ATTENTION: NC SENIOR LIVING ASSOCIATION
COVID-19 UPDATE 6/23/2021
A note from Executive Director Jeff Horton -
NCSLA has been proud to offer these helpful updates routinely the past few months as a service to ALL Assisted Living Communities across the state. If you believe these updates have been helpful to you, your staff and residents, we ask that you to consider joining NCSLA. Our whole reason for being is to advocate and provide education to North Carolina's Assisted Living Communities and we need your help and support to continue our mission. Thank you for all that you do!
Below are recent developments regarding COVID-19. Providers are encouraged to check the NC DHHS COVID-19 webpage for the latest updates regarding the virus and the state's response.
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NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 1,011,561 cases, which is a 0.20% increase in cases from Wednesday, June 16th (6/16 had 1,009,531 cases). In addition, there are 442 currently hospitalized and there have been 13,393 deaths related to the virus. The daily percent positive rate of those tested is 2.3%. As of June 21st, there have been 992,097 Patients Presumed to be Recovered. You can view the number of cases and other data Here. To see updated county demographic data for COVID-19 vaccinations, click Here.
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NEW: Governor Cooper Signs an Executive Order to Extend Measures until July 30th - One June 11th, Governor Cooper announced that he signed an Executive Order to extend a variety of measures currently in place to respond to the COVID-19 Pandemic until July 30. Click here to view this Executive Order.
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NEW: Health Officials Urge People to Get COVID-19 Vaccine to Help Combat COVID-19 Delta Variant - Health officials announced an increasing urgency for people to get vaccinated against COVID-19 as the more dangerous new Delta variant is rapidly spreading in the United States, including in North Carolina. The Centers for Disease Control and Prevention classified the Delta variant as a ‘variant of concern’ because it spreads faster than current COVID-19 variants.
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NEW: NC DHHS Announces Expanded Availability of Their At-Home COVID-19 Test Collection - NC DHHS announced the state is expanding availability of its at-home COVID-19 test collection. Any North Carolina resident may receive a Pixel by Labcorp® COVID-19 PCR Test Home Collection Kit that is shipped overnight directly to their homes at no cost. Tests can be used on people age 2 and up.
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NEW: Governor Cooper Announces Your Shot At a Million - Summer Cash Drawings! - Governor Cooper shared an exciting announcement on June 10th to motivate those who have not yet been vaccinated (and thank those who have)! As part of North Carolina’s effort to bring summer back with safe, effective and free COVID-19 vaccines, North Carolina is launching the Your Shot At a Million Summer Cash Drawings. Four vaccinated North Carolinians 18 and older will win $1 million each and four North Carolinians ages 12 to 17 will win $125,000 for post-secondary education. NC DHHS is asking for your help to get the word out.
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Visit SummerVaxCash.com for details about the program.
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Download the Communications Toolkit for resources to promote both drawings
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The drawings are part of the state’s Bringing Summer Back get-out-the-vaccine campaign to increase awareness of the availability and safety of COVID-19 vaccines and encourage North Carolinians to get a COVID-19 vaccination as soon as they can. The vaccines have been thoroughly tested and found to be safe and effective for anyone 12 and older. North Carolinians 18 and over who have received at least one dose of a COVID-19 vaccine will be automatically entered into four drawings for a chance to win a $1 million cash prize. Youth between the ages of 12 and 17 who have received at least one dose of the COVID-19 vaccine will be automatically entered into four drawings to win $125,000 towards post-secondary education. The $125,000 can be used at any post-secondary institution and are awarded by funding a savings account in the NC 529 Plan. The $4 Million Summer Cash and Cash 4 College Drawings will run from June 21st through August 4th. All North Carolina residents 12 and older who have been vaccinated with at least one dose are eligible, some restrictions may apply. Those vaccinated starting on June 10, will be entered twice for each drawing increasing the chance of winning for the newly vaccinated. Drawings will take place every other week on Wednesdays with the first drawing on June 23rd. New entries will close at midnight on the Sunday prior to the Wednesday drawing at midnight. Winners will be verified and then announced.
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NEW: NC DHHS Announces Vaccine Incentive Pilots - NC DHHS wants providers in Mecklenburg, Guildford, Rowan, and Rockingham Counties to be aware of the recently announced vaccine inventive pilot program launching this. Recipients that visit a participating vaccine site during the pilot period or that drive someone to get their vaccine are eligible for a $25 cash card. Currently, only sites in Guilford and Mecklenburg are populated, but more sites are being added shortly. For a list of sites, and more details, click HERE.
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NEW: Revised FAQs from NC DHHS LTC May 6th Webinar - NC DHHS sent out a communication stating that they heard from several of you with questions regarding the Department’s original response to Question No. 13 on the FAQ document from the DHHS “LTC Vaccine and Visitation” Webinar that was held on May 6, 2021. They know how important it is to provide clear information regarding the CDC guidance and they have slightly revised the original response to question No. 13 to provide a more complete answer. The updated FAQ document (click HERE to view) shows the highlighted, revised response to Question No. 13. For your convenience in reviewing the clarification, see below for the excerpted question and the revised response:
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Question No. 13: Do fully vaccinated staff have to continue to wear face shields
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Answer: The CDC has not changed its guidance on PPE in response to an individual staff member or HCP's vaccination status. At this time, yes, all staff should continue to wear a face shield and N95 when working on a “COVID hall” or with a resident who is COVID-positive or under quarantine. In all other situations, all staff regardless of their vaccination status should wear a face mask, and in communities with moderate to substantial transmission, eye protection should be worn during patient care encounters. Eye protection could consist of a face shield or goggles. Facilities should ensure that staff are aware of the difference between a face shield and a face mask and that these elements of PPE are not the same thing.
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NEW: Follow-Up from NC DHHS May 6th LTC Webinar "Vaccine & Visitation" - During the May 6th webinar many providers submitted questions. During the presentation DHHS also provided email addresses where licensed providers could submit their visitation questions. NC DHHS collected all of the questions and organized them into several subject areas to make the FAQ document a convenient reference document for your use. As you’ll see, DHHS received a large number of questions and they hope the answers are useful as you continue expanding visitation in your facilities to allow visitation both indoors and outdoors to the greatest extent safely possible. For providers who weren’t able to join the live “LTC Vaccine and Visitation” webinar presentation on May 6th, it was recorded and below are links where the recording may be accessed. Multiple download links are included in case your local firewalls restrict access to the cloud-based storage services. May 6, 2021 LTC Vaccine and Visitation Recording Links:
- Video Recording:
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Click Here
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Click Here
- Audio Recording:
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Click Here
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UPDATE: NC DHHS Kicks Off Bringing Summer Back Campaign - The North Carolina Department of Health and Human Services kicked off the Bringing Summer Back campaign on May 9th with more than 140 partner organizations across the state registered to rally together to promote COVID-19 vaccination in their communities. The new summer get-out-the-vaccine campaign offers a fun, flexible and community-centered approach that creates a space for every organization and individual to roll up their sleeves and do their part to stop the spread of COVID-19. The campaign will run during two weeks in May (May 9–15 and May 16–21) and two weeks in June (June 6–12 and June 20–26).The more than 140 organizations registered vary and include the business sector, medical organizations, health departments, faith-based organizations, community-based groups and various charitable organizations. Partner activities will vary and are set by participating groups. Groups plan to host vaccine clinics, distribute information about COVID-19 vaccines, offer incentives to those who get vaccinated and participate in other ways that will resonate with their communities.
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NEW: NC DHHS Provides Update On North Carolina's Vaccination Progress - On May 6th, NC DHHS announced more than 50% of adults 18 and older in the state have received at least one dose of COVID-19 vaccine. More than 43% of the adult population is fully vaccinated against the virus. To date, the state has administered more than 7.4 million vaccines. More than 74% of the population over 65 years of age is fully vaccinated, and nearly 40% of the total population of the state, regardless of age, has received at least one dose. The department is working to ensure receiving a COVID-19 vaccine is easy and convenient for anyone 16 and older. The vaccine is widely available through a variety of providers, often with no wait time and without the need for an appointment. To find a vaccine in your area, use the Find a Vaccine Location tool or call 888-675-4567.
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NEW: Johnson & Johnson Vaccine Offered at Greensboro Four Seasons Town Centre in Greensboro, NC - The federally supported COVID-19 Community Vaccination Center in Greensboro at Four Seasons Town Centre began offering the single-dose Johnson & Johnson vaccine, which is available in addition to the two-dose Pfizer vaccine already offered. The vaccination site is offering the Johnson & Johnson and Pfizer vaccines on a walk-in and drive-up basis, without appointment.
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NEW: Governor Cooper and Secretary Cohen Announced Updated Guidelines for NC in Accordance with CDC's Updated Guidelines - Following guidance announced on May 13th from the Centers for Disease Control and Prevention (CDC) that fully vaccinated individuals can safely do most activities without wearing a mask or the need to social distance from others, Governor Cooper and Secretary Cohen announced that North Carolina will remove its indoor mask mandate for most settings. Additionally, the state will lift all mass gathering limits and social distancing requirements. These changes are now in effect as of 1:30 p.m. May 14. Masks will still be required in child care, schools and camps as most children are either not yet vaccinated or are not yet eligible to be vaccinated. Everyone, including people who are fully vaccinated, will still be required to wear a mask in certain settings such as public transportation, health care settings like hospitals, doctor’s offices and long-term care settings like nursing homes, and certain congregate settings like correctional facilities and homeless shelters. NC DHHS will continue to have strong public health recommendations for individuals to continue to protect one another until more people are vaccinated. People who are not vaccinated should wear a mask and maintain distance in all indoor public settings and in outdoor settings when they can't maintain six feet of distance. Read the frequently asked questions for more information.
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NEW: Johnson & Johnson COVID-19 Vaccine Update - Click Here to view MMWR on Recommendations for Johnson and Johnson. Interim Clinical Considerations: COVID-19 vaccines have been updated with specific language below. NC DHHS is still awaiting updated CDC pre-vaccine checklist and they will update the statewide standing order to reflect that. NC DHHS will share when they have that.
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Considerations for use of the Janssen COVID-19 vaccine in certain populations - TTS is a rare syndrome that involves acute venous or arterial thrombosis and new onset thrombocytopenia in patients with no recent known exposure to heparin. In the United States, the majority of persons with TTS that occurred after Janssen COVID-19 vaccination had clots located in cerebral venous sinuses; clots occurred in other unusual locations including in the portal vein and splenic vein, and also included a combination of venous and arterial thromboses. FDA has added a warning to the Janssen COVID-19 vaccine EUA and fact sheets and prescribing information regarding rare clotting events that have been reported among vaccine recipients. The EUA fact sheet should be provided to all vaccine recipients and their caregivers (as relevant) before vaccination with any authorized COVID-19 vaccine.
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Woman aged <50 years - Women aged <50 years can receive any FDA-authorized COVID-19 vaccine. However, they should be aware of the rare risk of TTS after receipt of the Janssen COVID-19 vaccine and the availability of other FDA-authorized COVID-19 vaccines (i.e., mRNA vaccines). The highest rates of TTS per vaccine doses administered were identified in women <50 years of age. TTS reporting rates to VAERS were 7.0 cases per million Janssen COVID-19 vaccine doses administered to women aged 18−49 years and 0.9 per million to women aged ≥50 years.
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People with a history of thrombosis or risk factors for thrombosis - Although the etiology of TTS associated with the Janssen COVID-19 vaccine is unclear, it appears to be similar to another rare immune-mediated syndrome, heparin-induced thrombocytopenia (HIT). Until more information becomes available, experts advise that persons with a history of an episode of an immune-mediated syndrome characterized by thrombosis and thrombocytopenia, such as HIT, should be offered another FDA-authorized COVID-19 vaccine (i.e., mRNA vaccine) if they are within at least 90-180 days after resolution of their illness. Venous thromboembolism (VTE), defined as deep vein thrombosis, pulmonary embolism, or both, are common. The biologic mechanisms for VTE (as well as arterial thrombi) differ from the underlying immune-mediated mechanism for HIT. Based on current knowledge, experts believe that people with risk factors for VTE (e.g., inherited or acquired thrombophilia including Factor V Leiden, prothrombin gene 20210A mutation, antiphospholipid syndrome, protein C, protein S or antithrombin deficiency), or a prior history of other types of thromboses (including cerebral venous sinus thrombosis [CVST]) not associated with thrombocytopenia are unlikely to be at increased risk for TTS. Likewise, although the risk of thrombosis is increased during pregnancy and the postpartum period, and with certain hormonal contraceptives (e.g., combined oral contraceptives, patch, and ring), experts believe that these factors do not make people more susceptible to TTS after receipt of the Janssen COVID-19 vaccine. These people can receive any FDA-authorized vaccine, including the Janssen COVID-19 vaccine.
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Use of aspirin or anticoagulants - People who take aspirin or anticoagulants as part of their routine medications do not need to stop these medications prior to receipt of the Janssen COVID-19 vaccine. It is not recommended that people take aspirin or an anticoagulant before vaccination with the Janssen COVID-19 vaccine or any other FDA-authorized COVID-19 vaccine (i.e., mRNA vaccine).
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NEW: Updated LTCF Visitation & Quarantine Guidance - The Guidance for Visitation and Quarantine in Long Term Care Facilities has been updated to recommend that facilities conduct a risk assessment to consider whether quarantine for residents is needed following off-campus visits. Specific language is below:
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Quarantine is not required for off-campus visits of short duration (e.g, less than 24 hours). However, facilities should consider quarantine for unvaccinated residents. Facilities should conduct a risk assessment taking into consideration the activity of the resident while visiting off-campus.
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Elements to consider in this risk assessment include:
- COVID transmission (e.g., county positivity rate) in the community that the resident will be visiting
- Individual and community (known or perceived) adherence to infection control recommendations (3 W’s)
- There is generally less risk in visiting a single household than a medium or large event that involves more than one household (including but not limited to a group dinner, wedding, or graduation)
- Vaccination status of residents in the facility as well as close contacts to the resident outside of the facility
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NEW: Long-Term Care Facility On-Going COVID-19 Vaccination - Third dose clinics are currently underway, and CVS and Walgreens have agreed to providing first doses of the COVID-19 vaccine to any facility residents and staff members that have not yet had the opportunity to be vaccinated during the third clinics. The CVS/Walgreens partnership is limited to only three clinics so, facilities will have to find an alternate source for second doses for all facility residents and staff members vaccinated during the third clinics. Many long-term care pharmacies throughout the state have been enrolled as COVID-19 vaccine providers to ensure the availability of vaccination services to long-term care facilities once the federal program has ended. If your facility currently works with a long-term care pharmacy, please contact them to coordinate any needed vaccination services your facility may require. If you do not have a pharmacy partner that can provide ongoing vaccinations, the contact information for long-term care pharmacies that are willing to assist with your facilities vaccination needs has been provided. To view the LTC Pharmacy Contact List, click Here.
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NEW: Group 5 Now Eligible for the COVID-19 Vaccine - April 7th marks the opening of vaccine eligibility for Group 5. This means anyone 12 years and older who wants a safe and effective COVID-19 vaccination is eligible to get one. To find a local vaccine provider, visit myspot.nc.gov.
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NEW: CareStart Antigen Test Expiration Date Extension - For facilities that have a CLIA waiver and received the AccessBio CareStart Antigen tests, these tests have received an expiration date extension (9 month shelf life). To read the full notice, click Here.
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NEW: Updated CDC and CMS Visitation and Quarantine Guidance for All Facilities - All licensed long-term care facilities regardless of size must allow visitation to the maximum extent possible following principles outlined in both updated CDC guidance (here) and updated CMS Visitation guidance here. These guidelines recognize that expanding visitation has substantial benefits to residents, and that vaccination of residents and staff can mitigate some of the associated risks of COVID-19. Summary points on federal visitation guidance, as well as, quarantine guidance are below.
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Visitation:
- Outdoor visitation continues to be preferred even when the resident and visitor are fully vaccinated against COVID-19 as this space allows increased space and airflow.
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Facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident or visitor, unless certain scenarios exist, including:
- Unvaccinated residents if the COVID-19 county positivity rate is > 10% AND <70% of residents in the facility are fully vaccinated;
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Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue transmission-based precautions; or
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Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
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DHHS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection prevention, including maintaining physical distancing and conducting visits outdoors whenever possible. However, residents who are fully vaccinated may choose to have close, physical contact with visitors if both parties wear well-fitted masks and perform hand-hygiene before and after contact.
- If a new case of COVID-19 is identified among residents or staff, visitation should be suspended and the facility should immediately conduct outbreak testing. If the first round of facility-wide outbreak testing reveals no additional COVID-19 cases in other areas/units of the facility, then visitation can resume in the unaffected areas/units.
- However, if outbreak testing detects one or more COVID-19 cases in other units of the facility, the facility must stop visitation for both vaccinated and unvaccinated residents until it can meet criteria to end outbreak testing.
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Compassionate care visits, and visits required under federal disability rights law, should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak.
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While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations are outlined in CMS guidance.
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Quarantine:
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Residents leaving the facility for less than 24 hours: quarantine is not recommended for vaccinated or unvaccinated residents (unless there is prolonged close contact with someone with SARS-CoV-2 infection). Residents are encouraged to adhere to the 3 W's.
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For unvaccinated residents that leave the facility for ≥ 24 hours: quarantine is recommended when they return.
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For vaccinated residents that leave the facility for ≥ 24 hours: quarantine is not recommended unless they have had prolonged close contact with someone with SARS-CoV-2 infection while they were outside the facility. An exception to this would be if residents have “traveled”. CDC travel guidance states that individuals who have traveled should quarantine for 14 days after travel (regardless of vaccination status) if they will be having contact with individuals at increased risk for severe illness.
- Fully vaccinated residents being admitted to a LTCF no longer require quarantine as long as they have not been in prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.
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Fully vaccinated residents in LTCFs should continue to quarantine following prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.
- Although not preferred, facilities could consider waiving quarantine for fully vaccinated residents following prolonged close contact with someone with SARS-CoV-2 infection as a strategy to address critical issues (e.g., lack of space, staff, or PPE to safely care for exposed patients or residents) when other options are unsuccessful or unavailable. These decisions could be made in consultation with public health officials and infection control experts.
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Fully vaccinated staff with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure. Work restrictions for the following fully vaccinated staff with higher-risk exposures should still be considered for staff who have underlying immunocompromising conditions (e.g., organ transplantation, cancer treatment), which might impact level of protection provided by the COVID-19 vaccine.
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NEW: Important Update Regarding COVID-19 Antigen Testing Info Required by State - NCSLA has received numerous calls regarding sensitive visitor information (i.e.: their social security number) the state is collecting when facilities are performing antigen (rapid) tests prior to a visitor seeing a resident. Jeff Horton, NCSLA Executive Director, reached out to NC DHHS and their response to the issue is as follows: "While we do prefer to get SSN if we can (since it helps us ensure against duplicate persons), we do understand that this can be sensitive information for some, so it is fine to leave the field blank when testing visitors if they prefer not to provide this information. In those cases, we would ask that the facility be certain to get a full name, address, DOB, and phone number to help us ensure against duplicates."
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NEW: Antigen Tests Available for Long-Term Care Facilities - NC DHHS is provisioning rapid, point-of-care antigen testing supplies to support nursing home, assisted living and adult care facilities to quickly identify and respond to cases of COVID-19. NC DHHS currently has a supply of Abbott BinaxNOW Ag Cards, which any long-term care facility can request to support diagnostic or screening testing for staff, residents or visitors at their facilities. Depending on demand, NC DHHS anticipates being able to supply tests through at least the next 4 months. We will provide additional communication should this timeline change. Please also anticipate future communications regarding long-term testing needs for your facility.
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Types of Testing: The below are approved use cases for antigen tests in long term care settings.
- Symptomatic or close contact testing of residents or staff
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Serial screening testing of staff and/ or residents as recommended by the CDC
- Screening of visitors upon arrival to the facility
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Requirements: Facilities interested in receiving tests from the state must meet ALL of the following requirements:
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CLIA Certificate -- Obtain a CLIA certificate or partner with an entity with a CLIA certificate
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Physician Order -- Secure a signed physician order or elect to use the Statewide Order
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PPE -- Maintain an adequate supply of PPE to perform tests
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Medical Waste -- Adhere to standards to properly handle and dispose of medical waste
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Training -- Ensure all testing personnel have completed BinaxNOW or BD Veritor training
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Reporting -- Verify ability to complete DHHS reporting requirements
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Options for electronic reporting can be found at Getting Started with Automated Reporting: NC DHHS COVID-19. Choices best suited for long-term care facilities are the COVID-19 Laboratory Data Automation (“CLDA”) process or an online tool, eCATR Patient Test Results (PTR ).
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Quarantine & Isolation Support – Sites should have a plan in place to safely quarantine and isolate all residents with suspected or confirmed cases of COVID-19 or who are close contacts of a COVID-19 case and support staff who may be disparately impacted by quarantine and isolation requirements.
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Request process: All facilities that meet the above requirements may apply to apply to request tests via the request form linked here. Please only request tests to meet your needs from the next 4-6 weeks.
- The NC DHHS Antigen Team will review requests on a case-by-case basis. The point-of-contact provided in your request will be contacted within 3-5 business days on the status of your request. Please note that due to anticipated high volume of submissions, request responses may be delayed but be assured that the team is working diligently to process all requests.
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Resources: For more information on antigen testing, please email NCDHHS_Antigen@dhhs.nc.gov. For general COVID-19 response guidance, please see the NCDHHS Toolkit of Long Term Care Facilities.
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NEW: Webinar Link from February 25th Regarding NC DHHS Infection Prevention Updates - NCSLA partnered with Evelyn Cook, Associate Director SPICE, to provide a training for our providers regarding the infection prevention guidance update NC DHHS sent on February 16th. To access the free 1-hour webinar from February 25th, 2021, click the link below:
Evelyn Cook, RN, CIC Associate Director SPICE
To access the slides from this presentation, click HERE
***CEUs for this training were available for the live session only***
- Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine) AND
- Are within 3 months following receipt of the last dose in the series AND
- Have remained asymptomatic since the current COVID-19 exposure.
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LTCF staff: These updated quarantine criteria could be applied when considering work restrictions for fully vaccinated healthcare personnel with higher-risk exposures as a strategy to alleviate staffing shortages.
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Residents of LTCFs: Vaccinated inpatients and residents in healthcare settings should continue to quarantine following an exposure to someone with suspected or confirmed COVID-19. This exception is due to the unknown vaccine effectiveness in this population, the higher risk of severe disease and death, and challenges with social distancing in healthcare settings.
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Residents of LTCFs: New admissions, regardless of vaccination status, should continue to be placed in quarantine.
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NEW: CDC Post-Vaccination IPC Considerations Guidance for Healthcare Personnel & Residents of LTCFs - Fever, fatigue, headache, chills, myalgia, and arthralgia can occur following COVID-19 vaccination. Most symptoms are mild to moderate in severity, occur within the first three days of vaccination, resolve within 1-2 days of onset, and are more frequent and severe following the second dose and among younger persons compared to those who are older (>55 years). Cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell are not consistent with post-vaccination symptoms, and instead may be symptoms of SARS-CoV-2 or another infection.
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Healthcare Personnel/LTCF Staff:
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Until more is known, vaccinated HCP/staff should continue to follow all current infection prevention and control recommendations. This includes use of all PPE for the care of patients or residents requiring transmission-based precautions, and adhering to universal facemask and eye protection, physical distancing, and hand hygiene.
- If staff exhibit typical post-vaccination signs/symptoms, evaluate and exclude from work for 48-72 hours.
- Staff with fever should be excluded from work pending further evaluation, including consideration for SARS-CoV-2 testing.
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Follow return to work criteria for the suspected or confirmed diagnosis. If symptomatic HCP/staff return to work, they should be advised to contact occupational health services (or another designated individual) if symptoms are not improving or persist for more than 2 days.
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In facilities where critical staffing shortages are anticipated or occurring, HCP with fever and systemic signs and symptoms limited only to those observed following vaccination could be considered for work if they feel well enough and are willing. These HCP should be re-evaluated, and viral testing for SARS-CoV-2 considered, if fever does not resolve within 2 days.
- Strategies to minimize the impact of post-vaccination systemic signs and symptoms on healthcare staffing and limit unnecessary work restrictions include:
- Vaccinating HCP preceding 1-2 days off.
- Staggering delivery of vaccine to HCP in the facility so that not all HCP in a single department, service, or unit are vaccinated at the same time.
- Informing HCP about the potential for short-term signs and symptoms post-vaccination and use of nonsteroidal anti-inflammatory medications or acetaminophen.
- Provide timely assessment of HCP with signs and symptoms post-vaccination.
- Offering nonpunitive sick leave options (e.g., paid sick leave) for HCP remove barriers to reporting symptoms.
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LTCF Residents: For symptomatic LTCF residents who have received COVID-19 vaccination in the prior 3 days:
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Pending evaluation, these residents should be restricted to their current room or placed in a single person room (if available) and cared for by healthcare personnel wearing all PPE recommended for residents with suspected or confirmed SARS-CoV-2 infection. They should not be cohorted with residents with confirmed SARS-CoV-2 infection unless they are also confirmed to have SARS-CoV-2 infection through testing.
- Criteria for when Transmission-Based Precautions may be discontinued depend on the results of the evaluation. If the resident’s symptoms resolve within 2 days, precautions can be discontinued. Fever, if present, should have resolved for at least 24 hours before discontinuing precautions.
- Consider viral testing for SARS-CoV-2 if symptoms do not improve or persist for longer than 2 days.
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NEW: Staffing Shortages in LTC Facilities - NC DHHS acknowledges that staffing shortages are a difficult challenge faced by some LTC facilities during their outbreak response. NC DHHS does NOT recommend allowing positive HCP to work before completing their isolation period. It is important for the facility to communicate with LHD and local emergency manager as soon as possible if there is potential for unmet staffing needs.
- If the mitigation strategies listed below have been unsuccessful in meeting staffing needs the facility may consider allowing positive HCP to work with positive residents prior to completing their isolation period.
- Contact temporary staffing agencies/nursing pools
- Contact corporate leadership or other sister facilities for temporary staffing support
- Contact the local emergency manager and local healthcare coalitions for temporary staffing support
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Implement plans to allow asymptomatic HCP who have had a high-risk unprotected exposure to SARS-CoV-2 but are not known to be infected to continue to work
- Implement regional plans to transfer patients with COVID-19 to designated healthcare facilities or alternate care sites
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If staffing shortages continue despite pursuing the strategies listed above, consider implementing criteria to allow HCP with suspected or confirmed COVID-19 who are well enough and willing to work but have not met all the Return to Work criteria to work with positive residents and must follow all appropriate precautions.
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NEW: LTC Vaccination Provider Enrollment - If your long term care pharmacy wishes to enroll as a COVID-19 vaccine provider go to the CVMS Vaccine Support page and click the Register link at the top right of the page to start the process. Follow this link for CVMS Enrollment Instructions/Training it has a large amount of training information including training videos as well. As a reminder, COVID-19 vaccine providers must be qualified under the CDC agreement to prescribe COVID-19 vaccines and authorized under the appropriate NC licensing authority. Enrolled COVID-19 vaccine providers must be credentialed/licensed in North Carolina. Please understand that while currently qualified providers are welcome to enroll, requests will be addressed in an order aligned with the prioritization phases and the timeline for approval will vary. The State will continuously reassess enrollment prioritization based on needs.
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UPDATE: Reminder To Facilities of Requirement to Report Antigen Test Results - Facilities using a point-of-care antigen test device for detection of SARS-CoV-2 are required by State Health Director Order to report all results, positive and negative, of diagnostic testing for SARS-CoV-2, the virus that causes COVID-19. This includes antigen test results. Facilities that are reporting detailed results through Electronic Laboratory Reporting (ELR) or COVID-19 Laboratory Data Automation (CLDA) should include all Antigen testing in your reporting results. Click Here to review the Interim Guidance for LTC Facility Reporting.
If you need consultation regarding this process, please email your
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NEW: Scheduling of Public Hearings for Certificate of Need Applications During the COVID-19 Pandemic - During the COVID-19 pandemic, the Healthcare Planning and Certificate of Need Section asks that no one request a public hearing be held due to the number of people allowed to gather in indoor spaces at this time, social distancing guidelines and restrictions on locations to hold a public hearing. If a public hearing was required by law, members of the public will be given an opportunity to submit remarks in lieu of a public hearing in writing. Remarks should be sent to the project analyst assigned to the review attached to an email. To determine which project analyst to email the remarks to, visit the Healthcare Planning and Certificate of Need website at https://info.ncdhhs.gov/dhsr/coneed/applicationlogs.html. For more details, click Here.
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UPDATE: IMPORTANT UPDATE! Temporary Infection Prevention & Control Rules for ACHs & FCHs -- Effective 12/30/2020 - NCSLA sent out an email message from DHSR on December 30th, 2020 (click Here to view email) regarding updated temporary infection and prevention control rules for ACH and FCH providers. DHSR stated "On December 17, 2020, the N.C. Rules Review Commission approved adult care home rules 10A NCAC 13F .1801 & .1802 and family care homes rules 10A NCAC 13G .1701 & .1702 governing infection prevention and control for temporary adoption. The rules are effective today, December 30, 2020. Temporary rules are effective for 270 days and replace the emergency rules that became effective on October 23, 2020. To access these updated rules, click Here.
You can also contact Jeff Horton at jeff@ncseniorliving.org or at 919-787-2526 for questions or comments regarding the rules.
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NEW: Revised Information Dispute Resolution and Updated DHSR ACLS Raleigh Office Procedures - NCSLA sent out a communication (click Here to view) on Friday, January 8th regarding revised IDR procedures and updated DHSR ACLS Raleigh office procedures related to COVID-19. The revised IDR procedures are related to the guidance provided to limit the spread and prevention of COVID-19. The procedures are effective beginning January 1, 2021 and will soon be posted on the ACLS website. Additionally, the DHSR Adult Care Licensure Section shared that during this time of rising COVID-19 cases, they will not be conducting face-to-face meetings at their Raleigh office, instead utilizing multiple virtual methods. This is a temporary protocol and will be reevaluated in the coming weeks. If you have any questions or concerns, please feel free to contact Ms. Ibtisam Zatari, ACLS Program Manager, at 919-855-3791 or Ibtisam.Zatari@dhhs.nc.gov.
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NEW: Videos Developed by NC DHHS Regarding NC LTC Workers and the COVID-19 Vaccine - Some NCSLA member facilities participated in a collaborative effort with NC DHHS to help them with their vaccine information campaign for Long Term Care staff. NC DHHS Communications team created videos below to help share these messages with facility staff.
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NC Long-Term Care Workers on the COVID-19 Vaccine (90): https://youtu.be/09SWvCAW9Tk
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NC Long-Term Care Workers on the COVID-19 Vaccine (60): https://youtu.be/V5C2Mh8_qok
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NC Long-Term Care Workers on the COVID-19 Vaccine (30): https://youtu.be/RYCQecz0OMY
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NEW: North Carolina Regional Prevention Support Teams: Public Health Nurses to Begin Making Visits - Regional Prevention Support (RPS) teams have been established to assist LTCFs with infection prevention practices by conducting site visits to identify and address infection control gaps and provide education. These visits are collaborative, not regulatory or punitive, and the goal is to focus on quality improvement and patient safety to ensure your facility is doing everything it can to protect residents and staff from COVID-19. Your RPS team may send a letter or call to introduce themselves and discuss the program. Please take advantage of this great opportunity to work with infection control experts and help protect everyone at your facility. They are supposed to be informational in nature and are supposed to be scheduled with the community in advance.
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NEW: NC Medicaid Launches Website for Beneficiaries to Learn More About Medicaid Managed Care - NC DHHS announced on November 6th the launch of NC Medicaid’s managed care enrollment website, www.ncmedicaidplans.gov, in preparation for the launch of Medicaid Managed Care scheduled for July 1st, 2021. The purpose of the enrollment website is to help Medicaid beneficiaries learn more about Medicaid Managed Care. In 2015, the NC General Assembly enacted legislation directing NC DHHS to transition Medicaid and NC Health Choice from a primarily fee-for-service delivery system to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services. The enrollment website provides information about who will have to choose a health plan, who will stay in the traditional Medicaid program (NC Medicaid Direct) and who can choose between the two. It will also share the basic medical and behavioral health benefits that are offered. There will be a list of frequently asked questions and answers to help beneficiaries understand the changes. To read the entire press release, click Here.
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NEW: NC Medicaid Will Cover COVID-19 Testing Costs for the Uninsured - NC Medicaid is reimbursing COVID-19 testing costs for individuals without insurance who enroll in the NC Medicaid Optional COVID-19 Testing (MCV) program. This option was made available to all states through Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA). Enrolled MCV beneficiaries will also qualify for coverage of COVID-19 tests retroactive to June 1, 2020 provided they were uninsured at the time of the test. To qualify, individuals must be uninsured, a resident of North Carolina, and meet the citizenship and legal immigration status requirements of the Medicaid program. NC Medicaid is required to verify citizenship and immigration status. Individuals must qualify for MCV at the time the test was obtained. SPECIAL BULLETIN COVID #128: NC Medicaid Optional COVID-19 Testing Program Online Applications Available and a fact sheet (Click Here) describe the program in more detail. Additionally, a one-page flyer/signage (Click Here) is designed to help raise awareness of this program at testing locations, practices, clinics, health systems, Departments of Social Services and any organization that sees uninsured residents. The fact sheet and flyer are attached and also available at: https://medicaid.ncdhhs.gov/about-us/covid-19-guidance-and-resources/providers
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(Reprint from earlier communication) - CDC Updates Guidance on Duration of COVID-19 Isolation - Isolation can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with the improvement of other symptoms (removes 27 hour criteria). Also, a test-based strategy is no longer recommended to discontinue isolation except in very specific circumstances in consultation with infectious disease experts. Additionally, for persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection and quarantine is not recommended in the event of close contact with an infected person. You can access the updated guidelines Here.
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UPDATE: 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.
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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
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Templates are now available on the Cost Reports and Assessments web page and contain the following documents:
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NC Medicaid COVID Outbreak Report Template Cover (Click Here) provides guidance on completing the following form which is:
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the NC DHB Outbreak Facility Reporting Date Provider Name Template (Click Here)
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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
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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.
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ACH COVID-Outbreak Site PCS Reimbursement Increase -
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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 $8.25 per unit ($33/hr) for all Medicaid PCS beneficiaries in an ACH COVID-Outbreak site. Providers should bill their usual and customary charges.
- 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.
- 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.
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(Re-print from earlier communication) CDC Web-based Training Available - The CDC is offering web-based training on their Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs) webpage which can be found Here. If you scroll to the bottom of the webpage, you will find a number of short (5-7 minute) videos that can be used for staff training on basic infection control practices.
- 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.
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(Re-print from earlier communication) 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, strict 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.
Reducing resident exposure to individuals who are potentially infected with COVID-19 is of paramount importance since our residents are among the highest risk group for infection and mortality from this virus. Thank you and your staff for all you are doing to provide care to our residents during this difficult time in what we all hope will be a temporary event.
If you have questions concerning any aspect of this document, please do not hesitate to contact me at jeff@ncseniorliving.org or 919-787-2526.
Jeff Horton, Executive Director
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North Carolina Senior Living Association
4010 Barrett Dr., Ste. 102
Raleigh, NC 27609
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