Agenda COVID-19 Long-Term Care Facilities and Task Force TN Nursing - - PowerPoint PPT Presentation

Tennessee Health Disparities Task Force

Agenda

COVID-19 Long-Term Care Facilities and Task Force TN Nursing Home Civil Monetary Penalty Reinvestment Program Member Comments/Announcements

Office of Health Disparities Elimination November 5, 2020

https://www.tn.gov/health/health-program-areas/dmhde/covid-19-health-disparity-task-force.html

COVID-19 Long -Term Care Facilities

Presenters

Sally Pitt, Director, Office of Patient Care Advocacy, Tennessee Department of Health Caroline Tippens, Esq., CHC, Senior Associate General Counsel, Office of General Counsel, Tennessee Department of Health

Discussion

• Brief overview of TN COVID-19 Long Term Care Task Force
• CMS and TDH Long-Term Care Visitation Guidance:

Compassionate Care and Essential Caregivers

COVID-19 LTC Task Force

Task Force Members

• Long-Term Care Resident and Family

Members

• Long-Term Care Administrators
• Long-Term Care Providers
• AARP Tennessee
• Alzheimer’s Tennessee
• Alzheimer’s Association
• Community Advocates
• Tennessee Health Care Association
• Tennessee LeadingAge
• Tennessee Hospital Association
• Tennessee Nurses Association
• Tennessee Association for Home Care
• Tennessee General Assembly ( State

Senator and State Representative)

• Area on Agency on Aging and Disability
• Department of Health
• Department of Mental Health and

Substance Abuse

• Department of Intellectual and

Developmental Disability

• Commission on Aging and Disability

State Long-Term Care Ombudsman

• Tennessee Division of TennCare
• Quality Improvement Organization
• Medicaid Managed Care Organizations
• Industry Leaders and Organizations
• Community Behavioral Health
• Tennessee Latin American Chamber of

Commerce

Charge for the COVID-19 LTC Task Force

• Purpose

– Engage state, local and community stakeholders and state government to establish a formal structure for collaboration in the conceptualization and implementation of policies and strategies to minimize the spread and impact of COVID-19 in long term care facilities and health care systems.

• Objectives

– Monitor the safety and effectiveness of the expanded visitation and activity guidelines and refine them, as necessary. – Identify emerging issues to create visibility and focus on key priorities across the long-term care system.

Focus Areas

• Staffing/Delivery of Care
• Visitation
• Transitions of Care
• Mental Health

COVID-19 Visitation Guidance: Compassionate Care and Essential Caregivers

Compassionate Care and Essential Caregivers

Defining “compassionate care” visitation situations

March 13, 2020: CMS guidance allows visitors in nursing facilities only in compassionate care situations.

• The guidance gives one example of a compassionate care situation – “an

end-of-life situation.”

Reference: https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf

CMS Guidance: Compassionate Care Visitation

June 23, 2020: CMS clarifies provisions for compassionate care situations. It is allowed for more than just end-of-life situations, but should not be allowed routinely, and should be governed by local authorities and managers.

• Facilities are encouraged to consult with state leadership, families, and long-

term care ombudsman, to help determine if a visit should be conducted for compassionate care.

• Visits should not be routine and allowed on a limited basis as an exception to

restricting visitation.

Reference: https://www.cms.gov/files/document/covid-visitation-nursing-home-residents.pdf

CMS Guidance: Compassionate Care Visitation Continued

Examples of compassionate care situations:

• A resident who was living with their family before recently being

admitted to a nursing home.

• Allowing someone to visit a resident whose friend or family member

recently passed away.

Reference: https://www.cms.gov/files/document/covid-visitation-nursing-home-residents.pdf

CMS Guidance: Compassionate Care Visitation Continued

May 22, 2020: Nursing home and long-term care facility visitation restrictions were initially implemented in Executive Order #38.

• No guidance specific to “compassionate care visitation” was issued. Instead, the term “end of

life care” was used.

• The Facility determines in its judgment that: (1) the visit involves the provision of critical

assistance to a Resident; or (2) the visit is to a Resident receiving end-of-life care. (Emphasis added.) Amendments:

• Executive Order #49 was issued on June 12, 2020 and deleted paragraph 6 in its

entirety.

• Executive Order #50 was issued on June 29, 2020 which extended the provisions of

Executive Order #49 through August 29, 2020.

References: https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee38.pdf; https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee49.pdf ; https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee50.pdf

Governor Lee’s Executive Order: Visitation Guidance

Tennessee Department of Health Guidance: Compassionate Care Visitation

June 15, 2020 ( updated): Tennessee Department of Health’s COVID-19 Long-Term Care Facility Guidance:

• No guidance was issued specifically regarding “compassionate care visitation.”
• Persons should not visit a Resident in a Facility unless:

The Facility determines that the visit: 1. (A) Involves accommodations for support for Residents with disabilities, the provision of critical assistance to a Resident, or religious exercise; or (B) Is to a Resident receiving end-of- life care.

• The phrase “end-of-life care” was used in Executive Order #38.

Reference: https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/LTCF_Visitation.pdf

Essential Caregivers – LTCF Visitation Guidance – September 17, 2020

Essential Caregivers Essential caregivers (EC) are defined by designating a family member or guardian who, prior to visitation restrictions, was regularly engaged with the resident in activities of daily living (bathing, feeding, clothing, etc.) Essential caregiving visitation includes the following:

• Visitation should be scheduled with time restrictions.
• Each resident may have up to five (5) individuals designated as an EC although no

more than two (2) at a time can visit per resident.

• ECs should be screened before entry into the facility including temperature checks

and proper hand sanitization.

• Residents and ECs should wear a face covering and maintain physical distancing from
• ther residents and staff.
• ECs are subject to the regular testing required of the staff (see testing frequency table

below as established by CMS Rules). This could be accomplished by: EC has negative PCR test collected within previous 72 hours OR EC has negative onsite point-of-care test at the facility.

Reference: https://www.tn.gov/content/dam/tn/health/documents/cedep/novel- coronavirus/LTCF%20Guidelines_Visitation.pdf

Essential Caregivers – State LTCF Visitation Guidance

Table 2 2: R Routine T Testing I Intervals V Vary b by C Community C COVID-19 A Activi vity L Leve vel Commu mmunity C COVID-19 19 Activity County P Positivity R Rat ate i in t the p pas ast w week Minimum T Testing Frequency Low

• w

<5% Once a a m month th Medium 5% - 10% 10% Once a e a w week eek* High gh >10% Twice a e a w week eek* *This frequency presumes availability of Point of Care testing on-site at the nursing home or where off- site testing turnaround time is <48 hours.

Reference: https://www.tn.gov/content/dam/tn/health/documents/cedep/novel- coronavirus/LTCF%20Guidelines_Visitation.pdf

CMS QSO-20-39-NH – September 17, 2020

Compassionate Care Visits 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 include, but are not limited to:

• A resident, who was living with their family before recently being admitted to a

nursing home, is struggling with the change in environment and lack of physical family support.

• A resident who is grieving after a friend or family member recently passed

away.

• A resident who needs cueing and encouragement with eating or drinking,

previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.

• A resident, who used to talk and interact with others, is experiencing

emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past). Allowing a visit in these situations would be consistent with the intent of, “compassionate care situations.”

CMS QSO-20-39-NH Continued

• Also, in addition to family members, compassionate care visits can be

conducted by any individual that can meet the resident’s needs, such as clergy

• r lay persons offering religious and spiritual support. Furthermore, the above

list is not an exhaustive list as there may be other compassionate care situations not included.

• Lastly, at all times, visits should be conducted using social distancing; however,

if during a compassionate care visit, a visitor and facility identify a way to allow for personal contact, it should only be done following all appropriate infection prevention guidelines, and for a limited amount of time.

• Through a person-centered approach, facilities should work with residents,

families, caregivers, resident representatives, and the Ombudsman program to identify the need for compassionate care visits.

Reference: https://www.cms.gov/files/document/qso-20-39-nh.pdf

CMS QSO-20-39-NH discussion on “essential caregivers”

• CMS QSO 20-39-NH stated the following regarding essential caregivers:
• “We understand that some states or facilities have designated

categories of visitors, such as “essential caregivers,” based on their visit history or resident designation. CMS does not distinguish between these types of visitors and other visitors. Using a person-centered approach when applying this guidance should cover all types of visitors, including those who have been categorized as “essential caregivers.”

• As such, essential caregivers are only recognized in state licensed only

facilities such as assisted care living facilities and residential homes for the aged. This means that assisted care living facilities and residential homes for the aged must test essential caregivers in accordance with the testing schedule referenced in Slide 8.

Resources

• Tennessee COVID-19 LTCF Visitation

Guidelines ( 9/17/20)

• Tennessee COVID-19 LTCF Activities and

Dining Guidelines (9/17/20)

• Centers for Medicare and Medicaid Services

COVID-19 Nursing Home Visitation Guidance (9/17/20)

• Tennessee Department of Health COVID-19

Information

• Office of the Governor COVID-19

Information and Resources

Contact Us

Caroline Tippens, Esq., CHC | Senior Associate General Counsel Office of General Counsel Caroline.Tippens@tn.gov 615-741-3907 Sally Pitt | Director Office of Patient Care Advocacy Sally.Pitt@tn.gov 615-741-5879

Ten ennes essee ee Nursing Home e Civil Monet etary Pen enalty (CMP) R Rei einves estmen ent Pr Program

Shaquallah Shanks, CMP Reinvestment Program Director| 11/5/2020

CMP Reinvestment Program

24

Nursing Home CMP Program at a Glance

• Housed within the Office of Patient Care Advocacy
• Champions for health and prosperity of nursing home

residents in Tennessee

• Builds effective partnerships across state agencies and

external organizations

• Special Topics Webinar Series & Optimal Health As We Age

Newsletter

– https://www.tn.gov/health/health-program-areas/nursing-home- civil-monetary-penalty--cmp--quality-improvement- program/redirect-cmp/cpm-special-topics-webinar-series.html

COVID-19 Communication Technology Application

Maximum use of $3,000 per facility with exceptions allowable on a case-by-case basis (e.g., for facilities with a large number of residents). Devices will support telehealth as well as virtual social visits 77% of nursing homes across the state have been approved for funding

COVID-19 In-Person Visitation Aids Application

• Directly address the need

to facilitate in-person visits for residents.

• Examples of allowable

uses of CMP Funds for in- person visitation aids:

– tents or other shelter for

• utdoor visitation (purchase

and/or rental); and/or – clear dividers (e.g., Plexiglas or similar product) to create a physical barrier to reduce the risk of transmission during in- person visits.

COVID-19 In-Person Visitation Aids Application

Maximum allowance of $3,000 per facility. Tent or other shelter must allow for social distancing to be

• bserved

Ensure appropriate LSC requirements found at 42 CFR 483.90 are met, unless waived under the PHE declaration.

Additional Funding Opportunities

• Request for Applications (RFA)

– Projects can be awarded for up to three years – Proposals should address the following:

• Target the improvement of life or care of residents at any

certified nursing facility or multiple facilities with an established need;

• Clear evidence of strong community partnerships and proper

utilization of available resources; and

• Evaluation of effectiveness of the program and provided
• utcome measures related to the target area.

For more information visit: https://www.tn.gov/health/health-program-areas/nursing-

home-civil-monetary-penalty--cmp--quality-improvement-program/redirect-cmp/cpm-how-to- apply.html

Request for Applications (RFA)

Eligible applicants include:

• Certified long-term care facilities
• Hospitals and/or hospital systems
• Colleges and universities
• Community coalitions
• Resident or family councils
• Professional or state nursing home

associations

• Consumer advocacy organizations
• Private contractors

2020 Focus Areas

• Healthcare-Associated Infections
• Distressed and At-Risk Counties
• Preventable Hospitalizations
• Improving nursing home facilities’

CMS star rating

• Residents’ Rights

– Elder Abuse, Neglect, and Exploitation – Alzheimer’s disease and other dementias

Contact Us

Shaquallah Shanks Director, TN Nursing Home Civil Monetary Penalty Reinvestment Program Shaquallah.Shanks@tn.gov 615-741-6823 Kristyn Long Assistant Director, TN Nursing Home Civil Monetary Penalty Reinvestment Program Kristyn.Long@tn.gov 615-770-6805

Thank you!

Member Comments (5 min.) Q & A

Upcoming COVID-19 Testing Events

Friday, November 6, 2020, 12:00pm-4:00pm local time

• Sullivan County
• Saint Dominic Catholic Parish, 2517 N. John B Dennis Hwy, Kingsport, TN 37660

Saturday, November 7, 2020, 12:00pm-4:00pm local time

• Bradley County
• Iglesia de Dios Comunidad de Esperanza, 2779 APD 40 SE, Cleveland, TN 37323
• Knox County
• Iglesia Cristiana Caminando con Jesus, 4508 Millertown Pike, Knoxville, TN 37917

Questions??

Please contact Monique Anthony at 629-215-0642

• r

Minority.Health@tn.gov