November 11, 2022
Dear Resident/Family/Resident Representative,
In case you missed the updates regarding Phase 3 in last weeks letter- I’d like to inform and remind you of a few changes with Skilled Nursing. There have been some changes to regulatory guidance for Skilled Nursing Homes. Centers for Medicare/Medicaid, CMS, released this guidance and it became effective October 24,2022. These changes are better known as Phase 3. These new clarifications to current guidance focus on Resident Rights, Comprehensive Care Plans, Staffing, Arbitration Agreements, Quality Assurance/Infection Control. The specific changes include:
- Respect and Dignity for residents- Staff cannot act as an arm of law enforcement, residents must consent to personal and body searches in relation to illegal substances
- Abuse- Clarifies situations of when Nursing Homes need to report potential abuse, decreases the amount of time facilities have to report suspected abuse (immediately but no later than 2 hours after forming the suspicion), if a resident sustains an injury and meets the following criteria, it must be reported and investigated for abuse: 1) the source of the injury was not observed by any person; 2)the source of the injury could not be explained by the resident; and 3) the injury is suspicious because of the extent of the injury or the location of the injury or the number of injuries observed at one particular point in time or the incidence of injuries over time.
- Facility transfers/discharges- Once admitted, a resident has a right to remain in the facility unless the discharge or transfer meets a specified exception. Emergency transfers to acute care must be permitted to return to the facility unless the return would endanger the health/safety of the resident or others.
Comprehensive Care Plans:
- Cultural competency- Facility staff must be able to provide an atmosphere conducive to a resident’s right to practice their own beliefs, practices and cultural and/or linguistic needs, such as ethnic, religious, or social beliefs and be sensitive and respectful to the needs of different cultures.
- Trauma-Informed Care- Facilities must recognize the effects of a person’s past traumas and collaborate with the resident, their family and friends to identify and implement an individualized plan of care. Past traumas can include PTSD, substance abuse, depression, anxiety, and/or eating disorder, etc.
- Side Rails- All side rails, regardless of a resident’s wish to have them, can be considered a restraint. Due to the potential risk for entrapment with injury or death, CMS has very specific criteria of when side rails can be used. Those who can utilize side rails without them being considered a restraint are those who can exit their bed without the assistance of staff.
- Payroll-Based Journaling- Facilities are required to submit staffing levels to CMS, known as PBJ (Payroll-Based Journaling). This details the staff numbers on any day. The new guidance details how surveyors can investigate a facilities PBJ reporting.
- Binding Arbitration Agreements- The facility cannot require a resident or their representative to sign an agreement as a condition of the admission or as a requirement to continue to receive care. An agreement provides for the selection of a neutral arbitrator agree upon by both parties.
Quality Assurance/Infection Control:
- Quality Assurance Committee- The QA committee must maintain more detailed documentation and evidence of its ongoing Quality Assurance and Performance Improvement program. The QA committee must also perform one Performance Improvement Project annually.
- Infection Control- The Infection Preventionist must increase reporting to the QA committee on healthcare-associated infections, outbreaks, and occupational health communicable illnesses.
Compliance and Ethics:
- Compliance Officer- Requires a facility to identify a facility Compliance Officer and form a Compliance Committee, develop policies and procedures as well as standards of conduct for employees. The Committee must monitor and audit the facility’s compliance with policies and procedures as well as respond to violations and provide corrective action.
After the measures are put into place, the facility must extensively train staff to be compliant with all of the expectations. Each resident or their representative will be notified if any changes occur to their specific care pertaining to the new guidance. We encourage all residents and their loved ones to ask questions if they do not understand new interventions or care.
- Skilled Nursing: 88 total positive cases, 73 positive staff cases, and 15 resident cases. No new staff or resident cases since the last weekly letter (earliest onset of 5/4/22, latest onset 11/3/22). The Covid unit was reopened on 10/17/22 and only have one resident on the unit at this time. Staff continue to test twice weekly, residents test weekly. Testing will continue until we are 14 days without a new case. First potential day off Outbreak will be 11/18/22.
- Assisted Living/Memory Care Unit: 31 total positive cases, 15 staff cases and 16 resident cases. 5 new staff and 2 resident cases since the last weekly letter. Weekly testing continues for residents who are negative and twice weekly for staff.
Skilled Nursing is now also on Influenza outbreak. Two residents who have respiratory symptoms were tested for the Flu yesterday and have come back positive for Influenza A. Staff who are symptomatic are also being tested. At this time, we have had 4 staff members test positive. We are following the local health departments guidelines for testing, treatment, isolation, time off work, etc.
Skilled Nursing residents who have consented and medically cleared are continuing to receive their flu shots from nursing staff on the units.
COVID VACCINE: We have scheduled our next Bivalent Covid booster clinic for December 6th at 10:30am in the Auditorium at the main building. This clinic is for staff, skilled nursing, assisted living and memory care residents.
Independent Living residents are also invited- please notify Kathy Neville if you are interested in a booster. Forms must be filled out prior to the clinic- don’t forget your insurance cards!
COVID Vaccine Status Update:
Our current rate of skilled resident vaccination is broken down in to fully vaccinated and up to date- 96% of our skilled nursing residents are fully vaccinated with 63% being up to date with the Bivalent Booster. Our current rate of fully vaccinated residents is 93% in the Assisted Living and Memory Care Centers. Our current rate of fully vaccinated staff is 100%. This information is reported daily by the facility to Maryland Department of Health via PROPS and weekly to the CDC through reports to the National Healthcare Safety Network (NHSN). Here is the website to view this information for all nursing homes in Maryland: https://aging.maryland.gov/Pages/SNFVD.aspx
Weekly Metrics used to Determine COVID 19 Community Level:
Data through November 10, 2022:
COMMUNITY TRANSMISSION: Moderate
Case Rate per 100,000: 48.33
New COVID Admits per 100,000: 12.2
% Staffed In-Patient Beds in use by Patients with Confirmed COVID 19: 6.3%
The above information can be found at:
The facility tests according to Community Transmission levels and Outbreak Status. Twice weekly for staff, once a week for residents and Exposure Testing as indicated and required.
We continue to strongly encourage visitor testing. Visitors are not required to be tested nor are they required to be vaccinated to visit. Visitors are not required to show proof of vaccination either. Visitors MUST wear a mask while in our facility. If your loved one is in isolation for the Flu, we discourage you from visiting at this time. If you must come in, please wear appropriate PPE which is provided on the door of the room you are visiting.
- Any IL resident may receive rapid, Point of Care, testing upon request. If you would require PCR testing, we suggest going to a Meritus Care Center. Please contact Kathy Neville with your requests.
In closing, remember to be mindful of your surroundings when out and about. Stay healthy and safe.
Stephanie Young, LPN
Below, you will find a list of all the mitigation (preventive) measures the Facility has taken as of today. If you have questions, please do not hesitate to contact the Facility.
For visitation, here are the policies the facility will follow:
VISITATION POLICY AND PROCEDURE
To provide a safe and sanitary environment in which all resident’s and families are able to visit and see each other during the current COVID-19 health crisis. Visitation by family and friends is critical to the quality of life of our resident population.
Visitation can be conducted through different means based on the facility structure and resident needs, such as resident rooms, dedicated visitation spaces and outdoor access. Regardless of how visits are conducted, every visitor must abide by the Core Principles and best practices of Infection Control to reduce the risk of COVID-19 transmission. Those Core Principles are as follows:
- Signage will be posted at visitor entrances detailing the recommended actions for visitors related COVID-19 Infections. This will include instructions for visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or have had close contact with someone with COVID-19.
- Visitors will complete hand hygiene prior to visitation.
- Source Control (the use of PPE, including masks) protocols in accordance with CDC guidance.
- Signage will be posted at visitor entrances the t/o the facility on the signs and symptoms of COVID-19, infection control precautions, and other facility practices/protocols, such as entrances, exits, and routes to units.
- High-Tough surfaces in the facility are cleaned and disinfected often and designated visitor areas are cleaned and disinfected often as well.
- Staff utilize appropriate PPE
- Effective resident cohorting is utilized
- Resident and staff testing is conducted as required by state and federal guidance.
The facility strongly encourages but does not require visitors to comply with testing. Facility will request visitors to complete COVID-19 testing approximately 72 hours prior to visitation or the Facility will offer testing immediately prior to visit, especially when Community Transmission Rates are HIGH.
The facility does not require visitors to be vaccinated or show proof of vaccine in order to visit, but the facility does recommend that all visitors become vaccinated to help prevent the spread of COVID-19.
All visitors must don/apply a well-fitting surgical mask upon entrance to the facility. If visitor does not have a mask, the facility will provide a mask.
Children of any age may visit. Any child above the age of 2 will wear a mask. Any child below the age of 12 will be accompanied by an adult. One adult per child.
The facility encourages visitors to become vaccinated when they have an opportunity.
Procedure for Visitation:
The Facility will permit resident visitation under the following guidance:
- All visitors must screen at the entrance of the building and be asked to complete a release form. The risks associated with visitation will be explained to all visitors prior to the commencement of visitation. All visitors will make an informed decision regarding the safety of visitation.
- Any visitor who cannot adhere to the core principles of Infection Prevention will not be permitted to visit and will be asked to leave.
- The facility does not require but strenuously encouraged all visitors to be tested for COVID 19 prior to their visit. The facility will provide testing to all visitors.
- All visitors and residents must complete hand hygiene before and after all visits.
- Visitors who fail any screening, or who do not follow guidance or facility protocol during their visit will be asked to leave promptly. The resident involved, if determined to have a potential exposure, will then be placed in Transmission based precautions for 14 days or until they can be judged to be infection-free.
- Outdoor visitation is recommended.
- Indoor Visitation is allowed. Frequency and length of visits are not limited. Number of visitors are not limited either, but social distancing must be observed in large groups in a large area that can accommodate this measure.
- All visitors are asked to don and maintain a surgical mask during all visits, especially in HIGH COVID-19 Community Transmission rates. The facility can and will provide appropriate masks upon request/need.
- If a resident chooses, when they and their visitors are alone in the resident room or designated visitation area, may choose not to wear masks and may choose to have close contact. If a roommate is present, masks should remain in place.
- Residents who are in Transmission Based Precautions can still receive visitors. All of these visits will be in the resident room. The visitor will be made aware of the potential for exposure and precautions necessary to prevent infection. The visitor will be provided appropriate PPE by the facility.
COMMUNAL ACTIVITIES, DINING and OUTINGS
- The facility will provide communal dining and/or activities programs when appropriate.
- If a resident is unable to abide by core principles of Infection Prevention, they will be asked to dine in their rooms or abstain from communal Activities program.
- Residents will receive hand-hygiene before and after activities or dining.
- Residents will wear masks to, during and from all dining or activities programs, as well as communal areas of the facility.
- Residents who are in Transmission Based Precautions will abstain from communal dining and communal activities until Transmission Based Precautions are discontinued.
- Any equipment used for communal activities will be disinfected before and after use.
- Dietary staff will sanitize tables before and after meals.
- Activities personnel will sanitize tables before and after activities.
- Fully vaccinated volunteers will be permitted to volunteer their services. They must provide documentation of their vaccination status.
- Outside Group Activities may be held. The facility encourages every resident who participates, to practice all steps of core principles of Infection Prevention at all times when on these outings into the greater community.
- Frequent hand hygiene is required. Soap and water for at least 40 seconds or alcohol-based hand sanitizer if soap and water is not available.
- Every time you enter the building, you must complete hand hygiene.
- Limit your foot traffic throughout the building. If you do not need to be on a Nursing unit or in another part of the building, do not go.
- If you are sick, stay home. Do not come to work sick.
- Regardless of your vaccination status, you must report any of the following criteria to Infection Control without delay:
- A positive viral test for SARS-CoV2
- Symptoms of COVID-19
- A high-risk exposure to someone with SARS-CoV2 Infection
- Any staff member who have or report symptoms of COVID-19, regardless of vaccine status, must be tested as soon as possible and are restricted from entering the facility until results are known.
- All staff must don and maintain a surgical mask when entering facility and until they exit the facility.
- Masks are to be worn correctly at all times except during meal break times. Anyone observed with incorrect application will be reminded of correct wear and if continued disregard is observed, will receive corrective action.
- Frequent cleaning and disinfection of your work area is expected. If the area is soiled, you need to clean then disinfect. Just spraying disinfectant on a dirty area does nothing. Bleach solution requires a 1-minute contact time. Quaternary Ammonium/Quat requires a 10-minute contact time. High touch surface areas must be cleaned frequently. Who is responsible for this? YOU! Environmental Services will supply units with pump sprays of bleach solution daily. Once mixed, the bleach solution is only good for 24 hours. Please use it to clean your workspaces frequently. Focus on High Touch Surface Areas. Phones, doorknobs, handrails, med/treatment carts, tables, desks, and keyboards to name a few. IT has provided screen wipes to be used on computer screens and cell phones. Once applied, allow the area to air dry. If you have a resident with respiratory issues, do not use bleach, use Quat. But remember, Quat requires 10 minutes contact time.
- Practice Respiratory Etiquette. If you need to cough or sneeze, please do so into a tissue, or elbow. Wash your hands!!!!
- You must practice Social Distancing at all times. (Remain at least 6 feet apart as allowable in most situations). This includes mealtimes when your mask is off. YOU MUST SOCIAL DISTANCE!!
- When eating your meal, you must remain behind the shield to protect yourself from other staff persons. Overflow tables will be in the Main Dining Room. This means 2 staff persons per table. If there are no free tables in the breakroom, you may go to the Main Dining room for your break time and sit at one of the tables with plastic shields and maintain 6 feet from all residents while mask is not on.
- Every staff member must screen upon entry to facility. If your temp is 99.0 or above, you must alert your supervisor or Director. Do not pass the screening station until approved by your Director/Supervisor and Infection Control (Stephanie Young, Leah Miller, or Angie Thompson).
- COVID testing of staff will be determined by Federal and State guidance.
- You are expected to be swabbed at the times posted. No special circumstances will be made for anyone. If you do not get swabbed as directed, you cannot work, and you will receive disciplinary action up to and including termination.
- Any contractor or non-staff clinician must be symptom-free upon entry to the facility. If exhibiting any symptom of SARS-CoV2, any contractor or non-staff clinician will refrain from entering the building until they are free of symptoms or an alternative diagnosis of a noncontagious nature are made
- During your off time, the Facility requests that you follow mandated safety precautions, maintain Social Distancing and good hand hygiene to prevent opportunities of infection.
- Staff will be updated weekly with new or changed mitigation interventions.
- All medication carts will have a container of disinfecting wipes and a bottle of hand sanitizer.
- All vital signs machines will have a container of disinfecting wipes and bottle of hand sanitizer in basket.
- All Mechanical lifts will have a container of disinfecting wipes and bottle of hand sanitizer in bag. The lift will be disinfected each time after using on a resident.
- No more than 2 staff or other individuals in an elevator at a time.
- Staff members are to report any HIGH-RISK exposure to any individual with a confirmed SARS-Cov2 infection. See Return to Work Criteria for HCP Who Were Exposed to Individuals with Confirmed SARS-CoV2 Infection of CDC’s Interim Guidance for Managing Healthcare Personell with SARS-CoV2 Infection or Exposure to SARS-CoV2 for definitions of HIGH-RISK exposures. Once reported, staff will be expected to test immediately but not earlier than 24 hours after the exposure. If negative, again after 48 hrs after 1st negative result, and if negative for 2nd test, then test again in 48 hours after 2nd test (a total of 3 tests). If an asymptomatic staff person who has recovered from SARS-CoV2 Infection within the previous 30 days of exposure, they should not be tested. If exposure occurs on day 31 through 90, they should only be given an antigen test, do not test using NAAT.
The exposed, asymptomatic staff member will wear well-fitting source control and monitor themselves for any symptom of SARS-CoV2. They will not report for work if they have symptoms or test positive.
- Staff members with SARS-CoV2 infection will be managed according to CDC guidance as outlined in Interim Guidance for Managing Healthcare Personell with SARS-CoV2 infection or Exposure to SARS-CoV2.
- As of August 1, 2021, all staff will be required to be fully vaccinated or have a plan in place to become fully vaccinated as part of their employment.
- All new admissions, readmissions and any resident who is out of the facility for more than 24 hours, will be tested upon admission, and if negative, again 48 hours after the first negative test, and if negative, again 48 hours after the 2nd negative test. They will also be asked to wear source control for 10 days following their admission or return to facility.
- Residents are asked to wear facial covering when a staff person is in their room.
- Residents will be assessed daily for signs and symptoms of COVID-19
- Any Aerosol Generating Procedure requires that staff don full PPE prior to initiation of procedure and close the resident room door during procedure. IE: med aerosols and suctioning. PPE for any aerosol causing procedure is disposable gown, gloves, N95 and face shield/goggles.
- The use of med aerosol medications is strongly discouraged. Nurses, please encourage Metered Dose Inhalers along with spacer use when physicians or nurse practitioners are making orders.
- Any resident with a significant change in condition must be seen by clinician within a timely manner. Either in person or via telehealth.
- Any Resident who is given the diagnosis of Pneumonia, of an infectious nature, will receive the following tests: COVID Nasal Swab, Rapid Flu swab or Influenza PCR, sputum culture to include Legionella, and Legionella/Streptococcus pneumoniae urine antigen test.
- Any resident who displays respiratory or gastrointestinal symptoms will have Transmission Based Precautions, Droplet/Contact initiated and remain until symptoms have resolved.
- Nursing, Rehab, EVS, Activities and Maintenance will be required to complete Quarterly PPE Doffing and Donning Demonstration training with Laura Cheung. Also, all staff will have monthly refresher questionnaires to be completed. All staff must comply, or corrective action will be given.
- Residents and their families or legal representatives will be updated weekly with facility status and new or changed mitigations interventions.
- COVID testing of residents will be determined by Federal and State guidance.
- The COVID Unit will have dedicated staff.
- Potential COVID Unit will be rooms 137, 138, 139, and 140.
- Residents residing on the COVID Unit will receive a head-to-toe assessment every shift along with vital signs assessment every 4 hours. If any change in condition for the resident is assessed, a Change in Condition will be initiated.
- Staff will screen upon entry, every 4 hours and upon exit of COVID Unit
- Contact Tracing will be completed for anyone who may have been in contact with the positive resident case. Residents and staff.
- Residents on the COVID unit will be in Transmission Based Precautions, Droplet and Contact. Both signs will be placed at each room door. All care will be provided in their room.
- Staff will be required to wear PPE during each contact with any resident housed on the COVID Unit. Disposable Gown, Gloves, Face Shield, Fit-Tested N95 mask, and gloves.
- Staff will be required to perform increased environmental cleaning with EPA-List N approved disinfectants.
- Frequent Hand Hygiene will be completed by all staff.
- Staff will not have personal items on the COVID Unit.
- Staff will enter and exit from the dedicated entrances.
- Staff on the COVID Unit will not enter other areas of the facility.
- Staff who are not providing direct care to the COVID residents are not allowed entry to the COVID Unit.
- Dedicated equipment will be used on the COVID unit. Multi use devices will not be used. IE: stethoscopes, B/P cuffs, pulse ox.
- Residents need to remain in their rooms.
- Resident room doors on the COVID Unit will remain closed at all times.
- You should disinfect your face shield between residents. Wipes will be provided.
- When doffing your PPE (removing), you cannot come into the hallway. You should doff in the doorway. There will be a large trashcan at all room doors for you to place your soiled PPE in. Then complete hand hygiene upon exiting the room.