COVID-19 UPDATE #261

September 13, 2022

A Dear Administrator Letter dated September 13, 2022, informs providers that CDC up to date guidance was revised September 2, 2022, to include recommendations that anyone 12 years of age or older receive one updated Pfizer or Moderna (bivalent) booster.  

The bivalent vaccine should be available to long term care settings over the next three months.  Until the bivalent vaccine is available, a person is up to date on all COVID-19 vaccines when they have received all eligible vaccine doses in the primary series and all recommended monovalent booster doses. Once the bivalent vaccine is widely available, up to date will mean boosted with a bivalent vaccine.

The letter advises long term care settings must:

• Actively monitor and document bivalent dose availability through your vaccine provider.
• Once the bivalent booster vaccine is available, offer the bivalent booster to residents.
• Follow DOH Guidance
• Contact DOH to request vaccine assistance, if needed.  DOH can assist coordinating with LTC pharmacies, local health, or other resources to get assistance for vaccinations onsite at facilities of all sizes.

If you have further questions, please do not hesitate to reach out to DOH or DSHS (RCS) at: DOH:  DOH-HAI-COVID@doh.wa.gov DSHS (RCS): RCSpolicy@dshs.wa.gov 

In a Dear Administrator Letter dated September 9, 2022, DSHS advises several proclamations issued in response to the COVID-19 pandemic state of emergency will be rescinded October 27, 2022, including proclamations which waived and suspended rules and laws in long term care settings. To see the list of requirements waived by these proclamations and the actions being taken in preparation for the end of the proclamations, click here.

AHCA/NCAL reports that members of Congress on both sides of the aisle are asking the Centers for Medicare and Medicaid Services (CMS) to work with lawmakers to address historical workforce challenges in long term care.

Last week, a bipartisan group of 14 federal lawmakers, led by Congressman Brett Guthrie (R-KY-2), sent a letter to CMS, requesting the agency’s support of H.R. 7744, the Building America’s Healthcare Workforce Act. The legislation would extend the 1135 waiver flexibilities for a period of 24 months upon the end of the COVID-19 public health emergency (PHE) declaration. The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) supported the bill when it was introduced earlier this year.

The flexibilities have been critical in allowing long term care facilities to hire temporary nurse aides (TNAs) during the COVID-19 pandemic, especially as nursing homes continue to face the worst job loss compared to all other health care sectors. TNAs provide companionship and assistance to residents for non-clinical, everyday tasks. More than 300,000 heroes stepped up to serve seniors during the pandemic by completing online training to become a TNA. A survey of TNAs found that more than 80 percent are interested in becoming certified nursing assistants (CNAs). However, nationwide, many aides face delays in earning their certification due to state training and testing backlogs.

Earlier this year, CMS announced it was ending the 1135 waiver ending the employment of TNAs as members of the caregiving team in just a few weeks, on October 7. However, the agency recently announced a partial option, offering states and nursing facilities the ability to apply for a short-term waiver. While this was a step in the right direction, industry experts argue that training and testing delays that currently exist in the majority of states may extend well beyond the PHE.

View the full letter here.

A Dear Administrator Letter dated September 9, 2022, advises SNF providers that the waiver allowing NARs to work in nursing homes without completing certification ended June 5, 2022.  Nursing homes must not allow NARs hired on or before that date and who have not obtained certification to continue working after October 5, 2022.  While DSHS and DOH are requesting a waiver from CDC to extend this timeline, facilities are urged not to wait and are strongly encouraged to direct staff to complete certification as soon as possible. 

For more information regarding the DOH Mass Testing project, dates/locations, and how to register, click here https://www.whca.org/nac-testing/

NHSN announced updates and modifications being released for the long term care facility component of NHSN. The changes will take effect after the September 2022 NHSN release, and several are a result of AHCA/NCAL efforts. Read More.

Join Comagine for monthly interactive sessions designed to address questions about barriers or issues regarding adult vaccinations and offer opportunities for problem solving and discussion. During the meetings, Comagine will share community risk data, updates to immunization regulations or current guidance, as well as educational resources.  

To find out more about Comagine Health Vaccination Station, click here. To register, click here. 

The WA State DOH HAI/AR Occupational Health Team provides support for LTC facilities on the L&I standard for respiratory protection. Support includes training and answering questions/concerns on respiratory protection, assisting with the cost of the medical evaluation and fit testing, and providing training on how to conduct a valid fit test.

The DOH Occupational Health team can help keep you be compliant with the L&I rules and regulation on respiratory protection, and prepare your facility for the next potential outbreak. With high staff turnover rates, don’t wait for the next outbreak; visit www.doh.wa.gov/ltcrpp now to learn how to stay compliant with the respiratory protection rules and regulations or email your questions HAI-FitTest@doh.wa.gov