Coronavirus Update #191
HFAM Update


Friends:

We have been warning about the fall 2020 COVID-19 surge for several weeks. While we hoped it would not come, we have helped prepare leaders and teams in our sector. We have updated on issues relative to testing, government expectations, staffing, and PPE. As always, we stand with you, your teams, and the Marylanders in your care. This recap is critically important, as is your continued preparation and execution. 

Testing

  • Based on lower community positive rates in recent months, random mandatory weekly testing requirements have been relaxed according to federal guidelines and state orders. Some more cautious nursing homes have voluntarily continued with weekly resident and patient PCR commercial lab testing despite the reduced frequency requirements of CMS and state orders. According to research from Brown, Harvard, and the University of Chicago, a higher positivity rate in the community often results in higher positivity rates in nursing homes and assisted living campuses.

  • As we warned earlier, community positivity rates are spiking and we are seeing more isolated positive cases in nursing homes and assisted living centers. And when testing is triggered or more frequent because of a known positive case, we will see positivity rates go up because testing is done with known possible exposure.

  • The difficult task for you and your healthcare heroes remains: follow infectious disease protocols, stop the spread, reduce the mortality. No small task when you consider that nursing homes care for people who by definition are more sick with pre-existing chronic conditions, and as a result are highly vulnerable to COVID-19. We all have COVID fatigue. All teams must be vigilant in mask-wearing and social distancing outside of work, and diligent with PPE use and donning/doffing at work.

NOTE: Cautious nursing homes might consider serial weekly point of care (POC) testing of all staff, POC testing of all visitors and vendors, and weekly PCR commercial testing of patients and residents. In addition, we remain very concerned about the critical need for the testing of ambulance personnel, dialysis employees, and state health inspectors, which has not been ordered.


Personal Protective Equipment

As required by Maryland State Government order, Maryland nursing homes are required to have a 30 day supply of PPE on hand by the end of November, and a 60 day supply by the end of January. Spot shortages of some PPE (currently gloves) and increased prices (due to production supply and demand) remain. We have promoted both Medline and our joint association buying collective with LeadingAge Maryland and LifeSpan.


Staffing and Bridging

Staffing in all healthcare and in our sector was challenging before the pandemic. Your teams are on the front lines against this virus, and staffing has become even more challenging. Elected leaders across the nation who have vilified nursing homes and missed the opportunity to acknowledge our teams' hard work have added to staffing challenges. I know it’s hard, but keep up the good work, praise and support your teams, and remind them that HFAM has had their back since the beginning of this pandemic and will continue to do so.

As we advised the Board on October 14, the State of Maryland’s expectation is that our sector will self-bridge during this fall and winter COVID-19 surge. Unlike the first surge in March and April, state bridge teams of RNs, nurses’ aides, and physicians will be VERY limited. The support of State and National Guard Technical Assistance Teams that have been in all 227 centers in recent weeks to review infectious disease protocols, staffing, and PPE, has been helpful. Even now, those teams are doing a second round of review and instructional visits. But again, the State’s expectation is that our sector will self-bridge during this fall and winter COVID-19 surge. In the earlier March/April surge, HFAM was proactive in coordination with the Maryland Hospital Association, UMMS, Johns Hopkins Medicine, and Lifebridge on issues of emergency RN staff supervision/training support, and in general coordination. We will continue on this front.

NOTE: A new advantage on the infectious disease, acute and post-acute collaboration, and workforce fronts are the federally supported AHRQ ECHO National Nursing Home COVID-19 Action Network being stood-up by Johns Hopkins and MedStar Health. In speaking again today with Michele F. Bellantoni, M.D., C.M.D. from Johns Hopkins Medicine and Bryan O. Buckley, DrPH, MPH from MedStar, I know that all of us are 100 percent dedicated to connecting and collaborating during this long battle against COVOD-19 for the benefit of Marylanders in need and to ensure quality care.
Healthcare Heroes, Thank You
In addition to the healthcare heroes video above:

Click here for the HFAM audio thank you message (March 25, 2020)

Click here for the highlight reel of our healthcare heroes event (September 3, 2020).
Reminders, as always:

  • People first, quality counts.
  • Our sector MUST double our efforts on infectious disease protocol, staffing, PPE, observation, and testing.
  • Train, train, and train teams again on infectious disease protocol.
  • Recognize that COVID-19 fighting fatigue is an issue across the county, not just in our sector.
  • Overcommunicate with residents, patients, families, staff, and government partners.
  • Work with your hospital partners, and coordinate with local and state regulatory partners.
  • Take and document your action; keep a timeline
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we first distributed a couple of months ago.

Be well,
Joe DeMattos
President and CEO
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from our federal and state partners.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.