The Lead November 20, 2020 - LeadingAge Illinois

Assisted Living:
Assisted Living Update
Member Spotlight: Country Lane Memory Care
National Assisted Living Salary and Benefits Study Deadline Extended
Argentum Infection Prevention and Control Guidance

Nursing and Rehabilitation:
CMS Presents Nursing Homes Session at LeadingAge Virtual Annual Meeting

Independent Affordable/Subsidized Housing:
LeadingAge Illinois HUD Member Regional Monthly Meeting Recap
Governor Extends Eviction Moratorium

Home Health and Hospice:
Hospice Compare Going Away

Other:
Monoclonal Antibody Treatments

Top Stories:

LeadingAge Press Conference on Impact of COVID Community Spread and Holidays
On Monday at 11 a.m. CST, LeadingAge will hold a press conference on the impact of COVID community spread and holidays. As coronavirus cases nationwide continue to rise and the death toll among older adults in long term care approaches 100,000, nonprofit aging services leaders from some of the hardest hit states across the country–including Iowa, Wisconsin, and Georgia–will discuss the challenges and call for action as we head into Thanksgiving week. Register here to listen in.

JCAR Approves IDPH Emergency Rules on Testing in Assisted Living
The Joint Committee on Administrative Rules (JCAR) approved emergency rules on Thursday for testing requirements for assisted living supportive living. We are awaiting the official copy from the Illinois Department of Public Health (IDPH), but have been told in our meetings with staff that the rules will mirror the requirements in the skilled nursing testing rules. We will keep you updated on the rules and requirements.

White House Coronavirus Task Force Briefing Recap
The White House Coronavirus Taskforce held a briefing Thursday for the first time since July. A number of important updates were presented.

Here are some highlights:

Deborah Birx talked about heightened community spread and hospital capacity and emphasized the need for vigilance in public health measures like mask wearing, hand washing, and physical distancing.
Anthony Fauci discussed the vaccine data and how effective both the Moderna and Pfizer vaccines are. He emphasized that the process for development was not rushed and that outside parties reviewed Pfizer and Moderna’s data and that both will be carefully reviewed by the FDA. He also discussed the need for continued public health measures saying “The cavalry is coming, but when it is coming, you don’t stop shooting.”
General Gusteve Perna spoke on vaccine distribution. The information on the far right side of this slide shows where the Task Force is targeting for vaccine distribution.
The Pfizer vaccine has to go out in minimum allotments of 975 doses.
Pfizer can distribute vaccine on their own partnering with UPS and FedEx.
“Ancillary kits” will include wipes, diluent, needles, syringes, etc.
The Moderna vaccine has to go out in minimum allotments of 100 doses.
Morderna will add the ancilliary kits at a warehouse, then distribute both pieces together via UPS and FedEx.
100 million ancillary kits to administer vaccines are ready to go when the Emergency Use Authorizations are approved.

Long Term Care Weekly Meeting Recap
As you know, LeadingAge Illinois and the other associations have been meeting weekly during the pandemic with leadership from the Illinois Department of Public Health (IDPH) and the Illinois Department of Healthcare and Family Services (HFS). We had an extended meeting yesterday to discuss a number of important issues impacting members.

Issues and updates included:

Project ECHO:
An update was provided on Project ECHO and the Illinois subcontractors working on the program with nursing homes in Illinois. The Alzheimer’s Association-Illinois Chapter and the University of Chicago are two Illinois subcontractors with the primary ECHO program at the University of New Mexico. The ECHO program is free and provides CEUs as well as compensation to nursing homes that participate.

Vaccinations:
Dr. Wayne A. Duffus, the IDPH chief medical officer provided a presentation on the COVID-19 Vaccine, Operation Warp Speed, and vaccinations in general. Each vaccination trial involved about 30,000 persons. Illinois planning guide is now available online. Millions of doses of the vaccine have been produced already. Chicago will get their own supply. There are eight million people residing outside of Chicago and IDPH will get it out to 80% of the population. Dr. Catherine Counard of IDPH restated that Governor’s messaging that Illinois will not offer the vaccine unless it is safe and effective.

Coverage of Testing:
LeadingAge Illinois again strongly urged the Governor to issue an executive order on coverage of testing. New York and California currently have an order in place for testing coverage. We will continue to press this issue with the departments and administration.

CARES Funding:
HFS reported that round two of the CARES Act funding started going out this week in a rolling process. We expect a more in-depth update from the department next week.

Cases:
Cases in long term care are trending up, but not as high as the spring peak. Dr. Counard said the measures in place appear to be working. The IDPH Director also made that statement this week in one of the Governor’s briefings.

TNA Program:
LeadingAge Illinois again requested a further extension/expansion of the Temporary Nurse Assistant (TNA) program. IDPH is strongly considering it and we will continue to discuss this issue with the department.

With next Thursday being Thanksgiving, we requested that our weekly meeting take place on Tuesday. We are waiting to hear back from the departments and will pass on any important updates if the meeting transpires.

Provider Relief Fund Updates
This week’s Provider Relief Fund (PRF) updates include updates on the Nursing Home Infection Control Incentive Payments, Phase 2 and 3 distributions, CARES Act payments, and more.

Nursing Home Infection Control Incentive Payments:
LeadingAge received the following communication from HHS in response to the submission of 44 member nursing homes who believe they should have qualified for an incentive payment, but did not receive one. Note the highlighted section “Provider Quality Incentive Payments (QIP) were determined using data collected by the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN).

To be eligible for September payments, facilities were required to properly report 10 weeks of NHSN data: the 4 weeks of the September performance period and the 6 preceding weeks. Facilities that believe they were eligible for a September payment, but did not receive a payment, should work directly with NHSN to ensure that their data is accurately represented and data reporting issues do not occur going forward.”

This requirement is listed under “NHSN data quality checks” that are performed for each nursing home and stated in the methodology document (top of p. 2). HHS did not indicate whether this was the reason that each of the our individual member nursing homes did not receive a payment for September. It does underscore yet another reason for our members to be getting their data into NHSN in a timely fashion, as these incentive payments are determined for each month through the end of 2020.

The second portion of the September performance payments were expected to arrive in bank accounts this week. These payments reflect nursing home’s performance on the mortality measure for those who had one or more deaths during the performance period. October Incentive Payments are expected to go out next week.

Phase 2 and 3 Distributions:
HHS continues to move Assisted Living TINs to its curated list. Some of these providers will go through a secondary program integrity list review. LeadingAge and the other associations are continuing to assist HHS in clearing TINs for AL and other providers. The last day for providers whose TIN’s get approved to apply continues to be November 27. The proposed methodology for the add-on payments that are part of Phase 3 is unknown but is under review currently by the White House.

Potential of Phase 4:
It is looking less likely that there will be a Phase 4 distribution under the current Administration as HHS is hoping to announce the Phase 3 distributions at the end of November and have indicated that this will be the “last major PRF announcement.”

CARES Act:
As we reported in an earlier article, the Illinois Department of Healthcare and Family Services (HFS) informed us Thursday that second round allotments began going out this week.

Governor’s COVID-19 Briefings Recap
LeadingAge Illinois continues to monitor the Governor’s daily COVID-19 briefings for information pertinent to members.

Updates this week included:

Cases:
There have been over 621,383 total cases and over 11,178 total deaths.

“It is very hard to keep any establishment COVID-free in the midst of a COVID storm,” said IDPH Director Ngozi Ezike in regards to long term care. “We are doing a good job there. We are hoping to keep cases at a minimum because we have our most treasured individuals who are highly susceptible.”

Hospitalizations (as of Thursday):

6,037 in hospital
1,192 in ICU
587 on ventilators

Testing:
Illinois is averaging 101,000 tests per day and has completed about 9.5 million. The lab holiday schedule has also been released.

Assisted Living:

Assisted Living Update
Lynda Kovarik, division chief of assisted living at the Illinois Department of Public Health (IDPH), was the featured speaker at this week’s LeadingAge Illinois Assisted Living Boot Camp. Over 150 providers connected to the virtual event.

Lynda has worked as a nurse for over 47 years and has been with IDPH for the last 20. She also recently gave LeadingAge Illinois an update on the assisted living program. Her updates included:

There have been no COVID-19 fines to date for assisted living and shared housing communities.
Rules that will spell out testing requirements for assisted living have yet to be released, but in the interim, the Department recommends following testing guidance that nursing homes currently follow.
The IDPH plan is to have testing for surveyors. The details are still in the works at the Department.

The LeadingAge Illinois Assisted Living Cabinet meets early next month to discuss these issues and more as we set our assisted living agenda for 2021.

Argentum Capitol Hill Briefing:
At the federal level, Argentum hosted a Virtual Senior Living Congressional Briefing on Thursday morning, titled Vulnerable Senior Populations in the Pandemic: Many Senior Caregivers Still Waiting for CARES Act Relief. The briefing gave congressional offices the opportunity to hear from caregivers and experts detailing the preparations needed to keep this frail population safe as the pandemic spreads. Other points driven forward during the briefing included:

Despite caring for the population most vulnerable to the COVID-19 virus, many assisted living providers are still waiting for financial relief. As financial resources dwindle, closures are looming. For the senior residents of these communities, who need direct assistance with activities of daily living, such as eating, dressing and personal care, it could mean losing their caregiver and their home.
Assisted living communities are not nursing homes yet provide care for the same vulnerable population. Despite that, these facilities are on track to receive just a small fraction of the relief of nursing homes. This wide discrepancy in relief could leave senior populations even more vulnerable to the pandemic. Nearly 75% of respondents said their expenses related to COVID-19 have increased significantly.
Nearly 40% said they foresee the possibility of closures if their financial situation does not improve.

Member Spotlight: Country Lane Memory Care
Country Lane Memory Care, situated on former farm ground in Riverton, has existed for four years. The family-owned and operated assisted living community began serving their first resident in August of 2016. The 34 specially trained staff members serve 25 residents with early-to-middle stages of Alzheimer’s Disease and other forms of Dementia. The community also offers adult day and respite care.

Cari Claussen, administrator and owner at Country Lane has been in the healthcare industry for over 18 years. Her work started at a hospital when she was still in college and has also included working on elder abuse issues. “I have always had a deeply rooted passion to create quality care for individuals that suffer from Alzheimer’s and Dementia,” explained Cari. “The drive to make a difference for me began when I was 16 years old and visited my grandmother in a local nursing home. She lost her ability to speak. I would arrive at the nursing home to find her alone and not being taken care of. My heart broke for her and I acted as an advocate for her by communicating to the nurses that she needed to be taken care of. I decided that I would always be a voice for the elderly who could not communicate their needs.”

Communicating the needs of the elderly has never been more important, especially for residents with Alzheimer’s and Dementia. Like many of her colleagues in the industry, COVID-19 has equated into the most challenging moment in her career. “I am responsible for my residents’ and employees’ health and safety. I cannot remember a time that that I have felt so much worry for my residents and staff. At the beginning of March, I started doing webinar’s with LeadingAge Illinois and Illinois Department of Public Health. I then realized that this was going to be very serious and was not going to go away for a long time,” said Cari.

Through the pandemic, she has grown an even greater appreciation for her staff. “Even with these difficult times they continue to work hard and take care of our residents,” said Cari.

National Assisted Living Salary and Benefits Study Deadline Extended
Your organization can still participate in the National Assisted Living Salary and Benefits Study. The deadline for the study, conducted in cooperation with LeadingAge has been extended to November 30. The study is conducted by Hospital and Healthcare Compensation Service (HCS). Nationally known, the Report is recognized as the standard for reliable and comprehensive compensation data for ALFs/PCFs/RCFs. The results will report data on 50+ jobs and show salary/hourly rates by unit size, profit type, revenue size, CBSA, state, region, and nationally. Information on 20 fringe benefits will also be reported, including health, dental, vision insurance, 401(k)/403(b) and PTO. Questionnaires can be downloaded here. There is no cost to participate in the study. LeadingAge member participants may purchase the results at the reduced price of $165, versus the $350 nonparticipant rate. The results will be published in January, 2021.

Argentum Infection Prevention and Control Guidance
Working under the direction of Argentum’s COVID Advisory Council, the Infection Prevention and Control Work Group has developed members-only guidance for infection prevention and control (IPC) specifically for assisted living communities.

The comprehensive guidance begins with an overview of the goals for an IPC program and follows with information on 16 infectious diseases, as well as measures and considerations for addressing emerging pathogens. This guidance is intended to help communities assess readiness for various infectious diseases and emerging pathogens, and strengthen operations where appropriate.

Argentum will continue to support members in IPC efforts and provide additional programs and educational opportunities. This IPC guidance will be supported by a webinar in the coming weeks, and we’ll share those details once available.

Nursing and Rehabilitation:

CMS Presents Nursing Homes Session at LeadingAge Virtual Annual Meeting
Evan Shulman, director of the division of nursing homes at CMS, helped wrapped up the LeadingAge annual meeting with a break-out session entitled “Preparing for Your Next Nursing Home Survey”, followed by a live Q&A chat session. Shulman reviewed current nursing home guidance and provided clarification to some pressing questions.

Outbreak Testing:
Shulman reviewed guidance for testing of nursing home residents and staff in response to onset of symptoms, outbreak within the nursing home, and routine staff testing based on county positivity rates. Mr. Shulman clarified that outbreak testing is not triggered by a resident who is admitted to the nursing home with a COVID-19 diagnosis, but rather by a resident who contracts COVID-19 inside the nursing home or while living at the nursing home.

Further, outbreak testing would not necessarily be triggered by a staff member who tests positive but has not been inside the nursing home at any point during the time when the staff member was potentially contagious. For example, a staff member who has been on vacation for two weeks and tests positive prior to return, or a per diem staff member who has not been in the nursing home at any point over the past 2 weeks would not trigger outbreak testing.

If a positive test result is suspected of being a false positive and there are no other active cases of COVID-19 in the nursing home at that time, the nursing home may delay the initiation of outbreak testing until a confirmatory test result is received. Remember, confirmatory tests must be conducted within 48 hours of the initial test. Likewise, the nursing home may delay notification to residents and families and reporting through NHSN until the confirmatory test result is received. If the result pending confirmation is for a resident, the nursing home should delay moving the resident to the COVID-positive unit until the confirmatory result is received; however, transmission-based precautions should be implemented immediately. Shulman also noted that while CMS has specified that test result turn-around times should be 48 hours or less, this time-frame is relative. Test results returned within a more general “two days” is acceptable. Test results that take 3 days or more are not acceptable.

Staff Testing:
Shulman acknowledged that due to CMS’s intended definition of “staff” and the reality that many individuals fitting this definition are not in the nursing home on a regular basis, requiring these individuals to present for regular testing may not be reasonable, and these individuals should be inserted into the nursing home’s testing schedule upon return to the nursing home. For example, a contracted staff member who enters the nursing home once per month would be tested prior to entry, but not required to present for testing otherwise.

Shulman described two additional considerations for the staff testing rule. As included in previous guidance, EMS personnel who are responding to an emergency at the nursing home are not required to be tested prior to entry. These individuals are also exempt from screening to ensure they can attend to the emergency without delay. However, staff providing non-emergent transportation should be tested. Mr. Shulman noted that although these individuals might never enter the nursing home, they pose a risk of transmission to the resident due to the closed environment of the transport vehicle and the consideration that transportation staff may be in contact with multiple residents and multiple healthcare settings. With this in mind, LeadingAge encourages members to reach out to transportation providers to discuss testing and screening procedures. Additionally, one may consider requesting assigned drivers to further limit exposure

When asked about testing of surveyors, Shulman stated that CMS is looking into this issue but confirmed that no federal requirement for testing of surveyors currently exists. As with all individuals entering the nursing home, surveyors should be screened for symptoms and exposure and nursing homes should refer any concerns to the state survey agency.

Visitation:
Guidance and restrictions around visitation remain in place, even during the upcoming holidays. Mr. Shulman reiterated that outdoor visits remain the preferred method of visitation but noted changing seasons make outdoor visitation trickier. Nursing homes in colder climates may consider creative solutions for visitation such as external or adjacent structures and should continue to utilize virtual visitation methods. Nursing homes should use their best judgment in determining whether to cancel outdoor visitation during an outbreak. Mr. Shulman also reminded members that CMS does not recognize a special, exempt role of “essential family caregiver” but nursing homes should keep in mind their discretion to allow compassionate care visits when necessary.

Many members have begun to ask about management of residents who have recovered from COVID-19. While these individuals may not be at as great of a risk for infection (or rather, reinfection) as residents who have not previously recovered from COVID-19 infection, these residents do not warrant exceptions to visitation restrictions, as any visitors to these residents continue to pose a risk of transmission to other residents and staff.

Other Regulatory Matters:
Shulman commended nursing homes for their inventiveness and innovation during this pandemic from resident activities like family parades and outdoor activities to clinical strategies like streaming hand hygiene videos in staff break rooms. He encouraged providers to “keep ears and eyes open” for hints at any regulatory changes that may be coming. Pay attention to the flow of attention to see where regulation might be focused next. He added that with health inspections resuming, health inspection ratings will soon follow, though CMS is not ready at this time to resume quality measures ratings.

CMS has also initiated a podcast series for frontline workers. The goal of the series, “CMS Beyond the Policy: Nursing Home Series for Frontline Clinicians and Staff,” is to reinforce training and infection control to help combat the spread of COVID. This first episode features a conversation between Dr. Shari Ling, CMS Deputy Chief Medical Officer and David Wright, Director of CMS’s Quality Safety & Oversight Group.

Independent Affordable/Subsidized Housing:

LeadingAge Illinois HUD Member Regional Monthly Meeting Recap
Every third Thursday from 12-1 p.m. CST, LeadingAge Illinois hosts the HUD Member Regional Meeting with important updates from LeadingAge National. The meeting is a collaboration with LeadingAge Illinois, LeadingAge Indiana, LeadingAge Minnesota and LeadingAge Missouri.

Gail Burks, a chief in HUD’s Chicago Office, was the special guest of this month’s meeting. She has pledged to continue to join the monthly meetings to give updates from HUD and discuss issues with members. She gave several updates, including:

Continuing Resolution. The federal government is working under a Continuing Resolution (CR) that expires December 10. The CR is linked to FY20 funding. Another CR or a passed federal budget is needed to avoid a federal government shutdown after December 10.
Moratorium on Evictions. There are two in effect. Jason Speaks reported that the Illinois Governor has extended his moratorium on evictions for 30 more days.
RAD for PRAC. The program is a way to capitalize/recapitalize PRAC projects that are now aging and in need of repairs. There are six active applications and one has been closed in Ohio. The application requires a capital needs assessment.
Contract Renewals. Some have not been funded yet. Budgets have been processed.

Linda Couch, vice president of housing policy and Juliana Bilowich, director of housing operations and policy at LeadingAge National also presented on several issues. Their update included:

COVID Relief. LeadingAge is working to convince Congress to pass a robust COVID relief package that includes assisting providers and residents throughout the continuum. The housing ask remains the same, in asking for items such as funding for service coordinators
President-Elect Biden’s Housing Platform. After review of his housing platform, the LeadingAge team has met with President-Elect Biden’s agency review team. The platform has a thorough commitment for housing with calls for investment in affordable housing, access to Section 8 vouchers, renter credits, etc. LeadingAge has provided the agency review team with the LeadingAge housing goals and issues.
Jason reported that he received an update from Illinois Deputy Governor Sol Flores and leaders at the Illinois Department of Public Health (IDPH) that HUD senior housing residents will be prioritized in the state’s mass vaccination program.
Revised Electronic Signature Guidance. HUD provided more information about revisions to their electronic signature guidance recently. HUD’s electronic signature guidance from May, 2020 permits (but does not require) HUD multifamily partners to use electronic signatures and electronic file transmission and retention. The revised Notice replaces the earlier guidance and provides updates to two sections, including the eligible Multifamily Housing programs and access of EIV data by Independent Public Auditors. More information on the electronic signature guidance is available here. LeadingAge has invited HUD staff to join an upcoming Housing Advisory Group call to answer questions about the Notice. You can send advance questions to

Governor Extends Eviction Moratorium
Last Friday, the Governor joined Kristin Faust, executive director at the Illinois Housing Development Authority (IHDA) to announce an extension of the eviction moratorium for another 30 days.

“She has worked around the clock these last few months to help thousands of residents across the state to access housing supports they need,” said the Governor in regards to Faust. “Housing stability has been crucial to help mitigate the spread of COVID-19 and keeping people safe. People need to stay home without fear of eviction. Eviction leads to risk factors of COVID-19,” said the Governor.

On August 10, the Governor launched the largest housing assistance program in the nation in response to COVID, dedicating $300 million to help households pay rent. To date, $182 million in assistance has went to support 36,400 renters ($5,000 per renter) suffering financial hardships due to COVID. Funding is sent directly to landlords for the rent. By the end of 2020, 40,000 renters will be will have received $200 million in rent payments. The program was oversubscribed 2-1.

On June 10, the Governor signed legislation to authorize the funding. By August 10, the application was open. Last week, IHDA reached 30,000 applications. “This has been a herculean effort by the IHDA staff,” said Faust. The program is now open to renters who earned no more than $99,000 per year or $198,000 as joint filers.

Renters unable to pay their rent must submit a declaration form to their landlords , verifying they are unable to pay their rent due to loss of income or expenses during the pandemic. The new order clarifies that enforcement of pre-pandemic eviction orders can move forwards if there are health and safety concerns.

Home Health and Hospice:

Hospice Compare Going Away
Hospice Compare will be going away soon, but you’ll still be able to find the same information about Hospices and other health care providers on Care Compare on the Medicare website. The Provider Data Catalog on the CMS website also makes it easier for you to search and download publicly reported data. Start using these tools today and bookmark these webpages.

Other:

Monoclonal Antibody Treatments
CMS has released a new document on monoclonal antibody treatments, mainly addressing billing and coverage questions. These treatments can be provided in the nursing home and by home health agencies, provided they are equipped to treat severe infusion reaction (such as anaphylaxis) and can activate EMS as needed. The treatments will be covered by Medicare similar to how vaccines are covered. More information is available here.