The Lead September 25, 2020 - LeadingAge Illinois

Assisted Living:
HHS/Abbott BinaxNOW Webinar Recap

Supportive Living:
Phased Reopening Attestation Forms

Independent Affordable/Subsidized Housing:
Member Spotlight: Embrace Living Communities

Home Health and Hospice:
COVID-19 Hospice Respite Care Relief Act Introduced in U.S. House

Technology:
New Ziegler White Technology Paper

Other:
U.S. Department of Labor Revised Rule on Expanded Paid Leave

Top Stories:

Members Urge Congress to Act for Older Adults in National Day of Action
On September 23, LeadingAge Illinois members joined LeadingAge members throughout the country in contacting their members of Congress and urging them to Act for Older Adults. Illinois members were part of more than 5,400 interactions between providers and congressional offices during the National Day of Action. Special thanks to all members who took part in this effort.

The efforts proved to be timely as U.S. House Speaker Nancy Pelosi (D-CA12th; San Francisco) has reportedly called for a slimmed down version of the HEROES Act. This would signify as action towards additional COVID-19 relief. Speaker Pelosi has reportedly directed House committee chairs to prepare the scaled down version of the Heroes Act that the House passed in May. LeadingAge will be sending a letter to the Speaker with recommendations for items to be included and have requested a meeting for LeadingAge leadership with her staff.

Updates on Visitation and Testing
CMS recently held a national stakeholder call as well as a call with LeadingAge on nursing homes issues (testing, visitation, etc.). Presenters on the national stakeholder call were Lee Fleisher, MD, Chief Medical Officer, Evan Shulman, Director Quality and Safety Branch, and Shari Ling, M.D., Deputy CMS Chief Medical Officer. LeadingAge Illinois also learned more on visitation and testing in the weekly meeting with the Illinois Department of Public Health (IDPH). Here is a recap.

CMS created and implemented a national training program for nursing home staff. Fleisher recommended requiring staff to take this critical training with modules on infection control and other key areas.
The administration issued numerous recommendations to states as well as required testing of staff in nursing homes.
- Point-of-care testing machines have been sent to over 13,000 nursing homes.
- Administration has provided tools such as training, PPE and funding. Fleisher said it is critical to use these to focus on the basic infection control practices the federal government has long required.
Shulman gave an overview of what the administration has done since the onset of the pandemic and the visitation guidance.
- April: FAQs for enabling visitation.
- CMP funding for communicative technologies.
- May: Reopening guidance.
- June: expanded FAQs on the definition of compassionate care and creative ways for visitation to take place.
“The emotional, physical and psychosocial toll is too great on residents and families,” said Shulman. “We are very appreciative of all your efforts to be able to bring residents, their friends and their family together.”
CMS is aware of some issues with false positives returned from the field as testing requirements are being implemented. CMS is looking at refining the guidance. It is too soon right now, however, as they need to understand where this is happening and how the tests are being applied.
CMS is working with states on discrepancies between state visitation guidance/mandates and CMS’s latest visitation guidance released on September 17.
- The Illinois Department of Public Health (IDPH) said in our weekly meeting with the Department that their upcoming reopening guidance will address visitation in light of the new CMS guidance. It is up for final approval with the Governor’s office.
LeadingAge shared with CMS some of the tracking they have done on where state guidance conflicts with CMS guidance to help expedite and sharply focus their efforts. LeadingAge emphasized the difficult position nursing home members are in, juggling conflicting guidance with very eager residents and families.
General indoor visits are restricted in the midst of an outbreak/outbreak testing.
Indoor compassionate care visits may continue in the midst of an outbreak/outbreak testing. Remember compassionate care visits should be exceptional, but are at the discretion of the nursing home.
The most recently-released CMS data on county positivity rates were adjusted to account for low rates of testing. Approximately 350 counties with low rates of testing were placed in the lower testing frequency category than the positivity rate would otherwise indicate because the high positivity rate is determined to be a factor of low rates of testing rather than high rates of viral transmission. For example, a county may have a positivity rate of 23%, but be color-coded as yellow (medium). Nursing homes are to follow the color-code for testing frequency.
CMS states that nursing homes may also follow the color-code for visitation. In the above example, the nursing home may continue to offer indoor visitation (provided no other exclusionary criteria are met).
The new guidance states that residents who are on transmission-based precautions should not have in-person visits (indoor or outdoor) except in compassionate care situations. LeadingAge clarified that this includes residents who are on transmission-based precautions solely due to recent admission/readmission.
Final report on discordant COVID test results. Here’s the final version of the report on the survey LeadingAge and the American Health Care Association (AHCA) did together on discordant test results (the topic originally called “false positives”).

Partners in Quality Virtual Visits Held with U.S. Representatives Casten and Rush
The LeadingAge Illinois Partners in Quality Virtual Visits Campaign held two visits with members of U.S. Congress recently. They are the latest in another round of congressional visits held with members since the pandemic began. The visits were held with U.S. Representative Sean Casten (D-6th District; Glen Ellyn) and U.S. Representative Bobby Rush (D-1st District; Chicago).

Special thanks to the following members for taking part in the recent visits:

Blaire Goldstein, executive director, Oak Trace
Ralph Gaines, CEO, Embrace Living Communities
Dave Opitz, senior director of mission services, Embrace Living Communities
Greg Watson, director of housing operations, Embrace Living Communities

“I appreciate what you do,” said Rep. Casten when addressing members taking part in the visit. He discussed U.S. House appropriations recommendations and asked for feedback from members, who urged him to support the LeadingAge Act for Older Adults asks. A relatively new member of U.S. Congress, Rep. Casten made a visit to Greencastle of Barrington shortly after taking office, where he addressed residents and played the piano for them.

“We will be as supportive as we have been and we are willing to work with you to accomplish our common goals,” said Rep. Rush in the member meeting. “I rely on my staff and I encourage you to keep in contact with them. I am for you, you are my constituents.” Members targeted the LeadingAge senior housing ask during the meeting. Rep. Rush has been a member of the U.S. Congress for over 20 years and has visited members a number of times. His last visit included the presentation of the LeadingAge Illinois Partners in Quality Award.

NHSN Reporting Update
The CDC will soon be updating the COVID-19 module on NHSN to include data elements on flu vaccines. CMS confirmed that data elements on flu vaccines are not mandatory but are strongly encouraged. It would require regulatory action to make this reporting mandatory. Providers should check out the Tables of Instructions located on the NHSN website under “Data Collection Forms and Instructions” to be sure they are responding appropriately to these and other data elements. Providers can also find instructions for increasing their SAMS level access on this site under “Enhancing Data Security.”

CARES Act Funding Update
The Illinois Department of Healthcare and Family Services (HFS) reported at the weekly meeting LeadingAge Illinois and the association has with the Department that the first round of the $435 million CARES Act funding for nursing homes and supportive living has been mailed. HFS is developing a webpage that lists the allocations by provider type. A recipient agreement was mailed out with the checks to providers that must be signed. It provides detailed information on the requirements. HFS will have a provider portal which attestation forms must be sent to. A general repository has been setup for questions or issues.

Governor’s COVID-19 Briefing Recap
This week, Governor Pritzker held two COVID-19 briefings. The first was Monday in Springfield and the second was Wednesday from Chicago. Senator Andy Manar (D-48th District; Bunker Hill) attended the briefing held in Springfield. The Governor reported that Illinois has the lowest COVID-19 positivity rate among neighboring states. Over the course of the summer, Illinois’ rate had gotten as low as 2.6%, but has risen since.

Despite the rise, eight of the 11 regions in the state have seen a decline in positivity rates in the last week. Region 1, which contains Rockford, Dixon and Galena is being monitored closely with a current rate 7.5%. The Governor announced that Region 7 (Will and Kankakee counties) returned to Phase 4 of Restore Illinois on Wednesday. The region brought their positivity rate down to 4.7% since going into mitigation. Region 4 (Metro East), continues to see improvement. They entered mitigation with a 10% positivity rate and stood at 7.3% on Wednesday.

Illinois Department of Public Health Director, Ngozi Ezike, provided a medical update on Wednesday that included:

Cases:

Over 279,114 total cases.
Over 8,508 total total deaths

Hospitalizations:

1,563 in hospital with COVID-19
351 in ICU
144 on ventilators

Flu Vaccinations:
The Director urged Illinoisans to get a flu vaccination. IDPH reported in our weekly meeting with the Department on Thursday afternoon that they have no plans to issue a requirement for long term care staff to get the flu vaccination. However, facilities can require staff get the vaccination as a condition of employment.

Testing:
“Illinois is the number one testing state in the Midwest,” said. Sen. Manar. The state has now completed over 5,231,607 tests. “This is an auspicious moment for our state,” said Governor Pritkzer regarding Illinois’ testing efforts. The Governor reported on three valuable milestones:

Illinois reached a new high with over 74,000 test results in 24 hours.
Illinois is averaging 52,000 tests per day (third in nation behind California and New York).
Illinois, on Saturday, become one of the first states to surpass 5 million tests since the onset of the pandemic.

HHS/Abbott BinaxNOW Webinar Recap
On September 18, the U.S. Department of Health and Human Services (HHS) and Abbott held a webinar for assisted living providers on the BinaxNOW testing. Click here for the webinar slides.

Supportive Living:

Phased Reopening Attestation Forms
The Illinois Department of Healthcare and Family Services (HFS) would like to remind providers to submit their phased reopening attestation forms to Bureau of Long Term Care Regional Supervisors. Click here for a list of providers and the regional supervisor’s contact information.

Independent Affordable/Subsidized Housing:

Member Spotlight: Embrace Living Communities
Embrace Living Communities was founded in 1895 and was originally called “The Bensenville Home.” The organization has went from that single home over a century ago to now 34 communities across three states (Illinois, Florida and Missouri). They serve approximately 2,500 senior residents and have about 150 employees.

Their Illinois communities include Castle Towers in Bensenville, C.A.S.L. in Chicago, Immanuel Residences in Downers Grove, Patten House of Glenview, Peace Memorial Manor in Downers Grove and Greencastle communities in Barrington, North Aurora, Palatine, Rockford, Sterling, and Chicago.

Each year, since the LeadingAge Illinois Partners in Quality program began, Embrace communities have hosted their state and federal legislators to educate the lawmakers on affordable housing and develop a beneficial relationship. They, along with other housing members, have played a strong role in helping build the association’s agenda for senior housing.

Ralph Gaines knows a thing or two about housing. Before being named CEO of Embrace in April, 2020, he served as the Chief Operations Officer at the U.S. Department of Housing and Urban Development (HUD) in the Office of the Secretary. Prior to that role, he served as the Principal Deputy Assistant Secretary of Community Planning and Development.

“HUD’s mission is to provide safe and affordable housing to our country’s most vulnerable citizens. We have a very similar mission at Embrace related to senior affordable housing,” said Ralph. “Taking the time to work in public service for the government provided great leadership awareness and understanding of the critical elements involved in delivering government services and its impact on citizens.”

Since coming to Embrace, Ralph has taken a very active role in LeadingAge Illinois. He has taken part in a number of Partners in Quality virtual visits with members of Congress and has been active and engaged in the monthly HUD member regional meetings. His solid messaging to congressional offices in the virtual visits, grabbed the attention of LeadingAge National, who hosted him as a special guest on their Coronavirus Update Call.

Transitioning from government to the private sector has allowed Ralph to continue to provide for those less fortunate and carry through by leading a mission driven organization. “It’s very rewarding to lead an organization with people who come to work every day with a sense of purpose and meaning. The culture is amazing,” said Ralph.

He knows the challenges the industry faces and has vocalized those challenges in meetings with lawmakers. Those challenges include housing scarcity and increasing demand. “We need to take a holistic approach with the public and private sectors to come up with solutions. There are regulatory challenges that should be addressed,” said Ralph. “We also need to address the financial resource challenges and create an investment environment that attracts all groups.” Embrace currently has a two to five year waiting list for older adults wanting to join one of their communities. That is not uncommon nationally.

Ralph’s, in his role as CEO, is responsible for creating and implementing the organization’s vision and direction. His vision for the organization is to create more of the “Embrace experience” for other seniors needing affordable housing. “I want to create an awareness with the development community, philanthropic community, and property management community; both public and private so they can learn about what we’ve done for the last 125 years,” said Ralph. “Our model has sustained for many years and we’d like to continue to grow and partner with others.”

Home Health and Hospice:

COVID-19 Hospice Respite Care Relief Act Introduced in U.S. House
The COVID-19 Hospice Respite Care Relief Act was introduced recently in the U.S. House. The intent of the legislation is to permit those in hospice to receive Medicare-covered respite care in their homes instead of another setting. There is also companion legislation in the U.S. Senate. LeadingAge is fully-supportive as a partner in the legislation.

Technology:

New Ziegler White Technology Paper
Ziegler announced the publication of their new white paper, “Understanding the Technology Ecosystem for Senior Living & Care.” Within the paper, the authors outline a number of key trends driving the growth of technology in the longevity economy, including the effects of the COVID-19 pandemic, increased technology adoption amongst aging adults, projected caregiver shortages and labor-related challenges, and data-driven evidence that technology can help enhance care delivery. This whitepaper is the first document in what will be a series of technology-related publications from Ziegler.

Other:

U.S. Department of Labor Revised Rule on Expanded Paid Leave
The U.S. Department of Labor (DOL) issued a revised rule recently to clarify the definition of a “health care provider” for purposes of eligibility for expanded paid leave.

The revised rule was issued as a result of a federal court ruling on August 3, 2020 that the initial rule issued on April 1 was too broad in its definition of a health care provider. The new rule reverts to the existing narrow definition under FMLA and adds certain workers who provide diagnostic, preventive, or treatment services that are integrated with and necessary to the provision of patient care. This definition would only cover certain direct care workers in senior living, and not support staff.

The expanded paid leave rules only apply for employers with fewer than 500 employees. More information from Argentum on the revised rule, eligibility, and other considerations are available here.