• NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 15,045 cases, which is an 8.4% increase in cases from Friday (5/8 had 13,868 cases). In addition, there are 464 currently hospitalized (10% decrease from Friday, 5/8), there have been 550 deaths related to the virus and it is in 99 counties. You can view the number of cases and other data Here.

• NEW: NC DHHS Launches Program to Match Health Care Workers to Facilities Seeking Staff - Due to COVID-19, many health care facilities in North Carolina, particularly long-term care facilities, are seeking to hire staff for temporary, part-time or full-time roles. There is an urgent need for Registered Nurses and Certified Nursing Assistants, among other roles to supplement current workers and in some cases fill in for workers affected by COVID-19. Interested health care employees with the ability to pick up extra shifts or who may have been laid off from facilities and are seeking full-time roles can register at https://nc.readyop.com/fs/4cjq/697b. Local Health care Facilities affected by COVID-19 and in need of support can request assistance through their local (county) Emergency Management agencies (Click Here), which have the ability to fulfill the support requested within the county. You can read more about the program Here.

• NEW: NC DHHS Releases Flow Chart For Discharge from Hospital to Long Term Care - NC DHHS released a number of updated guidance documents on their website in the past week (Click Here) including a flow chart to follow when discharging someone from a hospital to a long term care facility. You can view/download the flow chart Here. While the guidance allows for transfer of patient with COVID-19 or a patient recovering from COVID-19 to a long term care facility, srtict CDC guidelines (Click Here) must be adhered to as noted below:
• Patients can be discharged from the healthcare facility (hospital) whenever clinically indicated. If discharged to a nursing home or other long-term care facility (e.g., assisted living facility), AND
• Transmission-Based Precautions are still required, they should go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.
• Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.
• Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.

• Positive Media About Assisted Living and COVID-19 - With all the negative press regarding COVID-19 affecting long term care facilities, we encourage you to read the below article and watch the accompanying video which shows how one NCSLA member community adapted to the difficult times and celebrated the birthday of one of its residents. :
• Randolph County community celebrates 105-year-old veteran’s milestone birthday- Read Story Here

• (Re-print from earlier communication) Governor Cooper's New Executive Order Easing Restrictions on Travel, Business Operations and Mass Gatherings Now in Effect Today: Phase I - On May 5th Governor Cooper issued Executive Order #138 (Click Here) which eases restrictions related to COVID-19 in a number of areas. You can read more about easing of restrictions as well as FAQs Here. It should be noted that all restrictions related to long term care facilities, which includes adult care and family care homes, still remain in effect until further notice.

• (Re-print from earlier communication) COVID-19 Status Reporting Template Now Available - Required Reporting to Maintain Retroactive Targeted Rate PCS Rate and Hours Increases for Adult Care Homes (ACHs) Serving COVID-positive Patients - As reported previously, NC Medicaid is directing increased financial assistance to North Carolina Skilled Nursing Facilities (SNF) and Adult Care Homes (ACH) to support addressing the increased costs of caring for COVID-19 residents in a congregate care setting. This targeted assistance is retroactive to April 1, 2020.
• UPDATE: NCSLA vendor member Richard Rutherford has been working through the process of getting the practical details on the Hardship Advance and the increased Medicaid PCS rate and hours and is willing to provide help, free of charge to NCSLA members, any provider that qualifies due to a COVID-19 outbreak in their facility. Richard's contact information is: Email: Medicaidwiz@gmail.com or Cell: (919) 264-2398
• Templates are now available on the Cost Reports and Assessments web page and contain the following documents:
• NC Medicaid COVID Outbreak Report Template Cover (Click Here) provides guidance on completing the following form which is:
• the NC DHB Outbreak Facility Reporting Date Provider Name Template (Click Here)
• For more information, please see SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients
• As noted in earlier NCSLA communications, NC Medicaid will pay providers an Expedited Hardship Advance (payment) based on the adult care home's PCS billings for January and February 2020 and multiplied by a factor of 1.25, the provider can receive a Hardship Advance to help offset the increased costs of caring for COVID-19 residents.
• ACH COVID-Outbreak Site PCS Reimbursement Increase -

1. An ACH COVID-Outbreak site will be assigned NPI-specific rates that allow them to be reimbursed the increased rates for services provided. The current 15-minute unit rate will be increased to $7.50 per unit ($30/hr) for all Medicaid PCS beneficiaries in an ACH COVID-Outbreak site. Providers should bill their usual and customary charges.
2. An ACH COVID-Outbreak site may bill up to 100 additional service hours per month for each beneficiary with current prior approval up to 80 hours per month. 
3. An ACH Outbreak site may bill up to 40 additional service hours per month for each beneficiary with current prior approval greater than 80 hours per month. 

• (Re-print from earlier communication) NCSLA Continues to Work for YOU! - As communicated previously, during the COVID-19 pandemic, NCSLA has continued to work with officials at the NC DHHS and with legislators to communicate our industry's needs during these unprecedented times. As a result, two important bills were passed this past weekend that will positively affect our industry. The two bills are described below and were both signed into law by Governor Cooper yesterday. Once NCSLA has more details regarding the $1,325 SA payments to facilities we will communicate to providers as things progress.
• The first bill is House Bill 1043/Session Law 2020-4 (Click Here) and includes the following, which was based in large part on NCSLA's lobbying and advocacy efforts with members of the General Assembly.
• Section 3.3 (1) of the Bill provides $3.75 million to the NC Senior Living Association for "(i) the purchase of supplies and equipment necessary for life safety, health, and sanitation, such as ventilators, touch-free thermometers, gowns, disinfectant, and sanitizing wipes, and (ii) the purchase of personal protective equipment that meets the federal standards and guidelines from the Centers for Disease Control and Prevention, such as surgical and respiratory masks and gloves". NCSLA will soon begin work of setting up a program that all licensed assisted living facilities in North Carolina may be eligible to receive PPE and equipment to address COVID-19 issues.
• Section 6.3 (30) of the Bill provides for a one time payment of $1325 for each SA resident that is residing in a residential facility that serves SA residents during the period of March 10, 2020 - July 30, 2020. This is the same language that appeared in the Health Committee draft that NCSLA sent out last week and which NCSLA worked very hard on behalf of adult and family care homes serving residents who receive SA.
• The second bill is Senate Bill 704/Session Law 2020-3 (Click Here) which we discussed last week.
• Section 3D.7 of the Bill provides liability protection language that NCSLA had worked on with other health care trade associations. Due to the limitations in PPE, finding sufficient direct care staff to provide care, etc., we believe providers should not be held liable for events related to COVID-19 that are beyond their control.
• Section 3E.3(a) of the Bill requires DHSR to "suspend all annual and biennial inspections and regular monitoring requirements for licensed facilities" except in cases where DHSR "deems necessary to avoid serious injury, harm, impairment, or death to employees, residents, or patients of these facilities."
• Section 3E.3(b) of the Bill requires DHSR to conduct a compliance history of mental health facilities and adult care and family care homes "that were determined to be in violation, assessed penalties, or placed on probation within the six-month period preceding the beginning of the COVID-19 emergency, for noncompliance with rules or statutes or Centers for Disease Control and Prevention guidelines regarding infection control or the proper use of personal protective equipment. DHSR shall require employees of these facilities to undergo immediate training designated by DHSR about infection control and the proper use of personal protective equipment. The training required by this section may be conducted online, by video conference, or in such manner as DHSR determines appropriate under the circumstances."

• (Re-print from earlier communication) Social Security and the CARES Act: Social Security and SSI recipients are eligible for the rebate payments - NCSLA received a number of inquiries this week from providers that are now seeing residents on Social Security or SSI starting to receive rebate checks (up to $1200/adult) as a result of the CARES Act signed into Federal law a few weeks ago. Providers are requesting confirmation that this additional income will NOT affect eligibility for SSI, State/county special assistance, Medicaid or other social programs. A recent document prepared by the US Congress House Committee on Ways and Means (Click Here) states "Like other tax credits, these payments do not count as income or resources for meanstested programs. So receiving a rebate will not interfere with someone’s eligibility for SSI, SNAP, Medicaid, ACA premium credits, TANF, housing assistance, or other income-related federal programs." Therefore, these payments will NOT affect adult care home residents' eligibility for Social Security, SSI, SA, Medicaid or other social program.

• (Re-print from earlier communication) Documents for Use by Adult Care and Family Care Homes Related to COVID-19 - Over the past two months, NCSLA has made available documents providers can use to screen residents and visitors, have hospitals complete prior to discharging someone to an adult care home and other forms that are useful with regards to COVID-19. In addition, NCSLA received additional documents from one of our members yesterday that may prove useful to providers as they strive to provide care during this difficult time to their residents and protect their staff. These documents are listed below and can be downloaded and customized for your facility's use free of charge.
• Daily symptom attestation form - COVID-19
• How facility is responding to COVID-19
• COVID-19 Reporting to work procedures
• COVID-19 Temperature control sheet
• COVID-19 Staff and visitor screening form
• COVID-19 Post-acute care transfer form

• (Re-print from earlier communication) NC DHHS Posting Names of Facilities with COVID-19 Outbreaks - NC DHHS posted the names of the facilities with COVID-19 outbreaks and other information on their website yesterday. You can view/download the information Here. Adult care homes and family care homes are in the Facility Type labeled "Residential Care Facility" which also includes behavioral health group homes and other residential settings. Nursing homes, corrections facilities and others have their own specific categories. According to the release "In a congregate living setting, a COVID-19 outbreak is defined as two or more laboratory-confirmed cases in persons who did not have COVID-19 diagnosed before arrival at the facility. An outbreak is considered over after 28 days have passed since the date of symptom onset of the last case. In situations where all persons in a congregate living setting test positive for COVID-19, the outbreak will be considered over when all persons have recovered or been released from isolation." The data will be updated on Tuesday and Friday by 4 p.m.

• (Re-print from earlier communication) DHSR Waives Certain Licensure Rules As a Result of COVID-19 - As the situation surrounding COVID-19 continues to change rapidly, DHSR approved statewide waivers this past Friday (4/24) for certain licensing requirements applicable to Adult Care Homes and Family Care Homes licensed pursuant to N.C.G.S. § 131D, Article 1, and rules 10A NCAC 13F and 10A NCAC 13G. The waivers will remove the need for providers to make individual requests, subject to the Waiver Terms and Conditions included in the attached Notice (Click Here), waivers are granted pursuant to N.C.G.S. § 131D-7 and the Director of Emergency Management’s request for waiver of certain regulations. This statewide waiver will expire at the conclusion of the Governor’s emergency declaration or sooner as determined by the Department and is subject to the terms and conditions set forth in the Notice. The waivers address the following areas:
• Personnel Requirements and Hiring New Staff
• Tuberculosis Testing
• Criminal Background Checks
• Personal Care Training and Competency
• Training on Care of Diabetic Residents
• Family Care Home Administrator Renewal
• Resident Admissions and Other Requirements
• Tuberculosis Testing Upon Admission
• Annual Medical Exam
• Care Plan
• Medication Orders
• Pharmaceutical Care
• Licensed Health Professional Support Quarterly Reviews and Evaluations
• Visitation and Activities
• Visitation
• Group Activities & Outings
• Nutrition and Food Service
• Disposable Place Settings
• Meal Times & Communal Dining
• Menus
• For questions regarding the Waivers, DHSR asks that providres email them at DHSR.AdultCare.Questions@dhhs.nc.gov . 

• (Re-print from earlier communication) DHSR Announces Additional Temporary Testing Sites for Medication Aide and Administrator Exams - In order to assist adult care home and family care home providers in ensuring there is adequate staff to meet the needs of residents during these challenging times due to COVID-19, the Division of Health Service Regulation Healthcare Personnel Education and Credentialing Section (HCPEC), the DHSR Adult Care Licensure Section (ACLS), and several county Departments of Social Services are partnering to offer additional temporary testing site locations for the medication aide and administrator exams. Throughout the remainder of April and through the end of May, DHSR will be offering multiple testing site locations across the state, on Monday, Wednesday and Friday’s at most sites listed below. Site locations, dates and times are being posted on the HCPEC Branch website https://www.ncnar.org/index1.jsp. Testing schedules can be found at https://info.ncdhhs.gov/dhsr/news.html#hcpr . All individuals who wish to take an exam must register and pay the normal required testing fee. In addition, for the safety of all testers and test proctors, we are taking the following safety and infection prevention measures:
• Tests will be limited to no more than 5 people per scheduled exam.
• Testers will be screened prior to entering the testing location. Any person who exhibits signs or symptoms of respiratory illness or has tested positive for COVID-19 will not be permitted to take the exam and will be asked to reschedule.
• All testers are asked to wear a facemask or other face covering upon entering the exam location and wear the face covering for the duration of the exam. 
• Exam proctors will be disinfecting all tables and writing instruments between exams. 
• Testers will need to remain in the testing room and will not be permitted to travel in other areas of the testing site.

• Below are the temporary additional testing sites. All locations will offer the medication aide exam. Select locations will offer the administrator exam.  Again, please refer to the HCPEC website for details and schedules. 
• Buncombe County – DHSR Black Mountain Office - 952 Old US Hwy 70, Building 17, Black Mountain, NC 28711
• Gaston County DSS - 330 Dr. Martin Luther King Way, Gastonia NC 28052
• Davie County Senior Services - 278 Meroney Street, Mocksville, NC 27028
• Mecklenburg County DSS - Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
• Guilford County DSS - 1203 Maple St. Greensboro, NC 27405
• Cumberland County DSS - 1225 Ramsey Street, Fayetteville, NC 28301
• No testing on Fridays.
• Jones County Civic Center - 832 North Carolina Hwy 58, Trenton, NC 28585
• Pitt County Cooperative Extension - 403 Government Circle Suite 2, Greenville, NC 27834
• Wake County – DHSR, Brown Building, Room 104, Dorothea Dix Campus - 801 Biggs Drive, Raleigh

• (Re-print from earlier communication) NC DHHS Publishes COVID-19 Toolkit for Long Term Care Facilities - The NC DHHS has published a COVID-19 toolkit for long term care facilities on their website which can be found Here. The toolkit contains the following items:
• COVID-19 Outbreak Toolkit for Long-Term Care Settings
• Long-Term Care Infection Prevention Assessment Tool
• Infection Prevention Education Resources for Long-Term Care FacilitiesOpen PDF
• Strategies to Optimize Personal Protective Equipment - FacemaskOpen PDF
• Strategies to Optimize Personal Protective Equipment - GownsOpen PDF
• IP Staffing Worksheet for Long-Term Care Facilities During COVID-19Open PDF
• What to Expect: Response to New COVID-19 Cases or Outbreaks in Long-Term Care Settings

• All long term care providers are encouraged to refer to these resources, particularly in the event a COVID-19 outbreak is discovered in a facility.

• COVID-19 Webinars Still Available on the NCSLA Website - Webinars from April 9th and the 14th are still available on the NCSLA Coronavirus Updates webpage. The April 9th webinar focused on "Infection Prevention in Assisted Living Facilities" and the April 14th webinar was on "COVID-19 Pandemic Legislative and Regulatory Changes: An Assisted Living Facility’s Guide." Both webinars are free of charge.

• Personal Protective Equipment (PPE) resources - In order to save space, NCSLA has now put it's list of PPEf resources into a PDF document which can be viewed/downloaded Here. The document contains embedded links to emails and websites as were found previously in previous communications. Please note that many of the suppliers are obtaining their PPE from overseas; therefore, it may take up to 2 - 3 weeks for the PPE to arrive after an order has been placed. In addition, many of the suppliers require payment for the PPE prior to submitting order for fulfillment as opposed to invoicing and getting paid at a later date.

• (Re-print from earlier communication) Executive Order 131 Now in Effect - This past Monday at 5 p.m. Executive Order 131 (Click Here) went into effect which contains a number of provisions, including for long term care providers. The provisions include:
• Policies for distancing in retail stores
• Lowering the risk in long term care facilities
• The Order sets public health and safety requirements for nursing homes during the public health emergency. The Order encourages (not explicitly required) other long-term care facilities, including adult care and family care homes, to follow the same guidance. Some of the directives include:
• Canceling communal activities, including group meals;
• Taking the temperature of employees and essential personnel when they enter the facility;
• Requiring specific personal protective equipment in the facility;
• Requiring close monitoring of residents for COVID-19 health indicators like body temperature; and
• The Order states these requirements will last until this order is repealed.
• You can read more about lowering the risk in long term care facilities on page 7 of the Order Here

• (Re-print from earlier communication) Additional Information Regarding Canceling Communal and Group Meals: NCSLA has received a number of calls from adult care home providers regarding communal dining issues and the difficulty of ending communal dining and serving residents meals in their rooms. This creates a lot of challenges related to having sufficient staff to perform this function and also providing adequate supervision to residents who require it during meals. As noted above discontinuing communal dining is encouraged/recommended for adult care homes but is not explicitly required. However, below are some things providers have implemented which helps achieve keeping residents separated during meal times: 
• Some facilities have bought the rolling tray tables or other tray tables to be able to serve meals to residents in their rooms. However, other facilities have indicated that this is not feasible for them for whatever reason. In those cases, it is recommended providers considering doing the following:
• Staggering meal times to allow for less number of residents in the dining room at one time
• Utilize other rooms not normally used for dining to be able to space residents further apart and still allow for social distancing and supervision of those residents who need it (activity room, living room, etc.)
• Serve meals to residents who are independent and do not need supervision or feeding assistance in their rooms, and serve those who do need assistance and supervision in the dining room.
• And obviously, serve any residents who are sick in their rooms.

• Facilities are encouraged to adhere to these recommendations the best they can and to the greatest extent possible. 

• (Re-print from earlier communication) NCDHHS to offer relief to essential workers for child care, bonuses to child care staff - The NCDHHS is providing financial assistance to help essential workers afford child care and bonuses to child care teachers and staff who provide care during the COVID-19. Information about the program including the COVID-19 Parent Application for Financial Assistance for Emergency Child Care can be found Here. Since adult and family care home staff are considered essential workers, many adult care home staff with children may be eligible to use this service to assist with child care needs during the COVID-19 pandemic.

• (Re-print from earlier communication) Division of Health Service Regulation (DHSR) Releases New Guidance for Long Term Care Facilities - The DHSR notified NCSLA last evening that they have adopted the latest guidance from the Centers for Medicare and Medicaid Services (CMS) for nursing homes (long term care facilities) to also be used for adult care and family care home providers. The guidance can be viewed/downloaded Here (Note: The guidance document contains links to the referenced materials below, i.e. CDC guidance, etc.) The new guidance addresses five areas:

1. Nursing Homes (long term care facilities including adult and family care homes) should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.
2. As long-term care facilities 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 urges State and local leaders to consider the needs of long-term care facilities with respect to supplies of PPE and COVID-19 tests.
3. Long-term care facilities should immediately implement symptom screening for all
4. Long-term care facilities should ensure all staff are 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.
5. To avoid transmission within long-term care facilities, facilities should use separate staffing teams for COVID-19-positive residents to the best of their ability, and 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. 

• (Re-print from earlier communication) NC Department of Public Safety (DPS) Issues Guidelines for Allocation of Personal Protective Equipment (PPE) - The DPS, which includes the state Division of Emergency Management and is coordinating the state's response to COVID-19, issued guidance yesterday regarding the allocation of PPE. As NCSLA has previously communicated, supplies of PPE are low and we have learned that North Carolina only received approximately 33% of the PPE they requested from the Federal Government. As a result, the DPS has issued guidelines (Click Here) that show the priority of how the state's supply of PPE will be distributed. The guidelines are divided into three groups with Group 1 being the highest priority. Adult care homes with identified COVID-19 infections are in Group 1 and should receive priority if a request is made for PPE. Because state supplies of PPE are limited, it is highly recommended that providers attempt to obtain their own PPE (resources identified below) since it is possible as the COVD-19 outbreak becomes more severe, the state's supply of PPE will be depleted.

• (Re-print from earlier communication) Requesting PPE from the Local Emergency Management Agency - We continue to hear from providers that have run out of or running low on supplies of PPE (masks, gowns, gloves, etc.) that they have contacted their County Emergency Management Agency and have been told the PPE supplies are limited.

• **We encourage members that need PPE to keep checking in with your County Emergency Management Agency on at least a weekly basis to re-emphasize the need for PPE to protect your staff and residents. **

• The COVID-19 Healthcare Coalition for Critical Equipment and Supplies recently provided the following forms (Healthcare Guidance for PPE and PPE Request Process) for providers to use when determining their burn rate of PPE and the request process for PPE. According to the state's Healthcare Coalition for COVID-19, if a long term care facility has a resident with COVID-19 and is at risk of exhausting their supplies of PPE, immediately contact your County Emergency Management Agency, it is imperative that you explicitly communicate this information to the Agency so they can work with their Healthcare Coalition to locate PPE and help get it to your facility.