Welcome to the ALF Provider COVID-19 Webinar with LTCR
March 17, 2021 Handout
A pdf version of this presentation is available in the Handout section of your control panel. Save the file to your computer to view or print l a t e r.
2 COVID-19 Resources
Available resources and tools for ALFs: • COVID-19 Response Plan • COVID-19 Emergency Rules • §553.2001 • §553.2003 • §553.2004 • Frequently Asked Questions • ALF FAQ • Provider Letters • Texas Division of Emergency Management - interactive map for finding testing resources
3 Public Health Regions
Map and contact info for all of the state’s Public Health Regions.
https://www.dshs.texas.gov/regions/default.shtm
4 Provider Letters
• PL 20-37 Reporting Guidance for Long-Term Care Providers (Revised)
• PL 20-42 COVID-19 Response – Expansion of Reopening Visitation
• PL 20-46 Reporting Guidance for Long-Term Care Providers – Point-of-Care Antigen Testing (Revised)
• PL 20-48 Transferring COVID-19 Positive Residents
• PL 20-49 Process to Request Free COVID-19 Point of Care Antigen Test Kits (Revised)
5 Provider Letters
• PL 20-50 Influenza (Flu) Vaccine Guidance during COVID-19
• PL 20-53 Guidance for Activities, Dining, and Volunteers
• PL 21-01 COVID-19 Vaccination Reporting
• PL 21-04 HHSC COVID-19 Reporting Process
• PL 21-06 LTCR Waivers During Severe Winter Weather
6 Webinar Recordings and PDFs
Access recordings and PDFs of previous ALF webinars from the ALF Portal. Click on COVID-19 Resources to expand the accordion to access resources and webinars.
March 3, 2021 ALF webinar: • Listen to the webinar recording here. • Read the webinar slide presentation (PDF).
7 COVID-19 in ALFs
8 BinaxNOW Cards
ALFs in counties where the COVID-19 positivity rate is more than 10 percent can request free COVID-19 testing kits.
PL 20-49 Process to Request Free COVID-19 Point of Care Antigen Test Kits (Revised)
To request free BinaxNOW POC antigen COVID-19 test kits, complete the Attestation for Free Test Kits (LTCR Form 2198)
9 BinaxNOW Cards - Continued
ALF Eligibility: • have a current Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver or a CLIA laboratory certificate; • only use the test kits to test essential caregivers; • administer the test only by provider staff who successfully complete training provided by Abbott Laboratories or who are clinicians with appropriate education and training;
10 BinaxNOW Cards - Continued
ALF Eligibility: • follow all reporting requirements associated with the use of the Binax cards; • report test results appropriately; • not be part of a large corporation; and • continue to seek out community resources to secure testing.
11 BinaxNOW Cards - Continued
To obtain a CLIA Certificate of Waiver for the free BinaxNOW COVID-19 tests, complete Form CMS-116 available on the CMS CLIA website or on the HHSC Health Care Facilities Regulation - Laboratories webpage found under the Application header. Email the form to the regional CLIA licensing group via the HHSC HCF Regulation – Laboratories webpage.
12 Rescheduling Essential Caregiver Visits
ALFs must accommodate essential caregiver (EC) visits, which may not be stopped as a result of a facility outbreak, county positivity rates, or facility policy.
ALFs can, with proper documentation and communication, reschedule an EC visit.
13 Rescheduling EC Visits
Reschedule means to change a visit time or date. If rescheduling the date of the visit, the visit should occur within 48 hours unless the resident is ill with COVID.
Documentation is required if, at the request of the facility, a visit is rescheduled to a different date.
Communication: As soon as possible, a facility must notify the EC and resident of the time and/or date the visit is rescheduled to and the reason it is necessary.
14 Rescheduling EC Visits – Examples
A facility experiences a new outbreak of COVID-19 and chooses to implement facility-wide testing. EC visits must continue with the EC wearing full PPE and the facility may postpone EC visits for a short period of time during contact tracing efforts.
15 Rescheduling EC Visits – Examples (Continued)
The facility has a scheduled training for a significant number of staff pulling them away from EC visits.
The facility may work with the resident and caregiver to reschedule the visit for later in the day.
16 Rescheduling EC Visits – Examples (Continued)
The facility scheduled repairs in a resident’s room and that resident has an EC visit scheduled while repairs are being made.
When possible, the facility must accommodate the visit to occur in a different area of the facility and notify the EC prior to the visit.
If there is no area of the facility to accommodate an EC visit outside of the resident’s room, a visit may be rescheduled.
17 Rescheduling EC Visits – Examples (Continued)
The facility has a staffing shortage for the scheduled timeframe due to staff illnesses. Rescheduling to another date may be the best option to consider with the resident and EC.
Visits should resume as regularly scheduled as soon as practical for the facility and resident.
18 CDC Guidance for Non- Healthcare Settings https://www.cdc.gov/coronavirus/2019 -ncov/vaccines/fully-vaccinated- guidance.html
NOTE: The CDC recommendations apply to non-healthcare settings.
19 CDC Updated Guidance
Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination
Updated Recommendations: • Visitation • Work restriction for asymptomatic HCP and quarantine for asymptomatic patients and residents • SARS-CoV-2 Testing • Use of Personal Protective Equipment
20 CDC Travel Guidance
Reminder for any staff and residents considering travel, please review current CDC Travel Guidance including: • Traveling during COVID-19 • Know your Travel Risk • After you Travel • Travel FAQ
21 CDC Travel Guidance
22 Save our Seniors
• The state will make a concerted effort to vaccinate seniors 65+ to ensure Texans most vulnerable to the consequences of COVID-19 are vaccinated. • The state will work with organizations such as Meals on Wheels and various nursing groups to identify seniors in need of the vaccine. • As part of this, TDEM will focus on identifying and registering homebound seniors and visit homes to administer vaccines. https://gov.texas.gov/news/post/governor- abbott-tdem-launch-first-week-of-save- our-seniors-initiative-in-26-counties
23 Infrastructure Workers
Essential critical infrastructure workers must be admitted to the facility. This includes utility workers, plumbers, electricians, persons conducting maintenance and repairs essential to safety of residents.
For additional information and guidance in identifying essential critical infrastructure workers, please refer to the following document: https://www.cisa.gov/sites/default/files/publica tions/ECIW_4.0_Guidance_on_Essential_Critica l_Infrastructure_Workers_Final3_508_0.pdf
24 Disaster Assistance Online Survey
Texans are urged to fill out the Texas Division of Emergency Management’s State of Texas Assessment Tool to help state and emergency management officials identify damages that occurred during the recent winter storm. Pass this survey on to family, friends and organizations who live and operate in counties not currently declared for federal assistance. Click here to check your county's status. Texans who live in current disaster- declared counties should apply for disaster assistance at disasterassistance.gov.
25 COVID-19 Vaccination Options
HHSC and DSHS have published Long- term Care COVID-19 Vaccination Options (PDF). The resource document provides COVID-19 vaccination options to ALFs. • Enroll as a Texas Vaccine Provider • Partner with Vaccine Provider • Contact local/regional health department or pharmacies • Reach out to [email protected]
26 Monoclonal Antibody Therapy
State Infusion Hotline Now Active to Request Monoclonal Antibodies HHSC LTCR and DSHS want to encourage LTC providers to contact the State Infusion Hotline at 1-800-742- 5990 to request infusions of monoclonal antibodies and a medical team at their facility.
27 Monoclonal Antibody Therapy
State Infusion Hotline Now Active to Request Monoclonal Antibodies Read the letter (PDF) for details and additional monoclonal antibody resources.
28 COVID-19 Vaccination Data Reporting Emergency Rules
Provider Letter 2021-01 COVID-19 Vaccination Reporting
§553.2004(b) Within 24 hours of completing a round of vaccinations, an assisted living facility must accurately report COVID-19 vaccination data for staff and residents to HHSC in the format established by HHSC.
Reminder: Vaccination reporting is a requirement.
29 PL 21-01 COVID-19 Vaccination Reporting
Remember: • Only report vaccinations occurring onsite at the facility; do not include vaccinations that occurred at an off- site pharmacy, doctor’s office, local mass vaccination clinic, etc. • Report vaccinations administered by the facility or a pharmacy partner. • Do not provide cumulative numbers - do not include totals from previous reports in a new report.
30 PL 21-01 COVID-19 Vaccination Reporting for Staff and Residents
ALFs must report the following data to HHSC within 24 hours of completing a round of vaccinations: • Total number of staff and residents who received their first dose of a two-dose vaccine or their only dose of a single-dose COVID-19 vaccine. • Total number of staff and residents who received their second dose of a two-dose vaccine.
31 PL 21-01 COVID-19 Vaccination Reporting
Report vaccination data via Survey Monkey tool: • https://www.surveymonkey.com/r/SRD M2GY
Complete the survey only when you have information to report.
On days when no vaccines are administered, you do not need to complete the survey.
32 COVID-19 Vaccination in Texas
DSHS vaccination dashboard: https://tabexternal.dshs.texas.gov/t/THD/views/COVID- 19VaccineinTexasDashboard/Summary?:origin=card_share _link&:embed=y&:isGuestRedirectFromVizportal=y
33 DSHS Vaccine Resources
Updated COVID-19 Vaccine Information: • COVID-19 Vaccine Information • COVID-19 Vaccine Frequently Asked Questions (FAQs) • COVID-19 Vaccine Allocations • COVID-19 Vaccination Hub Providers
Updated Information for COVID-19 Vaccination Providers: • Information for COVID-19 Vaccination Providers • COVID-19 Vaccine Provider Frequently Asked Questions • COVID-19 Vaccine Provider Webinars
34 COVID-19 Vaccination Phase 1C https://www.dshs.state.tx.us/coronavir us/immunize/vaccine/EVAP- Phase1C.pdf Phase 1C – Persons age 50 and older. The state will continue to work with vaccine providers and other local partners to ensure that people who are in Phase 1A, 1B and 1C have access to the vaccine. Individual providers will have the flexibility to further prioritize vaccination within these groups.
35 Who's Eligible to Get the Vaccine Now?
Texas continues to receive doses of the Pfizer, Moderna, and Johnson & Johnson COVID-19 vaccines, and is distributing statewide to hospitals, pharmacies, local health departments, freestanding ERs, and other clinics.
36 Who's Eligible to Get the Vaccine Now?
Phase 1A: Front-line healthcare workers and residents at long-term care facilities
Phase 1B: People 65+ or people 16+ with a health condition that increases risk of severe COVID-19 illness
Phase 1C: People 50 to 64 years of age
School and Licensed Child Care Personnel: Additional information for educators and school staff is available in the Texas Education Agency (TEA) K-12 COVID-19 Vaccine FAQ.
37 Where to Get Vaccinated
If you’re eligible to get vaccinated now, you can check with a large vaccination hub and/or a local vaccine provider, like a nearby pharmacy or your doctor. Find Vaccine: 1. LARGE VACCINATION HUBS 2. VACCINE AVAILABILITY MAP 3. LIST OF ALL PROVIDERS When searching for a vaccination site, remember: • Vaccine supply is limited. Not all local providers have vaccine each week and hubs may have long waiting lists. • Do not show up at a hub or provider looking for a vaccine. • Instead, check the provider’s website. Call only if the website doesn’t answer your questions.
38 FDA Issues Emergency Use Authorization for Third COVID-19 Vaccine
The FDA has determined that the Johnson & Johnson - Janssen COVID- 19 Vaccine has met the statutory criteria for issuance of an EUA. The Janssen COVID-19 Vaccine is administered as a single dose. The vaccine was approximately 77% effective in preventing severe/critical COVID-19 occurring at least 14 days after vaccination and 85% effective in preventing severe/critical COVID-19 occurring at least 28 days after vaccination.
39 Authorized and Recommended Vaccines
The CDC provides information on who is and is not recommended to receive each vaccine and what to expect after vaccination, as well as ingredients, safety, and effectiveness. Currently, three vaccines are authorized and recommended to prevent COVID-19: • Pfizer • Moderna • Janssen
40 Vaccine Allergic Reaction
The CDC provides recommendations on what to do if you experience an allergic reaction after getting a COVID-19 vaccination. It also provides recommendations for people who have had allergic reactions to other vaccines and for those with other types of allergies. https://www.cdc.gov/coronavirus/2019 -ncov/vaccines/safety/allergic- reaction.html
41 Vaccine Allergic Reaction
Observation period following COVID- 19 vaccination CDC currently recommends that persons without contraindications to vaccination who receive an mRNA COVID- 19 vaccine be observed after vaccination for the following time periods: • 30 minutes: Persons with a history of an immediate allergic reaction of any severity to a vaccine or injectable therapy and persons with a history of anaphylaxis due to any cause. • 15 minutes: All other persons
42 Management of Anaphylaxis after COVID-19 Vaccination
CDC - Interim Considerations: Preparing for the Potential Management of Anaphylaxis after COVID-19 Vaccination
These interim considerations provide recommendations on assessment and management of anaphylaxis following COVID-19 vaccination.
43 Vaccine Allergic Reaction
If you have had a severe allergic reaction to any ingredient in an mRNA COVID-19 vaccine, you should not get either of the currently available mRNA COVID-19 vaccines. If you had a severe allergic reaction after getting the first dose of an mRNA COVID-19 vaccine, CDC recommends that you should not get the second dose.
44 Reporting Vaccine Reactions
The Vaccine Adverse Event Reporting System (VAERS) is co-managed by the CDC and the FDA. VAERS accepts and analyzes reports of adverse events (possible side effects) following vaccination. Use VAERS to report adverse reactions to the COVID vaccine, which are very rare. VAERS
45 CDC Post-Vaccine Considerations for HCP
Do not prevent staff with only post-vaccine symptoms from coming to work.
Strategies to minimize impact on staffing due to post-vaccine symptoms: https://www.cdc.gov/coronavirus/2019- ncov/hcp/post-vaccine-considerations- healthcare-personnel.html
46 Vaccine Resources
Questions related to the Pharmacy Partnership for LTC Program: [email protected]
CDC webpage for the Pharmacy Partnership for LTC Program with FAQs for providers: https://www.cdc.gov/vaccines/covid-19/long- term-care/pharmacy-partnerships.html
Questions regarding COVID-19 vaccine registration can be sent to COVID-19 Registration Support: • Email: [email protected] • Toll-Free: (877) 835-7750
47 CDC Vaccination Toolkit
Long-Term Care Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility This toolkit outlines the importance of COVID-19 vaccination in LTCFs, provides strategies for encouraging COVID-19 vaccination, and includes tools a facility may use to monitor COVID-19 vaccination side effects among staff and residents.
48 CDC Info on COVID-19 Variant Cases
Emerging variants CDC is closely monitoring have mutations in the virus genome that alter the characteristics and cause the virus to act differently in ways significant to public health: • causes more severe disease, • spreads more easily between humans, • requires different treatments, • changes the effectiveness of current vaccines. It’s important to understand that genetic mutations are expected, and some variants can spread and become predominant while others subside. https://www.cdc.gov/coronavirus/2019- ncov/transmission/variant-cases.html
49 COVID-19 Vaccine FAQ
LTCR Publishes COVID-19 Vaccine FAQs HHSC Long-term Care Regulation has published COVID-19 Vaccine Frequently Asked Questions (PDF). The resource document answers commonly asked questions about the COVID-19 vaccine.
50 Essential Caregiver Vaccination
Essential Caregivers can be given the vaccine by the facility if all residents and staff wanting the vaccine have been vaccinated.
EC must meet criteria to receive vaccine.
EC vaccination not required to report.
51 Entry to ALF
An ALF cannot prohibit a person with legal authority from entering the facility unless the person does not pass COVID-19 screening criteria.
Persons with legal authority to enter include: • law enforcement officer • representatives of the long-term care ombudsman's office • government personnel performing their official duties such as LTCR surveyors
52 Screening
COVID-19 screening criteria: • fever defined as a temperature of 100.4 Fahrenheit and above; or • signs or symptoms of COVID-19 as outlined by the CDC; or • contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, is under investigation for COVID-19, or is ill with a respiratory illness, unless the visitor is seeking entry to provide critical assistance; or • has a positive COVID-19 test result from a test performed in the last 10 days.
53 Quarantine Reminders
If a resident leaves and returns on the same day, they do not need to be quarantined unless they fail the screening upon return. Quarantine the resident if: • Upon return screening, the resident has fever or other COVID-19 symptoms, • The resident spent one or more nights away, • The resident had close contact with someone who is COVID-19 positive or has symptoms of the virus, or • Upon return screening, it is determined that during the visit they weren’t able to follow all infection control protocol.
54 Review Emergency Preparedness Plan
Review Emergency Preparedness Plan post winter storm: • Did you follow the plan? • What worked? • What didn’t work? • What can you do better? • Provider Letter 2021-06 LTCR Waivers During Severe Winter Weather (PDF).
55 GovDelivery
To sign-up for Alerts: • Go to: https://service.govdelivery.com/account s/TXHHSC/subscriber/new • Enter your email address. • Confirm your email address, select your delivery preference, and submit a password if you want one. • Select your topics. • When done click “Submit.”
56 LTC Ombudsman
Patty Ducayet State Long-term Care Ombudsman Telework Phone: (737) 704-9075 https://apps.hhs.texas.gov/news_info/ombudsman/
Statewide Contact for an LTC Ombudsman: Phone: (800) 252-2412 or Email: [email protected]
Facebook Live Events Weekly Facebook Live Q&A for Families of LTC Residents: Every Wednesday, 12:15 to 12:45 https://www.facebook.com/texasltcombudsman?fref=ts ALF Chapter 553 Re-org and Legislative Implementation
• Reorganizes the chapter so topics within the rules will be easier to locate and provisions on related subjects will be grouped together to facilitate navigation within the rules.
• Updates rule references throughout the chapter in response to the administrative transfer of the chapter from Title 40, Chapter 92.
58 ALF Chapter 553 Re-org and Legislative Implementation
59 ALF Chapter 553 Re-org and Legislative Implementation (Continued)
• Updates the agency name throughout the chapter from the Department of Aging and Disability Services to HHSC.
• Reflects the transition from paper applications to the use of the online licensure portal, called Texas Unified Licensure Information Portal (TULIP)
60 ALF Chapter 553 Re-org and Legislative Implementation (Continued)
Implements bills passed in the 86th Legislature, Regular Session, 2019.
There will be a new rule to allow for an expedited inspection process to obtain an on-site health inspection.
61 ALF Chapter 553 Re-org and Legislative Implementation (Continued)
New regulation to require an ALF’s infection prevention and control program to include monitoring of key infectious agents, including multidrug-resistant organisms and procedures for making rapid influenza diagnostic tests available to facility residents.
Key infectious agents - Bacteria, viruses, and other microorganisms which cause the most common infections and infectious diseases in long-term care facilities, and can be mitigated by establishing, implementing, maintaining, and enforcing proper infection, prevention, and control policies and procedures.
62 ALF Chapter 553 Re-org and Legislative Implementation (Continued)
The definition of an ALF has changed to include that an ALF may provide health maintenance activities, as defined by the Texas Board of Nursing.
(HMA – tasks that may be exempt from delegation based on RN assessment that enable the client to remain in an independent living environment and go beyond ADLs because of the higher skill level required to perform.)
63 ALF Chapter 553 Re-org and Legislative Implementation (Continued)
The next rule project will propose revising some of the requirements in Chapter 553 to achieve better clarity and to better reflect the current population served in ALFs.
This will begin upon completion of reorganization project.
64 FAQ How to Contact
Jennifer Morrison, Manager [email protected]
LTCR Policy Mailbox [email protected]
COVID-19 Page https://hhs.texas.gov/services/health/coronavirus-covid-19
ALF Provider Portal https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care- providers/assisted-living-facilities-alf
66 Thank you!
67