Nov. 10th COVID-19 Update

New updates pertaining to the COVID-19 emergency continue to be announced by both the state and federal government on a regular basis. The latest developments for providers of long-term/post-acute care (LTPAC) and senior services are outlined below.

As a reminder, LeadingAge NY continues to convene weekly webinars on Mondays at 11 a.m. to address emerging questions on COVID-19. A recording of our most recent webinar, held on Nov. 9^th, is available here. If you have questions for next week’s update, please send them to Ami Schnauber, and be sure to check your email for the access information, or contact Jeff Diamond.

Cross-Sector Updates

New Travel Advisory Policy

On Nov. 4^th, the State implemented a new travel advisory policy that replaces the weekly list of states – which had grown to encompass nearly the whole country – with a new test-based strategy. Under the new policy, travelers coming to New York from states that are not contiguous to New York, or after travel to any Centers for Disease Control and Prevention (CDC) Level 2 or Level 3 Travel Health Notice country, must quarantine for 14 days unless they satisfy the test-based requirement to exit quarantine early. All travelers covered by this policy must continue to fill out the Traveler Health Form. This updated interim guidance provides details regarding the new policy as well as a process by which individuals can request an exemption for extraordinary circumstances. If an individual gets a positive test result, local health departments will become involved for next steps. For general inquiries on this, contact the State COVID-19 hotline at 1-888-364-3065 or Ask a Question. To file a report of an individual failing to adhere to the quarantine pursuant to the travel guidelines, click here or call 1-833-789-0470.

“Essential workers” are exempt from this policy and, absent updated guidance, should continue to follow provider-specific guidance for the conditions under which they can return to work. Specifically, adult care facility (ACF), home care, hospice, and other non-nursing home providers should follow this guidance. The requirements for skilled nursing facilities (SNFs) are less clear, as there is no nursing home-specific guidance for returning to work after travel. Pending the issuance of updated guidance for nursing homes, facilities should consider following the updated interim guidance and the previously issued Frequently Asked Questions (FAQs), which allow essential workers to return to work if certain requirements are met, including, among others:

Furloughing such health care personnel (HCP) would result in staff shortages that would adversely impact operation of the health care entity, and all other staffing options have been exhausted
HCPs are asymptomatic
HCP received diagnostic testing for COVID-19 within 24 hours of arrival in New York

In addition, the updated interim guidance includes a puzzling statement that the guidance “may be superseded by more specific industry guidance for a particular industry (e.g., for nursing home and adult care facility staff, a negative PCR test result is required before returning to work).” Since there is no existing “specific industry guidance” with that requirement, the applicability of this requirement is unclear.

More information can be found on the Department of Health (DOH) Travel Advisory website.

LeadingAge NY Releases Issue Brief on Risk Mitigation Strategies for Off-Site Holiday Visits

As the holidays approach, some residents of long-term care facilities and senior housing are hoping to visit with loved ones off-site. At the same time, COVID-19 cases are rising in many communities, presenting a risk that returning residents will bring new infections into their buildings. LeadingAge NY has released an issue brief to help nursing homes, ACF/assisted living (AL) providers, and senior housing to identify the relevant regulations and guidance applicable to off-site social visits by residents during the COVID-19 pandemic and the steps that these organizations may choose to take to mitigate the infection transmission risks of off-site visits, while honoring resident rights to access the community.

NYC Long-Term Care Providers Urged to Enroll in Surge Staffing GPO

New York City (NYC) Emergency Management and the NYC Department of Health and Mental Hygiene (DOHMH) have established a surge staffing group purchasing organization (GPO) to support health care providers to prepare for future staffing shortages during the pandemic. The City is encouraging nursing homes, ACFs, and home care agencies delivering services to city residents to enter into GPO contracts now, even if they are not currently experiencing staffing challenges. By establishing contracts, facilities will lock in pre-set rates and be prepared to utilize the agencies in the event they experience shortages. More information is available here.

Nursing Home and ACF/AL Updates

Point-of-Care Test Result Reporting Update

Reporting requirements for COVID-19 point-of-care (POC) test results are undergoing some changes at the state and federal levels. Click here for a detailed breakdown of the updates.

Salon Services Can Resume in ACFs and SNFs, Under Certain Conditions

On Nov. 4^th, DOH issued guidance regarding the resumption of salon services in ACFs and SNFs. The Department is allowing such services to resume effective Nov. 6^th, given many conditions are met, including strict infection control practices and testing is in place.

COVID-19 testing is required of beauticians and barbers, though the specifics differ depending on the type of service:

ACFs: Beauticians and barbers who provide services within the facility must be tested for COVID-19 at least once per week. Evidence of a negative test within seven days must be presented prior to initiating services.
SNFs: Beauticians and barbers must be tested for COVID-19 on each day they provide services within the facility. Evidence of a negative test within the last day (24 hours) must be presented prior to initiating services.

POC antigen testing can be used to meet the testing requirement. The Department indicated that if this provider tested positive, it would affect your ability to have visitation.

Salon services may not commence in SNFs or ACFs located in red or orange micro-cluster zones, and residents who are isolated or quarantined are ineligible for salon services.

The guidance also outlines some intensive infection control and documentation practices you should review carefully with your beautician or barber, including the requirement that the ACF or SNF be able to adhere to all local, state, and federal requirements relative to hair salons and barbershops.

The Department explained that the stringent guidance is due to the close, prolonged contact that beauticians and barbers have with residents when providing services, and the subsequent risk. In addition, DOH said that they would revisit the policy approximately 30 days after implementation, and so we welcome your thoughts and input as you implement the guidance.

Sign up ASAP to Receive Free Training and a Stipend Through Project ECHO!

The New York Academy of Medicine (NYAM) and LeadingAge NY will offer training through Project ECHO to help keep COVID-19 from spreading in New York’s nursing homes and prepare staff to protect residents and themselves. We invite you to join us in this essential effort, which is free and offers participating facilities a $6,000 stipend upon completion. Participation in the NYAM/LeadingAge NY training initiative is limited to the first 70 nursing homes, and the initial deadline to sign up is this Fri., Nov. 13^th. Click here for more information.

If Your Nursing Home Did Not Receive QIP Funds...

On Nov. 2^nd, the Department of Health and Human Services (HHS) distributed the first batch of Nursing Home Infection Control Quality Incentive Program (QIP) payments. This funding is part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Provider Relief Fund and is expected to distribute up to $2 billion in five installments to homes whose COVID-19 infection rate is lower than their community’s rate. Some additional information from HHS on the QIP is available here.

The initial installment was based on September performance and saw over 440 New York nursing homes receive a share of $7 million. Although some of the amounts were modest, we urge nursing home members who believe that they should have received a distribution, but did not, to submit their contact information here for submission to HHS.

While the community infection rates that HHS uses in the comparisons are not publicly available, much of the eligibility criteria is based on National Healthcare Safety Network (NHSN) reporting. Member nursing homes that believe that their facility’s infection rate in September was lower than the overall county infection rate and that also met the criteria listed below, yet did not receive funding, should submit their contact information for troubleshooting.

Nursing homes that met the following criteria were likely to be eligible for the September performance period QIP distribution:

Filed complete data on NHSN that would have passed the quality assurance check for September as well as the period six weeks prior
Achieved an infection rate during the four-week (Aug. 31^st to Sept. 27^th) performance period that was better than the county’s overall infection rate (county infection rates are measured using HHS Protect Data Program daily COVID-19 community profile reports)
Reported a COVID-19 mortality rate lower than 10 percent during the performance period
Reported non-missing values for occupied beds and infected residents in each performance period week
Had (and reported as having) availability to test residents for COVID-19
If applicable, have responded to direct outreach from HHS regarding mortality data

County Positivity Rates

The most recent listing of 14-day testing positivity rates for each county in New York State from the Centers for Medicare and Medicaid Services (CMS) is available here. Current daily county-level data for New York State are here, and ZIP-code level data for New York City showing infection rates during the most recent four weeks are available here.

NYC Releases Updated Fatality Management Toolkit

The NYC Office of Chief Medical Examiner (OCME) has issued an updated Fatality Management Toolkit to help NYC long-term care and nursing home facilities prepare to manage future fatality surges due to COVID-19. The guidance builds off normal day-to-day procedures and provides facilities with tools and information required to amplify operations. The toolkit is comprised of guidance distributed during the first wave of COVID-19 that has been updated with lessons learned and feedback from facilities. While it is only relevant to NYC long-term care and nursing home facilities, providers from the rest of the state are encouraged to review it for content and potential best practices.

The updated document provides content relating to:

Facility planning
Types of deaths to report or request pick-up
Decedent pick-up process
Paperwork instructions
Decedent storage
Key points to remember
Key contact numbers for borough administrators