Welcome Nursing Facility Providers! COVID-19 Updates and Q&A with LTCR and DSHS

Handouts at End

    Welcome Nursing Facility Providers!

  COVID-19 Updates and Q&A with LTCR
              and DSHS
                           March 17, 2021

                            For more information:
Web: https://hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-
                        covid-19-provider-information
                      Email: LTCRPolicy@hhs.texas.gov
                             Phone: 512-438-3161

COVID-19 Q&A
Panelist
Catherine Anglin
Program Manager: NF and LSC
Policy & Rules
Long-term Care Regulation
      ____________________________

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Reminder: Requesting
BinaxNOW Cards
Qualifying NFs are encouraged to request
free BinaxNOW antigen tests for testing
essential caregivers.

To request free BinaxNOW tests, NFs must:
• Be in a county with a COVID-19
  positivity rate of greater than 10%
• Be in a rural area where there are
  limited free test sites available
• Sign an attestation to only use tests for
  testing essential caregivers and adhere
  to all other applicable requirements.
See PL 2020-49 for additional information.
                                              3

COVID-19 Q&A
Panelist
David Gruber
Associate Commissioner for Regional and
Local Health Operations
DSHS

                                          4

CNA Virtual Symposium
NFs are encouraged to register for this free,
full-day symposium for CNAs. There are
separate sessions for nurses, administrators
and other long-term care leaders.

Topics include:
• caring for residents with responsive
  behaviors
• self-care in difficult circumstances
• person-centered care
• infection control
• empowerment and leadership
• preventing abuse neglect and exploitation
                                                5

CNA Virtual Symposium

April 8, 2021 | 8:30 a.m. – 6 p.m.
View the agenda and register here.

Registration is limited for the live event. All
sessions will be recorded and made available
later. See the CNA Strong flyer here.

                                              6

CNA Workforce Survey

HHSC is asking nursing facilities to
complete a short survey about their
Certified Nurse Aide workforce. Please
complete the survey by March 25, 2021.

HHSC will use this information to
understand CNA workforce needs
throughout the state and inform potential
future initiatives.
Take the survey here.

                                            7

Updated CMS Visitation
Guidance
CMS published updated QSO 20-39-NH on
March 10th.

HHSC is currently assessing the updated
CMS and CDC guidance regarding visitation
and is working to update visitation rules.

The current visitation rules remain in place
at this time, and HHSC will provide
updates as soon as possible.

Updates to the visitation rules, and
supplemental guidance documents, will be
provided via GovDelivery alerts as soon as
they are available.
                                             8

Resident Stimulus
Payments
If a resident receives money from the
recent Economic Impact stimulus payment,
that money can be used, gifted, or donated
the same way as any other money the
resident receives.

The following IRS webpages includes
helpful information related to Economic
Impact stimulus payments:
IRS Dec. 29th News Release
IRS June 16th News Release

                                          9

COVID-19 Q&A
Panelist
Christine Riley
Nurse III/Clinical Policy Specialist
Policy & Rules
Long-term Care Regulation
              ____________________________

Updated Quarantine Guidance

                                             10

Updated Quarantine
Guidance
The CDC has published updated quarantine
guidance for vaccinated individuals in
nursing facilities.

For healthcare settings, including LTCFs,
HHSC is sharing the following guidance
from the CDC: Infection Control after
Vaccination

                                            11

Updated Quarantine
Guidance
The following recommendations are based
on what is known about currently available
COVID-19 vaccines.
These recommendations will be updated as
additional information, including regarding
the ability of currently authorized vaccines
to protect against infection with novel
variants and the effectiveness of additional
authorized vaccines, becomes available.
This could result in additional
circumstances when work restrictions for
fully vaccinated HCP are recommended.

                                           12

Updated Quarantine
Guidance
Fully vaccinated refers to a person who
is:
• At least 2 weeks following receipt of the
  second dose in a 2-dose series, or
• at least 2 weeks following receipt of one
  dose of a single-dose vaccine

For asymptomatic staff:
Fully vaccinated staff with higher-risk
exposures who are asymptomatic do not
need to be restricted from work for 14
days following their exposure.
(Cont. on next slide)
                                          13

Updated Quarantine
Guidance
For asymptomatic staff (cont.):
Work restrictions for fully vaccinated staff
with higher-risk exposures should still be
considered for:
• Staff who have underlying
  immunocompromising conditions (e.g.,
  organ transplantation, cancer treatment)
  • These conditions might impact level of
    protection provided by the COVID-19
    vaccine. However, data on which
    immunocompromising conditions
    might affect response to the COVID-
    19 vaccine and the magnitude of risk
    are not available.
(Cont. on next slide)
                                               14

Updated Quarantine
Guidance
For asymptomatic staff (cont.):
Work restrictions for fully vaccinated staff
with higher-risk exposures should still be
considered for:
• Staff who have traveled should continue
  to follow CDC travel recommendations
  and requirements, including restriction
  from work, when recommended for any
  traveler.

                                               15

Updated Quarantine
Guidance
For asymptomatic residents:
Quarantine is no longer recommended for
residents who are being admitted to a
nursing facility if they are fully vaccinated and
have not had prolonged close contact with
someone with COVID-19 infection in the prior
14 days.

This includes new admissions, readmissions,
and a resident who was gone overnight – as
long as the resident did not have prolonged
close contact with someone with a COVID-19
infection. These residents may be admitted
into or return to the COVID-19 negative cohort
(cold zone).                                16

Updated Quarantine
Guidance
For asymptomatic residents:
Fully vaccinated residents should continue
to quarantine following prolonged close
contact with someone with COVID-19
infection.
   Close contact = within 6 feet for a
   cumulative total of 15 minutes or more
   over a 24-hour period
These individuals should be cared for using
recommended Transmission-Based
Precautions. This is due to limited
information about vaccine effectiveness in
this population, the higher risk of severe
disease and death, and challenges with
physical distancing in healthcare settings.
                                         17

Updated Quarantine
Guidance
For asymptomatic residents (cont.):
Although not preferred, NFs could consider
waiving quarantine for fully vaccinated
residents following prolonged close contact
with someone with COVID-19 infection as
a strategy to address critical issues (e.g.,
lack of space, staff, or PPE to safely care
for exposed patients or residents) when
other options are unsuccessful or
unavailable.

These decisions could be made in
consultation with public health officials and
infection control experts.

                                           18

Updated Quarantine
Guidance
Fully vaccinated people who do not
quarantine should still watch for symptoms
of COVID-19 for 14 days following an
exposure.
If they experience symptoms, they should be
clinically evaluated for COVID-19, including
testing for COVID-19, if indicated.
As of now, the CDC has not set a time limit
regarding how long those who have been
fully vaccinated may be exempt from
quarantine. Testing for COVID-19 should
continue per facility protocol and CMS
requirements, including for those who are
fully vaccinated.

                                              19

Updated Quarantine
Guidance
COVID-19 Testing:
Recommendations for COVID-19 testing for
Staff and residents remain unchanged.

Use of Personal Protective Equipment
(PPE):
Recommendations for the use of PPE by
Staff remain unchanged.

                                        20

PPE for NF Staff
PPE requirements for staff are defined by the COVID-
19 Response Rule and fall into two categories:

     Facemasks                   Full PPE

                                N95

                                               21

PPE for NF Staff
Full PPE consists of:         Full PPE
• N95 respirator (or
  equivalent)
• Gloves
• Gown
• Goggles or face shield

Full PPE is required when:
• Providing care to a
  resident with COVID-19
  positive status            N95
• Providing care to a
  resident with unknown
  COVID-19 status
                                         22

PPE for NF Staff
                   Facemasks are required
   Facemasks       for staff at all times while
                   in the facility (other than
                   times that require full
                   PPE).

                   Facemasks must cover
                   nose and mouth.

                                          23

PPE for NF Staff
The PPE requirements for staff established in
the COVID-19 Response Rule is the same
for all staff in all situations.
PPE requirements do not change for any staff
member, regardless of vaccination status, the
presence of COVID-19 in the facility, or the
county positivity rate.
PPE requirements are based on the COVID-19
status of the resident the staff member is
caring for. If the employee does not have
direct care duties for residents, the staff
member must at least wear a facemask.

                                           24

PPE for NF Staff
Per the COVID-19 Response Rule facilities
must have at least a two week supply of
the following at all times:
• Facemasks
• N95 respirators (or equivalent)
• Gloves
• Gowns
• Face shields or goggles

                                            25

COVID-19 Q&A
Panelist
Michelle Dionne-Vahalik, DNP, RN
Associate Commissioner
Long-term Care Regulation

                                   26

COVID-19 Q&A
Panelist
Renee Blanch-Haley, BSN, RN
Director of Survey Operations
Long-term Care Regulation

                                27

State Long-Term Care
Ombudsman Program
Statewide phone: 800-252-2412
• Statewide email:
ltc.ombudsman@hhs.texas.gov

State Ombudsman: Patty Ducayet,
737-704-9075 (or)
patty.ducayet@hhs.Texas.gov

Weekly Facebook Live Q&A for Families of LTC
Residents: Every Wednesday, 12:15 to 12:45
https://www.facebook.com/texasltcombudsman?f
ref-ts

                                         28

State Long-Term Care
Ombudsman Program
Ombudsman updates and reminders:
• ombudsman visits to your facility
• stimulus money and Medicaid
  determinations

                                      29

COVID-19 Q&A
Panelist
Melody Malone, PT, CPHQ, MHA, CDP,
CADDCT
TeamSTEPPS® Master Trainer
INTERACT® Certified Champion
Healthcare Quality Improvement Specialist
TMF Health Quality Institute

                                            30

NHSN Updates: Point of
Care Test Reporting Tool
Visitors are now captured in the testing
module via 3 drop down options to choose
whether the testee is:
1. A resident of the facility,
2. A staff/volunteer/contractor at the facility
   or,
3. A visitor to the facility.
Links:
1. Point of Care Test Reporting Tool
   Presentation Slides – February, 2021
2. Point of Care Test Reporting Tool –
   February 4, 2021
3. Point of Care Test Reporting Tool Table of
   Instructions – February 4, 2021            31

NHSN RESOURCES
1. TMF resources here: NHSN Resources
2. CDC NHSN FAQ:
   https://www.cdc.gov/nhsn/pdfs/ltc/ltcf-faqs-
   508.pdf
3. CDC NHSN COVID19 Module:
   https://www.cdc.gov/nhsn/ltc/covid19/index
   .html
4. Details on SAMS Level 3: SAMS Level Three
   Access Having backup Users is crucial to
   staying in compliance with reporting!
5. NHSN website changes: LTC Website Refresh
   Walk-through

                                             32

CMS Targeted COVID-19 Training for
Frontline Nursing Home Staff &
Management Learning
• Available through the CMS      • Management staff modules:
  Quality, Safety &
                                 Module 1: Hand Hygiene and PPE
  Education Portal (QSEP).
                                 Module 2: Screening and Surveillance
• Can be completed on a
  cell phone                     Module 3: Cleaning the Nursing Home

• Frontline nursing home         Module 4: Cohorting
  staff modules:                 Module 5: Caring for Residents with
                                 Dementia in a Pandemic
Module 1: Hand Hygiene and
PPE                              Module 6: Basic Infection Control

Module 2: Screening and          Module 7: Emergency Preparedness and
Surveillance                     Surge Capacity
                                 Module 8: Addressing Emotional Health
Module 3: Cleaning the Nursing   of Residents and Staff
Home
                                 Module 9: Telehealth for Nursing Homes
Module 4: Cohorting
                                 Module 10: Getting Your Vaccine Delivery
Module 5: Caring for Residents   System Ready
with Dementia in a Pandemic      • 4 hours total training time
• 3 hours total training time
                                                                     33

Other Training
Opportunities
• A Fireside Chat with CMS, CDC and Long
  Term Care Community Champions
  Passcode: 6jby41s= (40 minutes)

• QIO Program Training - 13 topics that
  nursing home teams must know to
  manage the COVID-19 pandemic: CMS-
  CDC Fundamentals of COVID-19
  Prevention for Nursing Home Management

• To customize your nursing home
  training for COVID-19 prevention,
  Take the Training Fundamentals Self-
  Assessment. (Have your CCN handy)
                                           34

TMF LTC Connect – 30
minute sessions
•   March 25 - The Best-Ever Formula to
    Improve Influenza Vaccinations

•   April 22 - The Best -Ever Formula to
    Improve Pneumococcal Vaccinations

•   May 20 – Hit the Easy Button on NHSN
    COVID Data

•   Register:
    https://tmfnetworks.org/Events
•   Sessions start at 1:30 pm

                                           35

Reach out to us at:
     nhnetwork@tmf.org
   to submit requests for
    assistance with NHSN
reporting problems or quality
  improvement assistance.

                            36

COVID-19 Q&A
Panelist
Catherine Anglin
Program Manager: NF and LSC
Policy & Rules
Long-term Care Regulation
      ____________________________

                                     37

Reminders
GovDelivery Alerts
Don’t forget to sign up for GovDelivery alerts
https://service.govdelivery.com/accounts/TXHHS
C/subscriber/new
Select “Nursing Facility Resources” as a topic
option to receive webinar updates.

CMS/CDC COVID-19 Training
CMS is offering free online training for nursing
facilities related to COVID-19
Click here to view currently available pre-
recorded trainings.
Facilities also have access to the CMS Targeted
COVID-19 Training for Frontline Nursing Home
Staff and Management                               38

Questions?
For more information:
Web: https://hhs.texas.gov/services/health/coronavirus-covid-
19/coronavirus-covid-19-provider-information
Email: LTCRPolicy@hhs.texas.gov
Phone: 512-438-3161
                                                                39

Thank you!
For more information:
Web: https://hhs.texas.gov/services/health/coronavirus-covid-
19/coronavirus-covid-19-provider-information
Email: LTCRPolicy@hhs.Texas.gov
Phone: 512-438-3161
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