Preparing for a Surge
For the past couple of weeks, Florida’s Surgeon General Scott Rivkees and Agency for Health Care Administration Secretary Mary Mayhew have been working with hospitals to prepare for a possible surge in the number of hospitalizations, or an increase in the number of COVID-19 patients needing to be hospitalized, especially in the Miami-Dade area. Hospitals are limiting elective surgeries and are looking for alternatives to free up more beds.
Florida is proactively building various field hospitals and mobile ICUs to ensure beds are available when needed. These temporary facilities, now being built in Miami-Dade, Broward, and Duval Counties, will likely focus on non-coronavirus patients, freeing up space in brick-and-mortar hospitals for those with COVID-19. If extra beds are needed, they will be there.
Right now, Florida's emergency managers say more than 20,000 hospital beds are still available versus 841 in use already by COVID-19 patients. For more information, AHCA has provided the public with an
Informational Dashboard
regarding the hospital bed capacity across the state. The dashboard filters the beds by county and by hospital as well as available ICU beds.
DOH/EMS Assessment of Needs Visits
On the March 31st Aging and Vulnerabilities Conference Call, the Department of Health told participants that County Emergency Management Offices have the authority to increase restrictions on business in their communities based on their local conditions. This explains why some ALFs (in Broward County, for example) are being directed during the DOH/EMS Assessment Visits that residents must stay in their rooms, regardless of an outbreak or the health of the resident.
The State Surgeon General and Agency for Health Care Administration representatives told providers during conference calls (3/27-3/30) that there was not a state-wide blanket requirement that residents stay in their rooms*. Keep in mind that even authoritative guidance is changing and continually utilize professional judgment in keeping residents and staff as safe as possible.
The Department of Health is contracting with local Emergency Management Service Departments to extend their reach in determining gaps in nursing homes and assisted living facilities. According to an EMS Representative on today’s FHCA/Agency Partner Call, local EMS departments have assessed 2,800 facilities and reported to DOH that 20% of those have unmet needs.
Should Residents Keep Doors Shut?
Below is information reported by Florida Health Care Association:
There have been several inquiries regarding the AHCA-directed facility visits being conducted by emergency medical services (EMS) and the Department of Health (DOH). In some parts of the state, EMS/DOH have instructed facilities to keep all residents in their rooms with the doors shut.
*Additionally, CDC updates to the guidance below were provided by DOH to Surgeon General Rivkees' guidance:
"Healthy residents do not need to be in their room with the door shut but should be practicing social distancing (at least 6 ft distance between each person) and not be in groups more than 10. Sick patients, however, should be isolated and monitored, and if they meet any of the criteria listed below, have the sick resident(s) tested to determine if they are COVID-19 positive.
- Individuals 65 or older who have new onset lower respiratory track disease or pneumonia
- Individuals with severe underlying medical conditions who have new onset lower respiratory track disease or pneumonia
- Individuals 65 or older with a fever of 100.0 or higher and cough
- Individuals with severe underlying medical conditions with a fever of 100.0 or higher and cough
- Individuals 65 or older with a fever of 100.0 or higher and other respiratory symptoms including shortness of breath
- Individuals with severe underlying medical conditions with a fever of 100.0 or higher and other respiratory symptoms including shortness of breath
- Individuals with diarrhea
Also, this morning, we spoke with a staffer in ESF-8 at the State Emergency Operations Center. He confirmed that the common areas are not closed - just follow the social distancing (6 feet) guidelines. The same for meals for memory care - follow the social distancing guidelines. However, if the facility has the virus, then the rules change and then everything is pretty much on lockdown.
The reason DOH/AHCA staff tend to take a stronger approach is they are using the guidelines created for Broward/Dade that were done in consultation with CDC. They are getting hit hard, so the restrictive guidelines may make sense down there - but not in the rest of the state (at least yet).
(Excerpted from FHCA, 4/1/20)
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Executive Orders from Governor Ron DeSantis:
Governor Ron DeSantis issued
Executive Order 20-88
regarding re-employment of essential personnel. This will allow recently retired law enforcement and healthcare personnel to immediately return to the workforce.
Governor Ron DeSantis issued
Executive Order 20-89
regarding public access restrictions in Miami-Dade County, Broward County, Palm Beach County, and Monroe County. This order will require Monroe, Broward, and Palm Beach County residents to follow the same directives with respect to essential and non-essential businesses as provided in the executive orders signed by Miami-Dade County Mayor Carlos A. Gimenez beginning on March 19.
Residents Tested Positive without Symptoms in CDC Study
Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.
AHCA/NCAL recommends that, unless a person is tested for COVID-19 and negative before admitting them to your building, you should assume the person has COVID-19 regardless of their having or not having symptoms.
AHCA
Approves Temporary Personal Care Attendant Program
A new temporary health care worker category has been established in Florida to help skilled nursing facilities maintain staffing ratios for Certified Nursing Assistants. The new Personal Care Attendant can perform certain limited resident care tasks after completing an 8-hour training program taught by an RN followed by a demonstration of competency. The 8-hour training program has been approved by the State of Florida so that completers may be counted in the skilled nursing facility staff ratios. The program is effective through May 1, 2020.
Hand Sanitizer Resources
If you are interested in purchasing hand sanitizer, we have received the following
list of breweries and companies
making hand sanitizers in Florida. FSLA would like to thank Ron D'Addio from Plastridge Insurance and James McFaddin from Southern Group for providng us with the resources.
