COVID-19 UPDATE #18
April 6, 2020
THE DEPARTMENT OF HEALTH ISSUES UPDATED GUIDANCE FOR HEALTHCARE WORKERS WITH CONFIRMED COVID-19 POSITIVE AND EXPOSURES
While our LTC facilities are struggling to meet staffing needs, it remains crucial that healthcare workers in all settings, and most importantly assisted living and skilled nursing facilities, remain healthy and able to work without transmitting COVID-19 within the facility and the greater community. In order to assist facilities to determine when COVID confirmed (symptomatic or asymptomatic), exposed, and/or symptomatic employees  may remain at or return to work and the need for necessary precautions, the Washington Department of Health has released updated guidance. The updated guidelines can be found here .
DIFFICULT TO DISCHARGE RESIDENTS
About ten days ago the Department of Social and Health Services (DSHS) sent all skilled nursing providers a notice referencing a $100 PPD rate increase for difficult-to-discharge residents who have been backed up in hospitals for more than 100 days. Here is an FAQ related to skilled nursing facility exceptional rates in support of the surge being done by Home and Community Services Division and Managed Care Organizations to expedite transitions of individuals who are functionally eligible for long term services and supports out of acute hospital care. The document contains contact information should you have specific questions.
DSHS FREEZES EMERGENCY SPENDING THROUGH APRIL
Washington State’s federal match (FMAP) for Medicaid was increased by 6.2 percent in recent federal legislation. The goal of this additional funding is to support the DSHS response to the COVID-19 pandemic. Facility rates for skilled nursing facilities and DDA residential providers were increased with these dollars; enhanced rates are intended to help move patients out of acute care hospitals. Despite our request for additional funding for Medicaid-contracted providers in assisted living, we have seen no increased funding for Medicaid clients.
 
DSHS Secretary Cheryl Strange issued a letter  yesterday (Sunday, April 5) notifying the DSHS executive cabinet and budget directors that, since the Department is unable to assess the full extent and fiscal impact of the COVID-19 response, additional spending decisions related to these funds will not be made in April. We will continue to advocate for additional funding in assisted living centers serving Medicaid clients, given the ongoing challenges these providers face with new infection control standards and staffing pressures. We are communicating our frustration and concern at the highest levels.
UPDATED: WHEN COVID-19 GETS INTO YOUR LTC FACILITY (ASSUME IT IS ALREADY THERE)
AHCA/NCAL has updated this resource  as COVID-19 is rapidly spreading across the country and is increasingly impacting nursing homes and assisted living communities. Due to the rapid progression of this virus, centers should assume it is already in their surrounding community and may be in their facility. This resource outlines four action steps.
UPDATED: COHORTING RESIDENTS DURING COVID-19
AHCA/NCAL has updated this cohorting consideration guide , as CMS released new guidance  on April 2 related to this topic. 

Pursuant to CMS guidance, all nursing homes and assisted living communities should make plans for cohorting residents now, even before COVID-19 enters the building. Cohorting is imperative to help control the spread of the virus. If possible, nursing homes and assisted living communities should also begin preparing wings, units, or floors as “isolation units.” An isolation unit should be a separate, well-ventilated area, ideally with a separate entrance.
CDC ISSUES REPORT ON ASSISTED LIVING COVID-19 EXPERIENCE IN SEATTLE
CMS released a Morbidity and Mortality Weekly Report (MMWR) on April 3 on an assisted living and independent living community in Seattle related to the COVID-19 outbreak. The report found that early intervention, increased social distancing among residents, and less contact with health care providers were possibly effective at minimizing the spread of the virus in an assisted living setting.

The report also found that symptom screening is unlikely to be sufficient to identify all persons infected. Three of four residents who had positive test results were asymptomatic. All assisted living providers are strongly encouraged to review CDC guidance for LTC Facilities  as well as AHCA/NCAL’s guidance for Assisted Living  on limiting the spread of COVID-19, and are encouraged to minimize the number of interactions with residents by reducing the number of various (non-essential) people entering the building, targeting the number of interactions with residents , and instituting non-communal dining . Many thanks to Dr. Albert Munanga of Era Living for contributing to the MMWR.
USE OF CLOTH FACE COVERINGS TO SLOW THE SPREAD OF COVID-19
The Centers for Disease Control and Prevention (CDC) recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies),  especially in areas of significant community-based transmission.

CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure. AHCA/NCAL references the use of cloth masks (referred to as “source control masks”) for all residents and non-caregiving staff to minimize spread.

Cloth face coverings should not be placed on anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance. The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance. Read more about cloth face coverings and refer to the CDC Q&A about cloth face coverings.
DEPARTMENT OF HEALTH TO HOST WEBINAR THURSDAY, APRIL 9 | 11 AM
Join leaders and experts from the Department of Health each Thursday at 11 AM to receive an update on current COVID-19 impacts and resources for long term care. They review FAQs they are receiving, and they make themselves available to answer questions. Visit the WHCA COVID-19 resources page for Q&A information from previous calls. The webinar is free and open to all. Click here to join the meeting.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website . If you have questions or need additional information, please call the WHCA office at (800) 562-6170.