KAHCF/KCAL Emergency Preparedness Contacts

COVID19@kahcf.org

 

KAHCF/KCAL COVID-19 Response Team

Betsy Johnson 
President


Ashlea Christiansen
Director of Regulatory Affairs

Wayne Johnson
VP of Finance


Press Contact

Emily Weber
Director of Communications

 

State Agency Contacts

Department of Public Health
Hotline: 1-800-722-5725
kycovid19.ky.gov

Clinical Call Center: 1-888-404-1539

CDC Clinical Call Center: 770-488-7100
coca@cdc.gov

Gov. Beshear Facebook Page
Daily Briefings at 5pm EST

 

The coronavirus disease (COVID-19) outbreak started in China in December 2019, and was labeled a pandemic by the World Health Organization on March 11, 2020. To date, almost 750,000 COVID-19 cases have been confirmed and almost 35,000 deaths have been reported in over 175 countries/regions. A significant number of deaths in the United States have been at long-term care facilities. This highlights the serious threat the diseases poses to the senior population. COVID-19 is currently believed to be spread from person-to-person through droplets in the air, very similar to how influenza spreads.

KAHCF/KCAL stands by your side during this particularly challenging time. We know that having the most up-to-date, accurate information is vital to keeping your residents and staff safe. We have twice weekly “huddle” calls with the OIG, DAIL and weekly calls with the DPH seek answers to seek answers for your most pressing COVID-19 related questions. Please follow these guidelines to assist in streamlining the communication process for everyone.

Please send all COVID-19 related questions to covid19@kahcf.com so that we can appropriately channel and respond. Also, DAIL and the OIG report that they are inundated with questions - many are duplicates. It would be helpful to everyone if questions are funneled through the association in order to assist them and all members.  

It is recommended that you designate one staff person to be responsible for checking the following on a daily basis for updates:

Centers for Disease Control’s COVID-19 Information

Kentucky Department for Public Health

General COVID-19 Information

Guidance for Long Term Care Facilities

 If you have a suspected case of COVID, have your provider call one of the following numbers: (502) 564-5459 or 1-888-404-1539.

It is strongly recommended that all levels of care follow the CDC and CMS guidelines regarding visitation, activities and screening given that the population we serve is the most vulnerable to this virus.

Please understand that these measures are an attempt to prevent the introduction of the virus INTO your facility and to reduce the impact on acute care that may swell should the virus continue to spread.

CMS Updates


    • NEW! CMS issued new guidance specifically aimed at SNFs late yesterday. Thankfully, much of this we are already doing here in Kentucky. This guidance included the following: 
      • Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.
      • As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests. 
      • Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.
      • Nursing homes should ensure all staff is using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
      • To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status. (**Note - this plan is being worked on here in Kentucky by the OIG and DPH)
    • NEW! CMS Reports Frequent Incorrect Use of PPE -  We have heard from CMS that a common theme they are finding during COVID-19 infection control focused surveys are PPE not being used correctly, including donning and doffing procedures. Surveyors are having staff demonstrate hand washing and donning and doffing of PPE. 
    • We encourage you to review with your teams the appropriate way to apply and remove all PPE, including gloves, gowns, masks, and eye protection. Performing observations yourself can be helpful to prepare staff for surveyor observation and to quickly correct any practices needing improvement.  
      • These documents can be printed and posted in your center to ensure your staff is aware of how to appropriately put on PPE.  
      • These documents can be printed off and posted in your center to ensure your staff is aware of how to appropriately remove PPE.   
      • The following video explains how to do hand hygiene and donning/doffing PPE appropriately.
    • NEW! The Centers for Medicare and Medicaid Services (CMS) has been hosting regular calls with a variety of clinicians, hospitals, other facilities, and states in an effort to keep stakeholders updated on our COVID-19 efforts.  As we know not everyone is available to attend the calls live, you can access recordings of the calls along with transcripts here

 

Department of Public Health Updates


  • The DPH is building out forms to collect hospital and LTC data. It is very important that they collect valid and relevant data because many decisions will be made using this data, such as PPE, tools, ventilators, etc. Web EOC is a tool they use. Reports have to be made on a daily basis. We understand that many of you don’t have access to Web EOC yet. You will likely be contacted by someone to set this up. When this occurs, know that the DPH needs PPE, bed & staffing info, info by 9 AM every day because between 10-1 is when federal reports are due up to HHS. 
  • Some alternate care site planning is being done through FEMA & Army Corps of Engineers. This will be at the Fair & Expo Center in Louisville. There are also parallel efforts by HHS and KDPH occurring. They are encouraging hospitals and coalitions to think about alternate care sites in their areas. In this past week they’ve started thinking about resources and assets coalitions have and what they would need from the federal government. Some are looking at facilities, floors that are available, one facility in a healthcare system, etc.
  • With regard to testing, be on the lookout for specimen collection and testing initiatives through Kroger clinics.  There is another testing initiative where collection kits will be sent to hospitals in each region to execute 1000-2000 statewide/day. There is a 24-48 hour turnaround time on those tests. One hospital in each region should be doing these tests. However, understand that there will likely still be screening criteria that will go along with these tests - folks will still have to have a physician’s order to get a test.
  • DPH is looking at isolation centers for people who aren’t at the level of care for a hospital but can’t go home. They are looking at hotels, empty college dorms, etc. 
  • DPH is looking to create triage tents outside of hospitals that will keep those people who can be quickly treated for more minor afflictions out of the hospital and away from the ER. 
  • DPH received grant money to provide to Coalitions for PPE when available for purchase
  • COVID Facilities for LTC Residents 3 in Louisville 
    1 in Winchester 

    Total of 100 beds between all 4 facilities
    This is handled through OIG coordination & Dr. Stack
    These facilities would only care for COVID patients (they are transferring everyone else out)
    DPH is getting them what they need to take care of COVID patients
    They are continuing to look for additional facilities 

 


Community 


  • Team Kentucky Fund - Governor Beshear has established a relief fund to provide financial assistance to those who have lost their jobs or need additional assistance due to COVID-19. To donate to the Team Kentucky Fund, please click here
  • Louisville Metro Government has created a webpage to help lift our spirits during the fight against COVID-19. Lift Up Lou helps you stay connected, provides ideas and stories, and is a great resource to find services and report issues.
  • Buffalo Trace Distillery is donating Clear Spring 190 proof spirit hand sanitizer during the COVID-19 health crisis.  They are offering 1 case (12 bottles) per applicable Kentucky based organization: first responders, health care, government, law enforcement, 501(c)(3) organizations, etc. To be considered and pick-up information, please fill out this form.
  • The Kentucky Distillers Association and the Kentucky Chamber created the website kyhandsanitizer.com to determine the critical need for hand sanitizer across employers in Kentucky. Please fill out this form if you need and would like to be considered for these supplies from our Kentucky bourbon distillers. This form helps create an efficient way to handle their overwhelming number of requests.
  • Show this inspirational video "You Absolutely Matter" by Clint Maun to your fellow health care workers. 
  • If your facility has purchased or had donated cell phones, Ipads, and other technologies to keep residents in touch with family and friends, contact the Kentucky State Ombudsman, Sherry Culp at nhoa@ombuddy.org. This will help them respond to concerns about access to communications.
  • Bonnie from Foundation for a Healthy Kentucky and fellow church members are working hard to sew face masks for health care workers in Kentucky. To be considered for these face masks, please contact Bonnie at bhackbarth@healthy-ky.org or 502-552-3770.
  • Tommy Cunningham from Murray, KY at Stroud Safety is transitioning seamstresses to producing face masks. The masks are $15.50 each and constructed from flame-resistant cotton with a pocket for adding a carbon insert. They have elastic bands to secure to head and a steel wire nose bridge. If interested in purchasing, please contact tommy@stroudsafety.com or you can contact Stroud Safety in Oklahoma City at 405-632-2022.
  • Kevin McKim, Chief Executive Officer for New Source Medical, has announced his company is producing KN95 masks for purchase. These are produced at an ISO certified, FDA regulated facility. Both masks have the required CE mark per the newest FDA regulations. Due to demand, manufacturers are adjusting pricing daily.  There are approx. 100,000 of the KN95 masks (scheduled to land April 13th) that will be available, first come, first serve. Surgical Masks will be about a week behind as they have already sold out of their initial order. Email ppe@newsourcemed.com to order.  Pricing will be as follows through 5PM Friday, April 3rd: Current Each Pricing (KN95 - $3.65, 3-Ply Mask -Disposable - $1.05) Currently, the minimum order quantity is 1,000.

 

*Any reference to a specific product, process, or service does not constitute or imply an endorsement by KAHCF/KCAL of the product, process, or services, or its producer or provider.

 

Advocacy


KAHCF/KCAL sent a letter to Gov. Andy Beshear on March 24, 2020  to request funding provided by the recent passage of the Families First Coronavirus Response Act. "Our understanding is that with the passage of the Act, an enhanced Federal Medicaid Assistance Percentage (FMAP) of 6.2% is being directed to each state.  We wanted to take this opportunity to request funding available to the state as well as outline additional costs currently being faced by nursing homes as a result of this crisis.  We are requesting that effective March 1, 2020, the enhanced federal match be used to increase funding to nursing facilities across the state to provide the resources needed to treat patients as a result of the novel coronavirus or COVID-19.  This equates to a Medicaid rate add-on of approximately $55 per resident day."

 

KAHCF/KCAL sent a letter to Secretary Alex Azar, Department of Health and Human Services regarding the Coronavirus Aid, Relief, and Economic Security Act and our request that part of the $100 billion allocated for health care providers be directed to skilled nursing facilities in the United States. 

KAHCF/KCAL also sent out a letter to be used to sent by Senate President McConnell to HHS Secretary Azar. 

 

Educations


Tuesday, April 7 at 10:30-11:30am EST
FREE WEBINAR
MANAGING RISK IN UNCERTAIN TIMES


As long term care, post-acute care, and senior living facilities navigate the evolving coronavirus (COVID-19) pandemic, enforcement of your facility’s risk mitigation plan is key to ensuring compliance with rules and regulations. During this webinar, experienced litigators and advocates will provide practical perspectives about managing risks that need to be considered both separate from and along with regulatory compliance.
Speakers: Caldwell G. Collins and Christy T. Crider
Click here to view flyer with more information
Click here to register

Thursday, April 9 at 2:00pm EST
Call in number is 877-366-0711
Code:  73641411#

12 IMMEDIATE ACTIONS DURING THIS PANDEMIC TO 'REFRESH, STABILIZE AND THRIVE’ IN YOUR STAFFING EFFORTS

KAHCF has partnered with Maun-Lemke team to offer a FREE 30-minute teleconference that outlines 12 immediate actions you and your facility can use during this pandemic to 'Refresh, Stabilize and Thrive’ your staffing efforts. These 12 actions focus on Recruitment, Engagement and Retention. Q&A will be held after presentation and a one-page handout will be available on website.

Speakers: Clint Maun and Cherly Boldt are nationally recognized for their innovative expertise in healthcare consulting, speaking and research.  

No advanced registration required. 

Wednesday, April 15 - Thursday, April 16
In KAHCF/KCAL Office in Louisville, KY - 8 person limit
METHODS OF INSTRUCTION- NURSE AIDE TRAINING COURSE


This train-the-trainer course will help prepare eligible nurses to become instructors for the Medicaid nurse aide training program. It will provide classroom and demonstration experiences to assist the nurse in becoming a better teacher of nurse aides. The course will cover philosophy, course preparation, learning styles of students, areas of knowledge, performance and training techniques, use of lesson plans, instructional methods, and use of instructional aids. There will also be an in-depth discussion of how to use the nurse aide curriculum developed by the Kentucky Department for Medicaid Services. Nurse aide training must be performed by or under the general supervision of a registered nurse who has a minimum of 2 years of experience, at least one of which is in the provision of long term care services. Directors of Nurse Aide Training should attend this training. 

Agenda (Two Day Training) 
Registration      8:00 am 
Program            8:30 am
Lunch              12 Noon Lunch on your own
Program           1:00 pm
Adjourn             4:30 pm

Presenter: Robert Flatt is the Nursing Home Administrator for Essex Nursing and Rehabilitation Center here in Louisville. He is a Registered Nurse and teaches classes for the Community College and is serving on the Board of Long Term Care Health Care Administrators. For more information, registration fees, and to register, click here.

 

FAQ's By Topic


 

ADMISSIONS/TRANSFERS

Our OIG has communicated that it is absolutely imperative during this time that facilities continue to accept admissions from the community and transfers in order to keep acute beds open for those who need absolutely need them. We recommend that you screen admissions as you would staff and anyone entering the facility. The OIG has communicated with the hospitals that they need to be transparent about COVID-19 patients post-treatment needing placement in lower levels of care. Screen carefully and monitor temperatures and residents often. But accepting admissions is vital to keeping our healthcare system stable as a whole.

On March 31, KAHCF/KCAL collaborated with the Kentucky Hospital Association and LeadingAge to release a hospital transfer to SNF/NF tool. To access this new protocol, click here.
AHCA is issuing interim guidance to help skilled nursing facilities (SNFs) make decisions about accepting hospital discharges to SNFs during COVID-19 pandemic.
The decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community.
This guidance is designed to help reduce the risk of admitting someone with COVID-19 into your building, along with the steps you should take to prevent any spread. Please click here to read the PDF.

  

ALTERNATIVE CARE SITES

You were recently asked to fill out a survey regarding your plan for an alternative care site. As we explained in our recent alert, the Commonwealth is attempting to collect information in order to plan ahead for the expected hospital surge, as other states are also doing.

Learn more from the CDC about the purpose of alternative care sites here.

See what other states are doing to plan using alternative care sites by clicking the following links:

https://www.crainsdetroit.com/health-care/hospitals-prepare-covid-19-patient-surge-alternative-sites-offer-space

https://www.wgrz.com/article/news/health/coronavirus/erie-county-looks-into-alternative-facilities-for-covid-19-patients/71-a5fb02f9-9830-4209-9d66-7995ea176478

https://www.ksby.com/news/coronavirus/trained-volunteers-to-staff-alternative-covid-19-care-sites-in-san-luis-obispo-county


ASSISTED LIVING COMMUNITIES

Today DAIL Commissioner, Victoria Eldridge, sent out a letter to all assisted living community directors stating, "There should not be any congregate activities of any type inside of an assisted living community, even with social distancing, all congregate activities shall stop immediately. This includes dining, leisure, and grooming." Please make sure that the information provided in the letter is put into action immediately if you have not already done so. 

The Department for Aging and Independent Living ("DAIL") issued new guidance for assisted living communities to help prevent the spread of COVID-19. Guidance provided by the CDC for assisted living communities that do not provide medical services can be found here. However, we still recommended that these facilities incorporate the more stringent requirements of the CMS guidance to the extent possible in an effort to protect their residents.


CARE PLANNING

While - as of yet - individual care planning around isolation is not mandated by CMS, it is recommended by the OIG that facilities take a look at this recent McKnight’s article regarding the psychosocial effects of isolation.

We strongly recommend that you keep amended care planning documents with regard to this new situation and each resident - to whatever capacity your facility is able. We know that you and your staff are coming up with creative and interesting ways to keep your residents safe and emotionally stimulated.

 

CELL PHONES

Right now, it is understood that residents need to be in contact with their family members. Therefore, there is no privacy concern on behalf of the OIG or Ombudsman regarding staff using personal cell phones to allow residents to contact family members. This is appreciated and understood. For effective communication in the future, facilities will need to look at additional methods, but it is understood that this situation is unprecedented and was unforeseeable. It was suggested that staff use selfie sticks if available to save on wear and tear on their arms and backs and to afford residents a bit more privacy, but this is simply that - a suggestion.


CHILD CARE PROGRAMS

-From Kentucky Cabinet for Health and Family Services website

  • Per the OIG, $50 per day is the YMCA recommended rate. Health care entities can work with child care entities to negotiate lower rates.
  • ONLY for counties with no formal day care centers, only private sitters, the OIG will not regulate private sitters. Employees can use these private sitters and negotiate prices.


DINING

Attached is a PDF from AHCA/NCAL, which includes communal dining guidance for your facility.

Dining services for higher risk patients such as restorative dining for those who need closer supervision can be provided in a dining room but spread out as per the social distancing guidelines, however dining hours will need to be expanded in order to accommodate for social distancing and disinfecting between each set of diners. 

 

DISCHARGES/TRANSFERS

On March 31, KAHCF/KCAL collaborated with the Kentucky Hospital Association and LeadingAge to release a hospital transfer to SNF/NF tool. To access this new protocol, click here.

On Sunday, March 29, The Society for Post Acute and Long Term Care Medicine and AHCA/NCAL released a statement, "State Advisories re: Hospital Discharges and Admissions to Nursing Homes and Assisted Living Communities." To read, click here.

If you haven’t already, be aware that your facility will soon be asked to electronically fill out a ReadyOp form that will report to Frankfort how many open beds exist in your facility daily. It is recommended that you assign a staff member someone to fill out and send in every day.

The OIG is still working on a Kentucky plan and accompanying guidance regarding transfers, taking admissions of COVID-19+ residents post-hospital stay, etc. We hope to receive information next week. In the meantime, please refer to this AHCA RESOURCE re: discharge & transfer.

The OIG has stressed the importance of keeping acute beds free for those who need them and accepting transfers and discharges as usual with the proper COVID-19 screening as you would anyone entering your facility. Then, it is recommended that you frequently monitor these residents for signs/symptoms following admittance, as you are all residents.

Our industry should show great restraint in discharging residents for non-payment at this time. It is also believed that Medicaid applications may be delayed due to family members not being able to gather paperwork due to restricted access. If you have a resident who is facing involuntary discharge for non-payment, please contact Sherry Culp at nhoa@ombuddy.org or 859.277.9215. 

 

EMERGENCY PREPAREDNESS PLAN

In your emergency preparedness plan, it is recommended by the OIG that you identify those residents that will be hard to isolate (wanderers, roamers) and plan for isolation. These individuals are likely to be first to contract illness due to their roaming habits and will also be difficult to isolate - so planning ahead is essential.

You and your staff are likely adjusting to this situation as needed, because it’s impossible to anticipate every twist to a scenario. Don’t forget to note what actions you are taking and update your emergency preparedness plan!

 

ENFORCEMENT ACTIONS

We have posed the question regarding DPNAs and facilities that need to be cleared and the OIG is seeking guidance from CMS. They report that CMS is supposed to be sending a memo relating to enforcement cases at any time, so be on the lookout.

Life safety inspections have been an issue brought up at the national level to CMS and we are awaiting guidance.

Fire inspections have been brought up to the OIG and we are waiting for guidance. The IG expressed that they are aware there are things they aren’t able to hold facilities accountable to during this time due to circumstances.


 
ENVIRONMENTAL/CLEANING

The question was posed whether it is advisable to close off a room for 24 hours before cleaning after a resident with possible COVID-19 is sent to the hospital. The CDC has released new guidelines on how to clean your facility if someone with COVID-19 has been present. Please review and update your policies as necessary. 

FEMA

We understand that many of you have received letters regarding FEMA reimbursement. 

To know if your facility is eligible, contact the following:

Jessica Mitchell, Kentucky Emergency/Management
Recovery Branch Manager 
100 Airport Road, 3rd Floor
Frankfort, KY  40601
Phone:  (502)-607-5762
Fax:  (502)-607-5740

 

 

FEMA will make the ultimate determination on eligibility, it can take months for the process, and there is no guarantee FEMA will actually pay out the money.

When FEMA says to capture expenses, everything has to have evidence of expenditure, invoices for everything, staffing expenses by times for each staff person, evidence of overtime, actual proof of costs incurred, etc. Anything not totally justified and proven will be rejected.

 

INVOLUNTARY DISCHARGE FOR NON-PAYMENT

Our industry should show great restraint in discharging residents for non-payment at this time. It is also believed that Medicaid applications may be delayed due to family members not being able to gather paperwork due to restricted access. If you have a resident who is facing involuntary discharge for non-payment, please contact Sherry Culp at nhoa@ombuddy.org or 859.277.9215. 

 

LEGISLATIVE UPDATE

GOV. ANDY BESHEAR SIGNS LEGISLATION RELATING TO STATE OF EMERGENCY IN RESPONSE TO COVID-19
PLEASE SHARE WITH IN-HOUSE COUNSEL AND OUTSIDE COUNSEL

On March 30th, Governor Andy Beshear signed into law SB 150- an act relating to the state of emergency in response to Covid19. The following important language for our members is within this piece of legislation:
 
(b) A health care provider who in good faith renders care or treatment of a COVID-19 patient during the state of emergency shall have a defense to civil liability for ordinary negligence for any personal injury resulting from said care or treatment, or from any act or failure to act in providing or arranging further medical treatment, if the health care provider acts as an ordinary, reasonable, and prudent health care provider would have acted under the same or similar circumstances. The aforesaid defense under this paragraph shall include a health care provider who:

1. Prescribes or dispenses medicines for off-label use to attempt to combat the COVID-19 virus, in accordance with the federal Right to Try Act, United States Public Law 115-176, and KRS 217.5401 to 217.5408;
2. Provides health care services, upon the request of health care facilities or public health entities, that are outside of the provider's professional scope of practice; or
3. Utilizes equipment or supplies outside of the product's normal use for medical 2 practice and the provision of health care services.

SB 150 does not define “health care provider” within the bill itself. Our position is that a “health care provider,” as used in the first sentence in section (b) must be defined as including skilled nursing facilities.   

BOTTOM LINE: This section of SB 150 can be very helpful to skilled nursing facilities in limiting liability for reasonable care provided in the COVID-19 context. Please consult with your legal counsel regarding this provision in SB 150. 
 

HOUSE BILL 356- JUDICIARY BUDGET
 
The Legislative Branch passed the Judiciary Budget on Wednesday, April 1st and Part III; Section 18 states as follows:
 
18. Public Health Emergency: For the duration of the Governor’s declaration of a State of Emergency in response to the novel coronavirus (COVID-19), the Chief Justice of the Commonwealth is authorized to declare a Judicial Emergency to protect the health and safety of court employees, elected officials, and the general public. A Judicial Emergency shall extend any administrative actions deadlines, and statutory timelines and statutes of limitations for court filings and proceedings, including but not limited to KRS 2 446.030, 500.050, and Chapters 342, 376, 403, 413, 456, and 620. The extensions provided herein shall be effective until 30 days after the emergency order of the Chief Justice or the Governor ends, whichever is later. This provision shall apply both prospectively and retroactively.

KRS Chapter 411, Rights of Action and Survival of Action was not included in the extension of time provisions in the Judiciary Budget.

 


MEDICARE PART A 3-DAY HOSPITAL STAY & SPELL OF ILLNESS WAIVERS

As you know, CMS has released a national blanket waiver of the 3-Day Stay and the Spell of Illness.  Blanket means these waivers apply to all states and all SNFs – no waiver requests are needed.  To view the waiver, click here and to view CMS detailed billing guidance under the waivers, click here

The AHCA team understands the complexity and risk associated with these waivers but need additional time to release more detailed and concrete guidance.  Rest assured, the KAHCF team will issue this information as soon as this becomes available from AHCA. 

 

MONITORING FOR SIGNS & SYMPTOMS

Per the OIG, it is recommended that all residents’ vital signs be monitored at least once every shift. This is because it is increasingly being reported that COVID-19+ patients - particularly those in the elderly age range -  begin showing symptoms and their condition deteriorates rapidly. We recommend developing a policy that requires frequent/regular temperature checks of both residents and staff throughout the day. See below in Staffing for a specific piece of guidance.

We are hearing more and more instances of individuals developing severe symptoms in a matter of hours. According to the Centers for Disease Control, the most common symptoms of COVID-19 are fever, cough and shortness of breath, which may appear 2-14 days after exposure. 

NON-EMERGENCY TRANSPORTATION

If you experience any issues with non-emergency transportation of residents during this time, please notify us at covid19@kahcf.org.

 

NURSES

From the Kentucky Board of Nursing

From the Kentucky Board of Nursing: Due to the multiple concerns related to the ability to educate and training additional SRNAs and the establishment of the patient care attendant program, KBN staff are planning a Question and Answer session for Healthcare Facility Nursing leadership via a webinar scheduled for Monday April 13, 2020.  The webinar will be scheduled from 10am -11am EST. The Kentucky Board of Nursing is continuing to host a series of targeted webinars in response to the complexities that have arisen in the wake of the COVID-19.  Information to access the webinar has been provided below:

The Kentucky Board of Nursing passed the emergency regulation (201 KAR 20:225E) to allow the board to issue temporary work permits to nurses whose license has lapsed or who have retired. The temporary permit is good for six months and a criminal background check is required.

  •  Patient abandonment: The KBN has prepared this FAQ regarding this topic due to questions coming in from nurses and employers.
  • Provisional Licenses
    • After graduation and after the individual applies for the exam, they will be granted a provisional license
    • Due to the unavailability of criminal background checks, these will not be done at this time
    • Individual won’t be issued a permanent license until a criminal background check is completed
    • The day before the provisional license expires, a notice will be sent to the email address that the KBN has on file (and the provisional address will be renewed if the state of emergency persists) - so individuals will need to make sure address on file is accurate
  • Reinstatements, Un-Retirements & Endorsements for Nurses from Other States
    • Individuals will need to fill out an application form and take a jurisprudence exam
    • They will be issued a work permit for 6 months that may be extended
    • If they would like it to be converted to a permanent license, a criminal background check will need to be completed
  • Out of State Registry
    • During the duration of the current state of emergency related to COVID-19, the Good Samaritan Act of 2007, KRS 39A.350-366, and KRS 314.101(1)(a) authorize the KBN to create a registry and authorize practice in the Commonwealth of nurses and board certified dialysis technicians who are not otherwise licensed to practice in Kentucky and who do not hold multistate practice privileges under the Nurse Licensure Compact but who are currently licensed and in good standing in another state. The Kentucky Registration for Emergency System for Advanced Registration of Volunteer Health Practitioners is applicable to both paid and unpaid positions. More information can be obtained here.


OMBUDSMANS' INFORMATION REQUEST     

We are aware of the Ombudsman's request for residents’ and family information. We have received several questions about this request, such as: How often is “routinely provide” when referring to providing this information? What is the Ombudsman’s Office doing with this information? What are they going to require facilities do once the information is provided?
Sherry Culp provided a Facts and questions regarding LTC Ombudsman services and requests for resident census and resident and family contact information memo

 

OSHA INFORMATION

Please check here for updated OSHA information and regulations relating to COVID-19.

 

OUTSIDE SERVICES

We’ve been made aware that, in some cases, hospital-based phlebotomists and certain therapists aren’t willing to enter into facilities even with orders. This issue was addressed on the OIG Huddle Call. IG Mather advised that he will remind the KHA of their duties. DAIL Commissioner Victoria Elridge advised that guidance has been issued by the OIG and distributed by the  Kentucky PT, OT, speech and resp therapy associations to therapists that they must continue services from IG; therapies need to continue when medically necessary.

 

PACKAGES/FOOD

For mail and packages, per the OIG, hold it for a day so that any existing COVID-19 virus has a chance to die. 

Per the OIG we are not able to stop residents from ordering food from outside the facility. All you can do is encourage residents to practice hand hygiene after handling food packages, or perhaps put the food in/on a different plate/container and leave the potentially contaminated container outside of the facility. 

PASRR GUIDANCE

 Effective with CMS’ approval of Kentucky’s 1135 waiver on March 25, 2020, PASRR screening for Level I and Level II were waived for 30 days.  According to the waiver, “Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments have been suspended for 30 days.  Section 1919(e)(7) of the Act allows Level I and Level II assessments to be waived for 30 days.  All new admissions can be treated like exempted hospital discharges.  After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) should receive a Resident Review as soon as resources become available.  Additionally, please note that per 42 C.F.R. §483.106(b)(4), new preadmission Level I and Level II screens are not required for residents who are being transferred between nursing facilities (NF).  If the NF is not certain whether a Level I had been conducted at the resident's evacuating facility, a Level I can be conducted by the admitting facility during the first few days of admission as part of intake and transfers with positive Level I screens would require a Resident Review.  The 7-9-day timeframe for Level II completion is an annual average for all preadmission screens, not individual assessments, and only applies to the preadmission screens (42 C.F.R. §483.112(c)).  There is not a set timeframe for when a Resident Review must be completed, but it should be conducted as resources become available.”


PERSONAL CARE HOMES

Kentucky Protection & Advocacy and the Administration on Intellectual and Developmental Disabilities, Administration for Community Living, U.S. Department of Health and Human Services has forwarded an easy guide to use at your facility to address COVID-19. Please click here to download the "COVID-19 Information By and For People With Disabilities."

 

PPE

For facilities within Jefferson County, the official process to request PPE: 

  1. Complete the attached resource request form with type and quantity of materials requested. (Make sure you fill out the facility in box #7 and phone number in box #13)
  2. Complete the attached status chart.
  3. Submit these attachments to IMTLogistics@louisvilleky.gov. (Please note: given limited supply, requests may not be filled in full. All requests submitted will be prioritized based on modeling surrounding need and capability to respond.)
  4. Once order is approved for pick-up, you will be notified by email with instructions and a map of the pick-up location. *Only those with a copy of approved email with them and on file at the POD location will be loaded.

For Jefferson County: Please see this handout from the Louisville Metro Public Health & Wellness COVID-19 Unified Command for Prioritization of PPE by Tier Levels.

Click here for printable instructions and forms from Louisville Metro Public Health & Wellness.

During our most recent huddle, the state was unable to provide an update on PPE. Betty Shiels was able to inform us that, at this point, we as a nation are waiting for production to ramp up both domestically and abroad. We have reached “crisis levels of care” with regard to PPE. She reported that the Joint Commission will soon be issuing guidance that staff may bring their own PPE into the workplace, and the CDC guidelines allow for this as well.  We strongly encourage you to communicate with your team members and encourage their safety during this time. If you are out of PPE, allow them to bring home-made masks and other PPE for their comfort and safety. 

  • If surveyors attempt to enter your facility without proper PPE, please immediately notify covid19@kahcf.org. Per CMS guidance, this should not be occurring. 
  • Please see the following presentation from the National Emerging Special Pathogens and Education Center formerly the National Ebola Training and Education Center (NETEC)

COVID-19 PPE WEBINAR - EXTENDED USE, REUSE, AND INNOVATIVE DECONTAMINATION STRATEGIES

FOR NORTHERN KENTUCKY FACILITIES: If you need assistance with supplies reach out to Stella Barber with the Disaster Preparedness of NKY.  Stella’s contact info is below.
Stella Barber
Disaster Preparedness Coordinator
Northern Kentucky Health Department 
8001 Veterans Memorial Drive, Florence, KY 41042
Office: 859-363-2036 |  Fax: 859-578-7871 
stella.barber@nkyhealth.org
 

Can facilities reuse homemade cloth masks? Per the OIG, it is recommended that facilities refer to CDC guidance. Homemade cloth masks or other types of homemade masks (bandanas, vacuum bags, etc.) are only to be used if you no longer have approved PPE available. If you find your facility in this position, here is guidance from the Minnesota Department of Health that is very helpful. 

The process for securing and expressing the need for additional PPE is ever-changing due to the extreme shortage. The latest information we’ve received is that you should continue to work with your local Healthcare Coalition

For the most updated guidance from the CDC on acceptable ways to conserve your PPE, please click here. However, you must provide access to your staff if PPE is available!

Attached is a template for your facility to use in your community to call for donations of personal protective equipment (PPE).

KAHCF/KCAL inquired with the OIG about utilizing CMP funds for PPE. Jackie Aitkin advised that there is a portion of the CMP fund set aside for emergency funds ($3.8M) and that a letter from Kentucky is already being looked at in Baltimore. However, a new letter will be submitted on behalf of all Kentucky counties seeking additional CMP funds for PPE. 

The Minnesota Department of Health has created interim guidance on the use of alternative face masks. Please refer to this guidance as it contains handy information.

 

REIMBURSEMENT/CODING

We have received an update from DMS regarding timeframes for completing Level II evaluations. Section 1919 (e) (7) of the Social Security Act allows Level II evaluations to be waived for 30 days in certain situations. Since a state of emergency has been declared, DMS is allowing all new admissions to be treated similarly to a hospital exemption. For new admissions that trigger a Level II, the NF will use the hospital exempt form and put COVID19 on the doctor's signature line for now instead of requiring the signature. The NF will send to Carewise for a LOC as they do now with hospital exempt. The NF will follow all the other requirements currently in place for hospital exempt admissions. As you receive Level II requests, make sure that they include a copy of the hospital exempt form noted as “COVID19” if they are using that exemption. We believe the 30 days begins when a PASRRII is triggered, but we are waiting for this to be confirmed. 

MDS Isolation Coding Guidance Remains Unchanged

Members have been asking if CMS has made any changes to the MDS coding guidance associated with item O0100M – Isolation for active infectious disease (does not include standard precautions) which is located in Chapter 3 of the MDS 3.0 RAI Manual v 1.17.1 October 2019. Below is an excerpt from the current coding requirements describing the four specific conditions that must be met to check the O0100M item box for the presence of isolation for active infectious disease. 
 
Code for "single room isolation" only when all of the following conditions are met:

  1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
  2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.
  3. The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.
  4. The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.).

 
In a recent email received from CMS the Agency indicates that providers should continue to code residents for the O0100M isolation item per current MDS-RAI manual instructions. 
 
AHCA recognizes that many providers have applied recent CMS and CDC guidance and 1135 waivers during the COVID-19 emergency and have sometimes cohorted beneficiaries in the same isolation room when the residents have tested positive for COVID-19 or are presumed to be positive. We also recognize that with respect to payment models including PDPM, State case-mix, and Medicare Advantage, the current inability to code for isolation in situations where residents were required to be cohorted into the same room may result in a lower payment rate. CMS is aware of this concern. AHCA will share updates as they become available.

 

The association has received an update from the Department for Medicaid Services (DMS) regarding timeframes for completing Level II evaluations. Section 1919 (e) (7) of the Social Security Act allows Level II evaluations to be waived for 30 days in certain situations.  Since a state of emergency has been declared, DMS is allowing all new admissions to be treated similarly to a hospital exemption.
 
For new admissions that trigger a Level II, the NF will use the hospital exempt form and put COVID19 on the doctor's signature line for now instead of requiring the signature. The nursing facility will send to Carewise for a LOC as they do now with hospital exempt.  The NF will follow all the other requirements currently in place for hospital exempt admissions.
 
As you receive Level II requests, make sure that they include a copy of the hospital exempt form noted as “COVID19” if they are using that exemption.

COST REPORT FILING DELAYS 
Medicare

 The Centers for Medicare & Medicaid Services (CMS) will delay the filing deadline of FYE 10/31/2019 cost reports due by March 31, 2020 and FYE 11/30/2019 cost reports due by April 30, 2020.  The extended cost report due dates for these October and November FYEs will be June 30, 2020.  CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports due by May 31, 2020.  The extended cost report due date for FYE 12/31/2019 will be July 31, 2020.  This is a blanket extension, so providers do not need to individually request extensions.

 Medicaid
The Department for Medicaid Services (DMS) will also grant any cost report extensions that Medicare has officially granted.  At this time, the following FYE cost report extensions have been granted:

Fiscal Year End (FYE)

Revised Due Date

10/31/2019

6/30/2020

11/30/2019

6/30/2020

12/31/2019

7/31/2020

 

If there are any questions, please contact (502) 564-8196 and ask for the below DMS staff based on provider type:

Provider Types

DMS Contact

Home Health

Tara Brewer

Hospital

Barb McCarter

Nursing Facility

Lynette Gurney

MEDICAID DELAY OF OPTIONAL STATE ASSESSMENT
 
On March 19, 2020, CMS announced (click here) that changes to the Minimum Data Set (MDS) 3.0 v1.18.1 are being delayed, therefore, the Department for Medicaid’s (DMS) Optional State Assessment (OSA) is not needed on October 1, 2020, as originally anticipated, in order to continue Resource Utilization Group (RUG) based Medicaid reimbursement.
 
It is expected that CMS will remove items from the MDS item set in the future that are needed for maintaining RUG case mix reimbursement.  As CMS modifies the items on the MDS assessments in the future, DMS will evaluate if OSAs will be needed to continue its RUG‐III reimbursement system.  Communications regarding any future OSA requirement will be issued at that time.  The DMS will continue to publish information as it becomes available.
 
Should you have any questions, please contact Jacob Wilson at (502) 564-8196 x 2103. Questions regarding the coding of the MDS assessments may be directed to Chrystal Daugherty, RAI Coordinator with the Office of Inspector General at (606) 330-2030, x 283.

 

 

We received an inquiry about how facilities should code “isolation” on MDS due to the mandate to limit the movement of residents around the building (realizing it is impossible to restrict all movement unless residents are confined to their rooms). The response from AHCA was that CMS has not issued any clarification on this issue and the MDS manual has not been updated to reflect any changes. 

CGS recently sent an update that cost report deadlines have been extended.  To see the CGS alert, click 
here.  Staff is checking with the Department for Medicaid Services to see if Medicaid cost reports will be delayed as well.  Providers will be notified once this has occurred.

 

DCBS Offices Closed for Appointments

Yesterday, the Association was informed that the DCBS office closures due to COVID-19 may not have been widely communicated to providers.  Due to the COVID-19 National Health Emergency, a representative with the Department for Medicaid Services informed the Association that all DCBS offices are closed to foot traffic.  All re-certifications are extended for three months beginning in March.  If there are new applications to be submitted for long term care – there will be no face-to-face review for Level of Care – they should be submitted on-line or they can be mailed in.

On March 19, the Centers for Medicare & Medicaid Services (CMS) posted an update to its Frequently Asked Questions (FAQs) on the Medicaid.gov website to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to the 2019 Novel Coronavirus (COVID-19) outbreak. CMS is taking this action to continue its efforts to protect the health and safety of providers and patients, including those who are covered by Medicaid and CHIP.

You can find the updated FAQs by clicking here. These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts.  To keep up with the important work the Task Force is doing in response to COVID-19, click here.  For information specific to CMS, please visit the Current Emergencies Website.

Regarding Medicaid eligibility, Gov. Beshear stated yesterday that the “Department for Community Based Services (DCBS) will extend certification periods for all recipients of all public assistance programs (including Medicaid and State Supplementation) for three months.  Those households whose certification periods end in May will automatically be extended to August, June to September, and so on.”

Visit the Benefind website here or call the DCBS call center at 1-855-306-8959.   For Medicaid only, call the Kentucky Healthcare customer service line at 855-459-6328 or contact an application assister through the Kentucky Health Benefit Exchange website here.

 

Executive Orders and Regulatory Directives

Date

Source

Directive Description

3/6/2020

http://apps.sos.ky.gov/Executive/Journal/execjournalimages/2020-MISC-2020-0215-266310.pdf

Executive Order - State of Emergency Due to Novel Coronavirus

3/9/2020

http://apps.sos.ky.gov/Executive/Journal/execjournalimages/2020-MISC-2020-0220-266317.pdf

Executive Order - State of Emergency Relating to Insurance

3/10/2020

http://apps.sos.ky.gov/Executive/Journal/execjournalimages/2020-MISC-2020-0224-266318.pdf

Executive Order - State of Emergency Relating to the Dispensing of Pharmaceuticals

3/16/2020

http://apps.sos.ky.gov/Executive/Journal/execjournalimages/2020-MISC-2020-0235-266346.pdf

Executive Order - State of Emergency Relating to Unemployment Insurance Claims & Benefits

 3/22/2020 Executive Order - Business Closure  Executive Order - Business Closure
 
 
RESIDENTS LEAVING THE FACILITY

According to the OIG, facilities can discourage, but are unable to prevent residents from leaving the facility without an executive order stating this. If a facility has residents expressing fear due to other residents leaving and returning, facility administrators should contact the OIG’s office at (502) 564-2888. This, in turn, will allow the OIG to communicate the need for such an order for a non-medical leave ban for residents of facilities. 

 
RESIDENTS RIGHTS
42 CFR 483.12(b)(5)(B) allows for up to 24 hours to report resident to resident abuse if no injury is noted. If an injury is noted, the report has to be made within 2 hours. It has come to our attention that, historically, Kentucky has interpreted the regulation to mean that even resident to resident incidents where no injuries occur have to be reported within two hours, which causes an incredible strain on staff, particularly with the workload as it is during the COVID-19 crisis. Remember to refer back to the actual language of the regulation and if you have any questions, don’t hesitate to contact us at covid19@kahcf.org. We have also notified the OIG that we have educated our members regarding this regulation.

 

SMOKING


Activities such as smoking that are routine and comfort-giving for residents should not be suspended during this time. However, it is advised that only a couple residents go outside to smoke at a time to allow for social distancing. Facilities should develop policies and procedures that incorporate good practices such as social distancing.
  

STAFFING

NURSE AIDE TRAINING: The following was posted on April 3 on the DMS NAT webpage and can be located under COVID-19 Information and is titled Kentucky Nurse Aide COVID-19 Information and Procedures. 

Due to the current State of Emergency in the Commonwealth of Kentucky, the Cabinet for Health and Family Services, Department of Medicaid Services (DMS) has issued a letter related to Kentucky Nurse Aide Training and Testing Competency Program (NATCEP) providers, frequently referred to as MNA or SRNA state testing.

The statement: Dear Kentucky Nurse Aide Training Providers: The purpose of this letter is to notify Nursing Facilities and other Nurse Aide Training Providers that due to the COVID-19 precautions, the Department for Medicaid will be temporarily waiving the mandatory sixteen (16) hours of supervised clinical instruction prior to testing as well as the skills demonstration portion of the final examination until further notice. Upon employment, the mandatory sixteen (16) hours of supervised clinical instruction must be completed within the first thirty (30) days of employment. The Department for Medicaid has increased the testing window by thirty (30) days which allows (150) days from date of employment to be identified on the registry. The Department will continue to monitor these waivers and update as needed during this COVID-19 emergency. 

The above statement in no way changes the regulatory requirements in Kentucky to become a State Registered Nurse Aide. This only changes the process/workflow. As the provider for Nurse Aide Training and Competency Evaluation Program (NATCEP), the following is being shared to provide clarity for these emergency deviations from the normal policy and procedure. These guidelines will only be in effect as long as the State of Emergency is in force in Kentucky. These guidelines are subject to change at any moment depending on information received from the Governor of Kentucky, Andy Beshear. The Kentucky Community and Technical College System will provide partial NATCEP written testing on a limited basis starting April 6, 2020. Testing priority will be given as follows:

  1. Current facility trained employees
  2. Nurse aide training students with an offer of employment or seeking employment to be employed within 30 days.
  3. All other nurse aide training students including those seeking testing to obtain college and career readiness or for nursing school application.

 
KCTCS testing's TOP PRIORITY is to prepare the workforce for Nursing Facilities. We can only do very limited testing at this point due to social distancing and infection control procedures. Please go to the KCTCS website for specific information on the testing process. This site will be updated frequently. By Monday, April 6, we will have links to every testing center for scheduling and the NEW COVID 19 rosters that MUST be used for testing during this time of emergency. Thank you.
 
If you have questions please email Michelle Fulner 
 

For now, the OIG does not need to be notified if a staff member tests positive for COVID-19 - only a resident. 

PERSONAL CARE ATTENDANTS/TRAINING: Kentucky Inspector General Adam Mather has issued a Kentucky waiver allowing for abbreviated training for personal care attendants. Please see here.  Because this waiver is modeled after Indiana’s, the Indiana online PCA training has been approved by the OIG. We are seeking other approved options as well and will let you know as soon as these are available. Note that personal care attendants are not to be feeding. Look carefully at the description of this position. 

CNA TRAINING: As you know, CMS recently issued a blanket waiver that includes an allowance for nursing centers to temporarily employ individuals who have completed alternative training paths, as long as they are competent to provide relevant nursing and nursing-related services.  

While AHCA/NCAL is offering an 8-hour online Temporary Nurse Aide training course free to all participants, we still need the Kentucky OIG to sign off on this and any other courses. We are seeking this permission and will provide this information to you as soon as we have it. 

But of note, AHCA has also developed a skills competency checklist for facilities to use on-site when they hire individuals to work as Temporary Nurse Aides. It is important to know the federal requirement at §483.35(c) is still in effect, which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care. The take-away...hang tight! We’re working on it!

 We continue to receive many questions about staff returning to work after “exposure” to COVID-19. Please refer to the CDC guidanceFor staff members who show signs or symptoms of COVID-19, the OIG advises there are no recommendations. This would be a company policy. 

 Background Checks:

  • We are aware the KARES system is down. However, the OIG advises that the Kentucky State Police are available to do background checks:
  • Here’s a link to the form that employers must use to secure a KSP background check.
  • Also, this form is specific to LTCFs.
  • As always, you can use a private vendor or the Kentucky Administrative Office of the Courts.


TELEHEALTH

Here is a CMS telehealth toolkit for your convenience. 

 

TELEMEDICINE

The Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the President’s emergency declaration.

For more information, please refer to the CMS.gov Medicare Telemedicine Health Care Provider Fact Sheet here.

We believe 60 day visits would be able to be done via telemedicine under this new flexibility as it applies to new patients, but the OIG is confirming.

 

TESTING

These labs have had their results confirmed by an accredited laboratory such as the Department of Public Health Lab or CDC:
LabCorp
Quest
University of Louisville
University of Kentucky
Solaris
Lexington VA

Out of State- Charleston Area Medical Center (CAMC)

Here is a link to an FDA site with general information regarding testing and locations.

FDA Alerts Consumers About Unauthorized Fraudulent COVID-19 Test Kits
At
 this time, the FDA has not authorized any test that is available to purchase for testing yourself at home for COVID-19. If you are aware of fraudulent test kits for COVID-19, please report them to the FDA. To read the full press release, please click here.


THERAPY

The OIG recommends telehealth when possible for therapy, but asks that best clinical judgment is used and documented.

 
VISITATION RESTRICTION/ACTIVITIES/SCREENING & UPDATED END OF LIFE CLARIFICATION

The IG reversed their “animals are ok” guidance. We have heard a cat tested positive for COVID-19, so out of an abundance of caution, they’d prefer we not allow animals in facilities if they’ve not been living there full-time.

Per CMS guidance, surveyors must be wearing proper PPE in order to enter your building during this time. If there is an instance when a surveyor enters without PPE, please immediately notify covid19@kahcf.org

What is “exposure”? If your staff have been wearing appropriate PPE and finds out they have been treating COVID+ resident, they have not been exposed. Kentucky DPH is telling people staff has to be closer than 6’ for longer than 20 minutes. Develop guidelines for this.

Screen everyone entering the facility. Every time. No exceptions.  Here is the most up to date screening tool. But be aware that often guidance comes out in the middle of the week prior to our Friday updates. Therefore, we recommend you continue to check our website for more up to date information. 

Are home health workers permitted in assisted living and on a campus that is a CCRC? Per the KY OIG/DAIL, facilities are advised to use as much telehealth as possible. This should be evaluated on a resident to resident basis, as you don’t want permanent loss of function, but this needs to be balanced with resident safety. Document your efforts to keep your facility safe.

For families that need to be trained for resident discharge, it is recommended that you use alternate forms of communication v. in-person instruction, such as Skype & Zoom (deemed HIPAA compliant), and written instructions.

The question was posed to the OIG whether CHFS is comfortable with lab and therapy staff working in multiple facilities. The OIG stated that he is unable to take a stance on this and recommends appropriate screening.

Hospice providers are considered essential to care for residents. Please continue to allow them access, but remember to screen them as you would any other visitor.

As you know, CMS issued guidance regarding restricting all visitor access from its facilities as the nation works to combat and limit the spread of COVID-19.

What is the definition for end of life for the purposes of visitation?

It is recommended that you defer to the patient's attending Physician, APRN or PA in consultation with the facility caregiving team when making the decision to call in the family. This is the procedure today and should continue to be the procedure. Please defer to that team for making the decision. Providers should notify family several days, up to one week in advance or when a substantial change of condition occurs. Providers should not wait until active dying.

Should first responders also be screened? What if they refuse?
Yes. Per CHFS/OIG first responders - like everyone entering your facility - must be screened (at the very least, temp taken and signs/symptoms questions answered). If a crew refuses to be screened, please immediately email covid19@kahcf.org and send the EMS/ambulance company name and name of first responder. We will communicate this through the proper channels.
Also, if able and appropriate, it is recommended that you meet first responders near the front door of your facility with distressed resident
during this time in order to minimize response time and facility exposure.


WORKFORCE

 
As COVID-19 continues to develop, many businesses are experiencing layoffs while others are ramping up hiring efforts. To continue supporting Kentucky businesses and citizens in these challenging times, the Kentucky Chamber will be working in partnership with the state government by connecting those experiencing job loss to industries across the state currently in need of talent.

The Kentucky Chamber Workforce Center staff will work with employers looking for talent due to surges experienced with COVID-19. Then, they will work with Kentucky's Workforce and Education Cabinet and Career Centers across the state to identify talent currently experiencing job loss due to COVID-19.

In the past week, an unprecedented number of unemployment claims have been filed. So, how can you help? If you have an employment opportunity, visit here  to fill out information on your facility so they can help recruit candidates to your team! This effort is a public service and of no costs to the employer or citizens of Kentucky. KAHCF/KCAL strongly urges you to take advantage of this process. 


 

Materials


COVID-19 Screening Checklist for Visitors and Employees.

Families First Coronavirus Response Act: Media Materials 

At this time, Kentucky does not have any mandatory curfews or travel restrictions, in the event that this does occur, please see this template emergency letter to your local law enforcement officials explaining the need for healthcare delivery services. 

Gov. Beshear directed the state nursing homes and other long-term care facilities to stop taking visitors. We advise that you immediately stop doing so and follow the guidance provided.
KAHCF/KCAL has designed a sign (approved by the Office of Inspector General) that your facility can post to alert visitors to this change. Click here to download.

Also attached is a form letter you can modify to fit the needs of your facility to notify residents and family members of this change. 

We have received a visitor screening toolkit from our Florida affiliate and have modified it for your facility. This toolkit includes a checklist, letter to families and residents, and posters to hang up in your facility. To download the toolkit, please click here.


KAHCF/KCAL Cancellations/Postponements


KAHCF Board of Directors meeting postponed to Tuesday, May 5.

The Day in Keeneland on April 22, 2020 has officially been cancelled. 

NIPP 2.0 Training scheduled for April 14-15th has been cancelled and will be rescheduled at another date. Check the KAHCF website.

Activity Director Training scheduled for April 20-24 has been postponed to June 22-26, 2020. At this time, we will re-register everyone who is registered for this course. If you have any questions, please contact Angela Porter.

KAHCF 2020 Quality Summit has been rescheduled for June 8-9, 2020. Please make sure to contact the Embassy Suites to change your reservation, they will not automatically do that for you. If you however have registered for the May dates, we will re-register everyone who is registered for this conference. If you are unable to attend, please contact Angela Porter.

KAHCF Day at the Races at Churchill Downs on June 12, 2020 has been cancelled.

 

Member Communications


Due to the unknown length of time the COVID-19 pandemic will potentially affect Kentucky long-term care residents and communities, the Kentucky Association of Health Care Facilities/Kentucky Center for Assisted Living (“KAHCF/KCAL”) has decided to refrain from filling your email inbox with daily COVID-19 updates.

 All COVID-19 communications will be sent on Friday afternoon UNLESS we need to communicate an URGENT COVID-19 message to the membership. If an urgent message is needed, we will send it as soon as we receive the information and determine (to the best of our ability) that it is accurate and useful.    

 

Resources


Activities/Social Interaction Ideas

  • Teepa Snow - 13 Engagement Ideas While Practicing Social Distancing
  • National Certification Council for Activity Professionals COVID-19 website for resources and tips for in-room activity programming.
  • Broad River Rehab has provided their powerpoint presentation, "Staying Close to the Ones You Love via Televisits" which has great information on how to deal with communication with family members with dementia patients and other considerations. 
  • AHCA/NCAL has developed a website that encourages and facilitates people caring social media messages of support for our nursing home and assisted living residents. Please visit here for ideas and share a message of support. #carenotcovid 

Alliant Quality

  • Alliant Quality, the QIN-QIO for seven states in the Southeast, is here to support your needs through the COVID-19 pandemic.  By joining their Nursing Home Collaborative, you will have free access to tools, resources, subject matter experts, and best practices to use in this crisis as well as in your future work to help improve your Total Quality Score, reduce Adverse Drugs Events, reduce unnecessary admissions and readmissions and more.  We will bring value, not burden, to this partnership, but the window is quickly closing on our recruitment deadline of May 1, 2020. Beth Greene – Beth.Greene@allianthealth.org – is the Senior Quality Adviser for the states of Alabama and Kentucky. Beth invites you to participate in the Southern Partners Action Collaborative for Excellence (SPACE).  Please sign up as a collaborative partner to achieve your quality improvement goals, and find the collaborative agreement at https://www.alliantquality.org/news/space-agreement/

American Heart Association

 

CDC Resources

Centers for Medicare and Medicaid Services

Communications

Consulting

  • For Louisville area: Craig Jennings is a former Regional Director of Operations for nursing homes and is currently available for consulting for business startups, operations, marketing, and workforce development. Attached is his resume.

Federal Disaster Resources

HealthPRO Heritage Communications Toolkit

KAHCF/KCAL

Kentucky Board of Nursing

  • The Kentucky Board of Nursing held a special board meeting to address COVID-19. Attached are the notes from meeting.
  • FAQ Patient Abandonment By Nurses here.
 

Kentucky Protection & Advocacy

  • Letter to facilities & programming regarding monitoring during the COVID-19 pandemic
  • For Personal Care Homes - Kentucky Protection & Advocacy and the Administration on Intellectual and Developmental Disabilities, Administration for Community Living, U.S. Department of Health and Human Services has forwarded an easy guide to use at your facility to address COVID-19. Please click here to download the "COVID-19 Information By and For People With Disabilities."

Signage

Society for Post-Acute and Long-Term Care Medicine

Supplies