parkinson, President and CEO for the American Health Care Association/National Center for Assisted Living. "We strongly encourage providers to participate in the COVID Action Network to get access to experts and learn the latest best practices to prevent the spread of COVID-19."

Note: The updated methodology is inside the updated spreadsheet for weekly county positivity rates: Rates of county positivity are posted here. 

The Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence. Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.” This information is critical to nursing homes, which are required to test their staff for COVID-19 at a frequency based on the positivity rate of their respective counties.

Under guidance CMS issued on August 26, 2020, nursing homes must test staff at a frequency of once monthly if the facility’s county positivity rate is less than five percent. Staff testing frequency increases to once weekly if the county positivity rate is between five and 10 percent. Finally, testing frequency increases to twice weekly if the county positivity rate exceeds 10 percent.

CMS heard concerns from some governors of rural states that the frequency guidelines did not work well for some rural areas. They were concerned that some rural counties had seemingly high comparative positivity rates as a result of low amounts of testing, rather than actual positivity in the community. This resulted in a significant burden for nursing homes being required to conduct staff testing at a higher frequency than necessary. In response to these concerns, the Trump Administration acted swiftly and decisively, and implemented the change to the positivity rate calculation in order to accommodate rural counties.  The new, resulting methodology reduces burden while still requiring facilities to conduct testing to at a frequency that can detect COVID-19 early to keep nursing home residents safe.

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CMS QSO Memo: Guidance related to the Emergency Preparedness Testing Exercise Requirements- Coronavirus Disease 2019 (COVID-19)

Memo # QSO-20-41-ALL

Posting Date 2020-09-28

Fiscal Year 2020

Summary

• Emergency Preparedness Testing Exemption and Guidance - CMS regulations for Emergency Preparedness require specific testing exercises be conducted to validate the facility’s emergency program. During or after an actual emergency, the regulations allow for an exemption to the testing requirements based on real world actions taken by providers and suppliers.

• This worksheet presents guidance for surveyors, as well as providers and suppliers, with relevant scenarios on meeting the testing requirements in light of many of the response activities associated with the COVID-19 Public Health Emergency (PHE).