COVID-19 Updates

As information continues to be made available regarding the Coronavirus, officially named COVID-19, the PHCA team is here to ensure you receive all appropriate guidance and necessary supplies to prevent the spread of this virus in your communities.

The CDC expects an increase of confirmed COVID-19 cases in the coming days and weeks and is relying on health care providers to take action and help prevent the spread of the virus. Due to the rapidly changing nature of the spread of COVID-19 around the world, it is important for our communities to be prepared.

For additional resources, please visit the links below:

In addition, the Hospital & Healthsystem Association of Pennsylvania (HAP), in partnership with the Pennsylvania Department of Health Bureaus of Epidemiology and Emergency Preparedness & Response, and Emergency Medical Services holds a statewide COVID-19 call for long-term care facilities, home care, post-acute, dialysis, and similar facilities every Tuesday at 1 p.m.

These calls will occur weekly until the risk of COVID-19 has subsided and will help infection prevention and control staff, hospital communicators, and frontline staff coordinate your hospital/facility’s coronavirus preparedness and response. To call in, dial 929-436-2866. The meeting ID is 621414465#.

Thank you for keeping our residents and communities safe!

If you have any questions, please reach out to PHCA staff:

  • For regulatory questions, contact Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org.
  • For quality questions, contact Chris Fisher, Director of Quality Initiatives, at cfisher@phca.org.
  • For communications support or questions about responding to media inquiries, contact Shayna Varner, Director of Communications, at svarner@phca.org.

 

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Wednesday, April 1, 2020 – 9:11 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there were 962 new positive cases of COVID-19, bringing the statewide total to 5,805. This is the highest daily number to date.

The department has reported a total of 74 COVID-19-related deaths statewide.

In addition, Governor Wolf has expanded his stay-at-home order to include all Pennsylvania counties. This stay-at-home order is in place until Thursday, April 30.

A few updates:

AHCA/NCAL: Effects of COVID-19 on Residents, Families and Staff
Long-term care providers and staff should prepare for COVID-19 entering a facility. As we saw in Washington state, and as we’re seeing (and experiencing) now across Pennsylvania, the virus affects everyone differently.

Residents and staff may become ill. Hospitalizations will likely occur. And, unfortunately, we’ve already seen residents in our facilities succumb to the virus.

These are difficult situations, but we need to be prepared.

Our national organization, AHCA/NCAL, has prepared the following steps to help you and your staff get ready for what’s ahead.

BHSL Issues New Collective Guidance
Late yesterday, BHSL issued new collective guidance related to infection control protocols, PPE and staffing, as well as additional resources from the CDC, CMS and the PA Department of Health. This guidance has also been added to our online portal: phca.org/COVID19.

In addition, BHSL is looking for ways to help AL/PC providers address existing and emerging staffing issues.

If you have any suggestions, please reach out to Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org and Kevin Cysyk, Director of Assisted Living and Personal Care, at kcysyk@phca.org.

Suppliers with Available PPE and Other Resources
Over the last few weeks, we’ve been in search of alternative sources of PPE across the state – and even across the country.

Many of our existing business partners – as well as new organizations – have stepped up to answer our call.

To make it easy and accessible for you, we’ve created a new page on our online portal, PHCA COVID-19 Resources. This will serve as an up-to-date list of PPE suppliers and other resources that may be helpful as your facility or community responds to COVID-19.

Honor our Healthcare Heroes
As a reminder: we’ve already asked you to send us heartwarming pictures, messages and stories about the residents in your facilities and communities. And we’re continuing to broadcast those incredible stories every day on social media.

But we cannot forget about you and your staff. You are heroes, in every sense of the word.

As this crisis worsens, and our direct care workers continue to risk their health and safety to protect their residents, we believe it’s our duty to share this story with state government, elected officials and the general public.

So film a quick video. Take a selfie. And help us show the world the good work you’re doing. You can send everything to Shayna Varner, our Director of Communications, at svarner@phca.org.

 

 

Tuesday, March 31, 2020 – 8:03 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there were 756 new positive cases of COVID-19, bringing the statewide total to 4,843 in 60 counties.

The department has reported a total of 63 COVID-19-related deaths statewide.

In addition, Governor Wolf has expanded his stay-at-home order to include Cameron, Crawford, Forest, Franklin, Lawrence, Lebanon and Somerset counties. More than half of Pennsylvania’s 67 counties are now included in the stay-at-home order.

Some additional updates:

CMS Issues Blanket Regulatory Waivers
Yesterday, CMS issued several blanket waivers for long term care providers that will apply across the United States. The waivers have a retroactive effective date of March 1st and will last through the end of the emergency declaration.

We were thrilled to see CMS finally remove some of the ‘road blocks’ that might prevent providers from creating standalone COVID-19 floors, wings or facilities.

Because of these waivers, providers can now transfer patients within facilities, or to other facilities, solely for the purposes of cohorting and separating residents with and without COVID-19.

CMS also approved the temporary certification of non-skilled nursing facilities to be used as emergency COVID-19 care sites, as well as waiving certain conditions of participation and certification requirements for opening a nursing facility if states identify a need for a new site to open quickly. We might begin to see schools, dorm rooms and convention centers open up as COVID sites.

Additionally, operators can also now use a variety of non-resident rooms, including dining rooms, activity areas, and conference space, to provide care on a temporary basis to help with surge capacity.

The updated guidance also waives certain training and certification requirements for nurse aides in an attempt to ease the workforce strain on operators.

Most of this is likely in response to New York’s decision to prevent operators from rejecting residents solely based on a COVID-19 diagnosis, or requiring a test as a condition of admission.

Additionally, PHCA will be submitting a waiver request to CMS to seek more relief for providers. We’ve heard from our members on the front lines regarding many issues, and we can’t afford to wait for this relief any longer.

DOH Recommending ‘Universal’ Masking
During today’s post-acute provider call, the Department of Health recommended universal, around-the-clock masking for health care providers in facilities.

While that sounds fine, we had a simple question: where are the masks?

We’re acutely aware of the need for PPE in facilities across the state, and every conversation with DOH, DHS, the Governor’s office and the legislature includes talk of more PPE for long-term care providers.

For now, universal masking is simply a recommendation, not a mandate.

Suppliers with Available PPE
Speaking of masks…

Over the last few weeks, we’ve been in search of alternative sources for PPE across the country. And as that search yields results, we’ll share it with you in our daily update.

Here is an additional option for sourcing masks and/or gowns:

NorthCape, a major outdoor furniture manufacturer based in Alsip, Illinois, has transitioned its production and distribution functions to produce and distribute hospital-approved and nurse-designed fabric masks and nurse gowns. They are currently producing these products, and have the capacity to increase output. For pricing and ordering information, click here.

Combating the Trial Bar
It’s important for you to be aware: in the midst of our membership risking it all on the front lines of the COVID-19 epidemic, not all advocacy groups seem to be supporting you in Harrisburg.

Late last week, the PA trial bar and trial attorneys sent a letter to the state Supreme Court, asking for the ability to continue to drag long-term care providers into court for discovery proceedings and civil cases.

Their reasoning? Trial attorneys are struggling, too.

Let me be clear: while PHCA may be focused on the regulatory and policy issues affecting providers during this crisis, we’ll never lose sight of the big picture. And we’re never too busy to stand up to the trial bar.

Yesterday, associations representing healthcare providers and workers sent a letter to the Supreme Court, asking for a delay in all court proceedings. We were proud to sign on to that letter.

Please know: we’ve got your back, no matter the issue or enemy.

 

 

Monday, March 30, 2020 – 7:18 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there were 693 new positive cases of COVID-19, bringing the statewide total to 4,087 in 59 counties.

The department has reported a total of 49 COVID-19-related deaths statewide.

In addition, Governor Wolf has expanded his stay-at-home order to include Carbon, Cumberland, Dauphin and Schuylkill counties.

This stay-at-home order, as well as school closures and the closure of all non-life-sustaining businesses, has been extended through Thursday, April 30. 

Some additional updates:

Ongoing Discussions with Federal and State Officials
Earlier today, PHCA participated in discussions with federal and state officials to share the significant challenges facing Pennsylvania’s long-term care providers during the COVID-19 crisis. We spoke with U.S. Senator Bob Casey, as well as the northeast PA Legislative Caucus, regarding critical PPE shortages, staffing challenges and much-needed state and federal funding.

Additionally, we shared our concerns related to any state mandate requiring nursing homes and long-term care facilities (including AL/PC) to accept all discharged hospital patients, including those who have tested positive for COVID-19.

Both conversations yielded positive support, and we will continue to work with our federal and state legislators to ensure you are not faced with mandatory admissions.

CMS Moves to Increase Hospital Capacity
In an effort to combat the lack of hospital beds nationwide, CMS today issued guidance to allow healthcare systems and hospitals to provide services in locations beyond their existing walls.

Under CMS’s temporary new rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare.

And ambulatory surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. CMS waivers will also permit doctor-owned hospitals to increase their number of beds without incurring sanctions.

AHCA/NCAL Releases New Guidance on Hospital Transfers 
Our national organizations are working on the very same issue. Today, they released new guidance for long term care facilities on accepting admissions from – and transferring patients to – hospitals during COVID-19.

These revisions are based on new evidence from the CDC, which found that 57% of elderly residents who tested positive for COVID-19 did not have symptoms, but shed the virus at levels that made them infectious to others.

Based on this new CDC data, unless a person has tested negatively for COVID-19 before admitting them to your building, you should assume the person has COVID-19 regardless of them having or not having symptoms.

New Suppliers Producing PPE for Pennsylvania
If state government won’t help us, we’ll have to find it ourselves.

Over the next few days, you can count on our daily updates including alerts on alternative sources of PPE in Pennsylvania (and across the country).

For the last few weeks, we’ve been in search of those alternative sources, and we’ve located a few. For example:

RCJ Global Enterprises, an organization run by Roberto Clemente, Jr., has identified a source of personal protective equipment in western Pennsylvania. The manufacturer has complete certifications and is used across the globe for medical supplies. For more information, please email rcjglobalenterprises@gmail.com. You will receive additional information about purchase minimums and other details for placing an order.

In addition, The Beistle Company, a Pennsylvania medical device manufacturer, has retooled its manufacturing capabilities to make plastic face masks. These masks are currently in production. While not yet FDA or ASTM approved, they would still be effective during a shortage. For more information, please contact Doug Holdren at dmholdren@beistle.com or 717-532-2131, ext. 324.

Updated Contact Information for Nursing Facility Field Offices
Outlined below are the email addresses for the nursing facility field office supervisors. Any waiver/exception request should be sent directly to the supervisor of the appropriate field office:

 

 

Sunday, March 29, 2020 – 6:39 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there were 649 new positive cases of COVID-19 in Pennsylvania, bringing the statewide total to 3,394 covering 58 counties. The department has reported a total of 38 COVID-19-related deaths statewide.

During a press conference early this afternoon, DOH Secretary Dr. Rachel Levine spoke about prevention measures in nursing homes, assisted living communities and personal care homes. She also indicated that 5% of nursing homes in Pennsylvania are currently treating COVID-19 positive cases, with the majority of cases identified in the southeast.

In the last two days alone, there have been dozens of news articles and television segments devoted solely to positive cases in nursing homes across the state. We are working with the Governor, his administration and the Department of Health to respond to these cases, and to mitigate the impact of the virus.

A few additional updates:

CMS: Medicare Accelerated and Advanced Payments 
CMS announced yesterday that it will expand its accelerated and advance payment program for Medicare providers during COVID-19. These payments provide emergency funding and address cash flow issues based on historical payments when there is a disruption in claims submission and/or claims processing.

To qualify for accelerated or advance payments, a provider must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s request form;
  • Not be in bankruptcy;
  • Not be under active medical review or program integrity investigation; and
  • Not have any outstanding delinquent Medicare overpayments.

Medicare will start accepting and processing the accelerated and advance payment requests immediately. CMS anticipates that the payments will be issued within 7 days of the provider’s request. See this informational fact sheet on the accelerated and advance payment process and how to submit a request.

CMS guidance on provider eligibility and submission processes from today’s announcement differ from those found in the Medicare Financial Management Manual (Section 150). Providers should contact their MACs directly to understand how the MAC will be operationalizing CMS’s guidance. The MAC regional coverage map can be found here.

Department of Labor Guidance on ‘Health Care Provider’ Definition
At the urging of AHCA/NCAL and PHCA to include nursing home, assisted living and personal care staff in their definition of “health care provider”, the U.S. Department of Labor has published guidance to address exemptions and employer requirements to the expanded Family Medical Leave Act and sick leave benefits included in the recently passed Families First Coronavirus Response Act.

The Department’s exemptions FAQ (see #56) states that the “health care provider” exemption to these new leave requirements applies to “anyone employed at any… nursing facility, retirement facility, nursing home, home health care provider… This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.”

Additionally, our friends at Post & Schell, P.C. have conducted their own thorough analysis and are extending it to our membership. Click here for their analysis, which can also be found on our online portal: phca.org/COVID19.

New State Guidance for AL/PC Providers
After a great deal of work, PHCA has learned that the Office of Long-Term Living (OLTL) has suspended, with conditions, specific license regulations for personal care homes and assisted living residences. In addition, OLTL has imposed restrictions on visitations and temporarily suspended annual inspections.

We’ve highlighted some of the provisions you’ve specifically asked about below:

  • Criminal history checks and hiring policies shall be in accordance with the Older Adult Protective Services Act: a facility may extend a provisional hire for the sole reason that FBI clearances/checks are not available. The facility must document the reason why the FBI clearance/check was not available. Providers shall obtain the FBI clearances/checks within 60 days from the date the suspension of the regulation is lifted. This only relates to licensing requirements and does not change any other law.
  • Direct Care Staffing: providers shall notify their Bureau of Human Services Licensing (BHSL) regional office via email of any anticipated or actual staff shortages and of their plan to mitigate the staff shortage for approval by the regional director for BHSL.
  • Annual Trainings: all the annual trainings required under these regulatory provisions are provided a 90 grace period. The training shall be completed within 90 days from the date the suspension of the regulations is lifted.
  • Fire Drills: the requirement of an unannounced fire drill at least once a month is being suspended. The suspension shall be lifted upon the date the Disaster Proclamation is lifted by the Governor. In addition, the annual requirement of a fire safety inspection and fire drill conducted by a fire safety expert is being suspended.  The annual fire safety inspection and fire drill must be completed within 60 days of the date the Disaster Proclamation is lifted by the Governor.
  • DME- Medical Evaluations: if the resident’s primary care physician determines that the medical evaluation can be conducted at a later date, then the facility can postpone the medical evaluation to the date determined by the physician; provided that, the medical evaluation must be performed no later than 90 days after the Emergency Declarations is lifted. The facility shall document the primary care physician’s determination in the resident’s record for subsequent review.
  • Medication Administration Training: staff who have been previously trained may continue to administer oral; topical; eye, nose and ear drop prescription medications; and epinephrine injections for insect bites or other allergies for up to 90 days beyond the staff’s training renewal date. Staff who have been previously trained may continue to administer insulin injections for up to 90 days beyond the staff’s training renewal date.

There are a number of other regulatory provisions that are being suspended. Please review this document for the full list. If you have any questions, please reach out to Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org or Kevin Cysyk, Director of Assisted Living & Personal Care, at kcysyk@phca.org.

 

 

Saturday, March 28, 2020 – 7:27 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there were 533 new positive cases of COVID-19 in Pennsylvania, bringing the statewide total to 2,751. The department has reported a total of 34 COVID-19-related deaths statewide.

In addition, Governor Wolf has expanded his stay-at-home order to include three additional counties: Beaver, Centre and Washington.

Federal Funding Update
Last week, Congress passed the Families First Coronavirus Response Act, which granted a 6.2% FMAP (Federal Medicaid match) increase to all 50 states. That 6.2% increase equates to $1.5 billion in Medicaid dollars for Pennsylvania.

Additionally, President Trump has signed the CARES (Coronavirus Aid, Relief, and Economic Security) Act. This package, which has reached upwards of $2 trillion total, will include a temporary suspension of the 2% Medicare sequestration cut and $100 billion for health care providers (including nursing homes, hospitals, etc.).

State Funding Update 
Given the $1.5 billion in FMAP dollars, PHCA is asking the Governor and General Assembly for a 3% rate increase for providers, plus a $290 million supplemental that will be paid to help combat increased costs due to COVID-19.

There is also $50 million in emergency funding available for Pennsylvania to purchase medical equipment and supplies for nursing homes, hospitals and emergency workers. We’ll be told how those dollars are being allocated in the next two or three days.

Mandatory(?) SNF Admissions from Hospitals
By now, you’ve likely seen the news out of New York state, as nursing home operators have been told they will be required to accept patients infected with COVID-19 who are discharged from hospitals. This is being done in an effort to make hospital beds available to new COVID-19 patients.

Other states are facing this mandate as well. Michigan, Ohio…the list will surely grow in the coming days.

Yesterday, SNF providers were sent guidance from DOH regarding admissions. I do not believe what you received yesterday was a mandate to accept any and all COVID-19 positive residents. And that was corroborated by DOH this morning.

But I do think you need to be ready for the very real possibility of accepting these patients very soon. And we may be on the cusp of ‘containment centers’, or entire facilities that house only COVID-19 positive residents.

And if it’s not an entire facility, it might be a dedicated floor or wing.

And if it’s not one of our facilities, it might be a hotel, convention center or a school.

Please know that this is the topic at the national level. Earlier today, Mark Parkinson, President & CEO of AHCA and Dr. David Gifford, Chief Medical Officer, released a statement addressing state orders directing nursing homes to accept all hospital patients.

To be clear, I think what New York did was wrong. I think it was unjustified. And I don’t want that to happen here in Pennsylvania.

But this is an extraordinary time, and we need to be ready. So, in an effort to make things easier for you, we’ve consolidated all the guidance surrounding new admissions, including additional resources offered by the CDC, into a one-stop resource.

This resource has also been added to the phca.org/COVID19 portal as well.

As this issue continues to be debated across the country and in PA, know that we’re on your side. We’ll share more as soon as we have additional information.

CMS Guidance for Implementing Telehealth in Long-Term Care Facilities
CMS recently issued an electronic toolkit regarding telehealth and telemedicine for long-term care providers.

As you know, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel.

We highly recommend utilizing telemedicine in your facility. If you have any questions, please let us know.

Weekly Statewide Call for Providers
The weekly statewide COVID-19 call for post-acute care providers hosted by HAP and the Pennsylvania Department of Health Bureaus of Epidemiology and Emergency Preparedness & Response has been moved from Wednesdays at 1 pm to Tuesdays at 1 pm.

These calls will help infection prevention and control staff, hospital communicators, and frontline staff coordinate your facility’s coronavirus preparedness and response.

To call in, dial 929-436-2866. The meeting ID is 621414465#.

Pennsylvania Offers Temporary Licensing Waivers for Health Care Professionals
The Department of State has announced a series of temporary licensing waivers for health care professionals and others during the COVID-19 disaster declaration.

To learn more, click here.

 

 

Friday, March 27, 2020 – 8:15 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there were 531 new positive cases of COVID-19 in Pennsylvania, bringing the statewide total to 2,218.

In addition, Governor Wolf has expanded his stay-at-home order to include nine additional counties: Berks, Butler, Lackawanna, Lancaster, Luzerne, Pike, Wayne, Westmoreland and York counties.

Before we provide a few updates, a note of appreciation:

Thank You
As another week comes to a close, we want to say ‘thank you’.

Thank you for the time you’ve spent, the dedication you’ve shown, and the support you’ve given to your residents, your colleagues and the team here at PHCA.

As you’ve spoken with family and friends about COVID-19 and your profession throughout the last few weeks, I’m sure you’ve heard the following sentiment:

“You didn’t sign up for this”.

Even I, the president of PHCA, have heard this from many colleagues in Harrisburg. “This isn’t why you took this job.”

But in talking to our membership, whether it’s one of our Board members, committee members, an administrator, executive director, front line staff, housekeeper, etc., every single person tells me the same thing: “No, this is exactly what I signed up for. This is why I chose to do what I do.”

Please know that rings true for me. It rings true for the PHCA team. And I’ve seen it ring true for every one of our members.

So I’ll say it again: thank you. Thank you for choosing this path, this profession, and for caring for our most vulnerable. Because there are not many people who can do what you do, especially in these circumstances.

It has been an absolute honor to serve this membership. And we will continue to do that, each and every day (including nights, weekends, etc.).

If you need anything, let us know. And please continue to visit phca.org/covid19 for up-to-date information.

A few additional updates:

Draft Letter to Request Administrative Relief from MCOs
Over the last few days, the Managed Care Organizations (MCOs) have requested providers take on additional administrative tasks during this epidemic. We know that your ability to take on this additional workload is incredibly limited, and we highly encourage you to complete and send this template letter to your MCOs to request relief on any and all administrative burdens that pull valuable staff time and resources away from the resident bedside.

If you have any questions, please contact Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org.

CDC Preparedness Checklist for Nursing Homes and other Long-Term Care Settings
As the number of positive cases of COVID-19 increase in hospitals, and our facilities are asked to accept transfers of those individuals, it is very important to review this preparedness checklist from the CDC to ensure you and your staff are ready.

This checklist should be used as a tool to develop a comprehensive COVID-19 response plan, including plans for:

  • Rapid identification and management of ill residents
  • Supplies and resources
  • Sick leave policies and other occupational health considerations
  • Education and training
  • Surge capacity for staffing, equipment and supplies

For guidance from the CDC on steps to take when there are cases in your facility, click here.

License Renewal Deadlines for Administrators, Nurses Extended
The Department of State has extended the occupational licensure renewal deadline for nurses, graduate medical trainees, nursing home administrators and other professionals. The April, May and June license renewal deadlines have been extended to July, August and September. For more, click here.

Third Federal Stimulus Package Signed into Law
Today, the U.S. House passed and the President signed into law the third stimulus bill, the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Of particular note to skilled nursing facilities and assisted living facilities it includes the following provisions:

  • A temporary suspension of Medicare sequestration cut
  • $100 billion fund for eligible health care providers
  • $200 million in funding to prevent, prepare for, and respond to coronavirus
  • Childcare support for health care sector employees

As we learn more about the funding, and exactly how the $100 billion fund for health care providers will be divided, we will let you know.

 

 

Thursday, March 26, 2020 – 5:26 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there are 560 new positive cases of COVID-19 in Pennsylvania, bringing the statewide total to 1,687 in 48 counties.

To date, more than 170 individuals who have tested positive for COVID-19 have required hospitalization. Of those hospitalized, 56 of these individuals have required intensive care and 32 of those patients have required the use of ventilators. More than 40 percent of those requiring hospitalization have been over the age of 65.

In addition, the department also reported five new deaths, bringing the statewide death total to 16.

Yesterday, Governor Wolf expanded his stay-at-home order to include Lehigh and Northampton counties. The stay-at-home order now covers Allegheny, Bucks, Chester, Delaware, Erie, Lehigh, Monroe, Montgomery, Northampton, and Philadelphia counties.

We strongly encourage you to visit phca.org/covid19 for up-to-date information from AHCA/NCAL, DOH, the CDC and CMS. Please use these resources, and let us know how we can help.

A few additional updates:

U.S. Senate Passes Coronavirus Aid Relief, and Economic Security Act (H.R. 748)
Yesterday, the U.S. Senate passed the CARES (Coronavirus Aid, Relief, and Economic Security) Act, which now heads to the House of Representatives for consideration. Of note to skilled nursing facilities and AL/PC, the stimulus includes:

  • A temporary suspension of Medicare sequestration cut
  • $100 billion fund for eligible health care providers
  • Deferral of 6.2% payroll tax
  • $200 million in funding to prevent, prepare for, and respond to COVID-19
  • Childcare support for health care sector employees
  • New loan program for certain employers
  • Funding for housing for the elderly and disabled

We expect the House will pass the bill tomorrow. We can then offer a more detailed summary of the various provisions specific to long-term care providers and workers.

Governor Wolf Announces $50 Million in Emergency Funding To Purchase Medical Equipment and Supplies for Nursing Homes, Hospitals and Emergency Workers
Today, Gov. Wolf announced the availability of $50 million in state funding to purchase medical equipment and supplies for nursing homes, hospitals and emergency medical services to meet urgent patient and staff needs to address COVID-19.

This was done in conjunction with the members of the state House and Senate.

While this certainly does not solve the problem, it is a step in the right direction for providers and workers. We were proud to work alongside the legislature and administration to secure these funds.

DHS Portal Offers Searchable List of Child Care Providers Approved to Operate During COVID-19 Emergency
DHS has added a searchable portal to help health care workers identify child care providers who have been approved to operate during COVID-19. To find a child care provider in your area, click here.

Please note that this list may change as providers may make the decision to close at any time. DHS is working to keep this list as up-to-date as possible.

HCC Asks Providers to Update Facility Information in Knowledge Center
In an effort to increase awareness and manage emergent concerns, the Pennsylvania Health Care Coalitions (HCC) and the Department of Health will be asking post-acute facilities to begin inputting facility-specific information into the Knowledge Center multiple times per day.

Additional information will be released soon; however, we strongly encourage all members to begin the registration and logging process. If you are not yet set up with an account for the Knowledge Center, please email kchelp@haponline.org with a request to join and include your title and facility name.

REMINDER: CDC Strategies to Optimize PPE and Equipment
As a reminder, the CDC issued guidance last week regarding the use and reuse of masks, gowns and face shields. We know many of you have already taken steps to significantly conserve masks and gowns and extend the availability of your remaining PPE and we encourage you to continue these practices as supply improves.

If you are in need of PPE, contact your regional Health Care Coalition. The Coalition will deploy a quick response team, which includes an epidemiologist, to your facility to assess the situation and provide emergency PPE based on the level of risk identified in your community.

 

 

Wednesday, March 25, 2020 – 12:15 p.m.

Today, the Pennsylvania Department of Health released new COVID-19 numbers: there are 276 new positive cases of COVID-19 in Pennsylvania, bringing the statewide total to 1,127 cases. This is the largest one-day increase of reported cases.

In addition, Governor Wolf has added Erie County to his stay-at-home order.

Please remember: PHCA is here to help during this time. We’re here to support you and your staff, to help with media response, and to mitigate the impact of this virus on your community.

We would encourage you to visit phca.org/covid19 for daily information from AHCA/NCAL, DOH, the CDC and CMS. Please use our resources, and let us know how we can help.

A few additional updates:

Update on Federal Stimulus Package
Late last night, the White House and Congress reached an agreement on a $2 trillion stimulus funding package to address growing economic challenges during the COVID-19 outbreak. Elements of the proposal include $250 billion for direct payments to individuals and families, $350 billion in small business loans, $250 billion in unemployment insurance benefits and $500 billion in loans for distressed companies.

There is also $130 billion included in the package for healthcare providers. The media may be reporting this will all be paid to hospitals; however, it appears as though this will be divided among all healthcare providers, including long-term care.

PHCA will fight to secure every single dollar for long-term care providers in Pennsylvania.

Retired Health Care Professionals and COVID-19 Response
This morning, Governor Tom Wolf formally suspended several regulations related to the state boards of Medicine, Osteopathic Medicine, Nursing and Pharmacy for the duration of the COVID-19 emergency.

These new suspensions will increase the number of available and qualified health care practitioners in Pennsylvania by allowing retired practitioners to re-enter their field without paying reactivation fees:

  • State Board of Medicine licensees who are inactive/retired status for less than four years can apply for reactivation of their license. This measure allows these practitioners’ licenses to become active unrestricted until Dec. 31, 2020.
  • Medical Doctors (MDs) and certain allied health professionals integral to providing care during this state of emergency, whose licenses are expired/inactive for less than four years, may apply for reactivation of their licenses. This measure allows retired/inactive MDs, physician assistants, respiratory therapists and perfusionists to become active until December 31, 2020.
  • State Board of Osteopathic Medicine licensees who are inactive/retired status for less than four years can apply for reactivation of their licenses. This measure allows retired/inactive Doctors of Osteopathic Medicine (DOs) to become active unrestricted until Oct. 31, 2020.
  • DOs and certain allied health professionals integral to providing care during this state of emergency, whose licenses are expired/inactive for less than four years, can apply for reactivation of their licenses. This measure, which applies to retired/inactive DOs, physician assistants, respiratory therapists and perfusionists, allows those individuals to become active until October 31, 2020.
  • Registered Nurses (RNs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Practitioners (CRNPs) whose licenses are expired/inactive for less than five years can apply for the reactivation of their licenses.
  • Pharmacists whose licenses are expired/inactive for less than four years can apply for reactivation of their licenses.

This was a consistent talking point for PHCA and our messaging to state government, and we were thrilled to see it was approved this morning.

PHCA to Launch ‘Connect Communities’, an Easier Way to Share Information
Information sharing has never been more important – especially during the COVID-19 epidemic. That’s why we’ve created a forum for you to share information in real-time between you and your colleagues across the state.

We are proud to announce the launch of two new private online community discussion groups, which are available to all PHCA members. These groups, called ‘Connect Communities’, are available for two groups (for now): PHCA Skilled Nursing and PHCA Assisted Living and Personal Care. Access to these online communities is included as part of your PHCA membership.

Later this week, administrators and executive directors will receive an email from the American Health Care Association (AHCA) with usernames and passwords, as well as additional information on how to use the community.

Be on the lookout for additional information in the near future, and let us know if you’d like to join.

 

 

Tuesday, March 24, 2020 – 8:35 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 207 new positive cases of COVID-19 in Pennsylvania, bringing the statewide total to 851 cases. This is the largest one day increase of reported cases.

Seven deaths in the Commonwealth have been attributed to COVID-19.

Additionally, it is our understanding that there are positive cases in Pennsylvania nursing homes. While this is certainly unfortunate, it is not entirely unexpected.

As positive cases do arise, know that PHCA is here for you. We’re here to support you and your staff, to help with any media response, and to mitigate the impact of this terrible virus on your community.

We would encourage you to visit phca.org/covid19 and download the PHCA COVID-19 Toolkit: Preparing for Positive Cases, which is located at the top of the page. Not only will it help you prepare, but it provides valuable steps to take if/when a case is confirmed.

Additionally, our COVID-19 page contains daily information from AHCA/NCAL, DOH, the CDC and CMS. Please use our resources, and let us know how we can help.

A few additional updates:

CDC Call on PPE Strategies
Tomorrow afternoon, the CDC will host a Clinician Outreach and Communication Activity (COCA) call that will focus on PPE optimization strategies.

The call will take place tomorrow, March 25th from 2 to 3 pm. Presenters will discuss strategies for facilities to optimize PPE supplies, such as eye protection, isolation gowns, facemasks, and N95 respirators. Advanced registration is not required.

Due to the high demand, we are encouraging participants to also consider viewing the call on Facebook Live. If you are unable to attend, the call will be available for viewing on COCA’s Facebook page a few hours after the live event ends. If you have questions or would like to learn more, email coca@cdc.gov.

CHC-MCOs to Host Webinars to Discuss Changes re: COVID-19
As a reminder, the Community HealthChoices Managed Care Organization (CHC-MCO) Coalition will be hosting one more webinar for all nursing facilities to discuss changes and updates occurring as a result of COVID-19. This webinar is scheduled for this Thursday, March 26th from 10 to 10:30 am.

You can register for this session here. Your confirmation email will include details for the webinar.

New Hospital to Post-Acute Care Facility Transfer Form
PHCA has been working with the Hospital and Healthsystem Association of Pennsylvania, LeadingAge PA and other stakeholders to create a consistent, streamlined transfer form to be used when a resident is admitted or re-admitted to your facility or community from a hospital. The revised and most up-to-date form can be downloaded here.

DOH to Expedite TB Testing Requirements
PHCA has also been in communication with DOH regarding the relaxation of the two-step TB testing requirement for new hires. As a result, any nursing facility that wishes to seek an exception should submit a request to their respective field office supervisor and include which part of the regulation they are seeking an exception for, as well as updated policy and procedures the nursing facility will follow if the exception is granted. By providing this information, DOH can expedite the process for review and approval of the exception.

If you have any questions related to this process, please reach out to Gail Weidman, our Director of Policy and Regulatory Affairs, at gweidman@phca.org.

 

 

Monday, March 23, 2020 – 7:43 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 165 new positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 644 cases covering 34 counties.

Governor Tom Wolf also announced a stay-at-home order beginning tonight at 8 p.m. and lasting two weeks for those residing in Allegheny, Bucks, Chester, Delaware, Monroe and Montgomery counties.

The Governor extended statewide school closures for two more weeks as well. This extended closure will now continue through Friday, April 10.

We recognize this new stay-at-home order, as well as the extended school closures, will impact the available workforce in your facilities and communities. We continue to work with the Wolf Administration to find opportunities for flexibility in the DHS daycare requirements and the DOH staffing requirements.

PHCA, LeadingAge PA, SEIU, UFCW and AFSCME Join Forces
Earlier today, PHCA sent an urgent letter, co-signed by LeadingAge PA, SEIU Healthcare, UFCW 1776 and AFSCME District 1199, to Governor Wolf, his senior staff and the Department of Human Services regarding critical Medicaid funding for long-term care providers.

You can read the letter here.

Last week, Congress passed the Families First Coronavirus Response Act, which (among other things) granted a 6.2% FMAP (Federal Medicaid match) increase. That 6.2% increase equates to $1.5 billion in Medicaid dollars for Pennsylvania.

We believe there are no providers more deserving of these dollars than those working in long-term care in Pennsylvania today. So we are advocating for a 3% rate increase, plus $290 million derived from the $1.5 billion that will be paid to providers to help combat increased costs due to COVID-19.

We’re hopeful the Governor will respond favorably to our request, and we’ve already begun to reach out to his administration and members of the legislature.

PHCA Roundtable with Senator Bob Casey
This afternoon, PHCA leadership held a virtual roundtable discussion with U.S. Senator Bob Casey regarding the COVID-19 epidemic and ways in which the Senator and his colleagues can support our sector throughout this crisis.

With no deal on a new federal stimulus package, members of Congress are currently negotiating the terms and structure of federal legislation designed to aid healthcare providers, working families and those directly impacted by COVID-19.

As more information becomes available, we will keep you updated.

CHC-MCOs to Host Webinars to Discuss Changes re: COVID-19
As a reminder, the Community HealthChoices Managed Care Organization (CHC-MCO) Coalition will be hosting two webinars for all nursing facilities to discuss changes and updates occurring as a result of COVID-19. These webinars are scheduled for:

Tuesday, March 24, 2020 – 10 a.m. to 10:30 a.m.
Thursday, March 26, 2020 – 10 a.m. to 10:30 a.m.

Register for the session of your choice here. Your confirmation email will include details for the webinar.

New Waiver Process for Child Care Centers
The Office of Child Development and Early Learning (OCDEL) has developed a waiver process for child care centers that support essential service employees, which includes health care workers, to allow the center to continue to operate. A child care center that serves the children of essential service employees can apply for a waiver using this form. The form should be completed and submitted to the following RA account: ra-pwdracert@pa.gov.

 

 

Sunday, March 22, 2020 – 6:29 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 108 new positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 479 cases.

Governor Wolf also reiterated his mandate for all non-critical businesses across the Commonwealth to close. Enforcement will begin at 8 a.m. tomorrow morning.

Philadelphia Mayor Jim Kenney also issued his own mandate to begin at 8 a.m. tomorrow morning: a stay-at-home order for the entire city. The order will prohibit public and private gatherings outside a single household, with certain exceptions.

DOH Long-Term Care Toolkit
Earlier today, the Department of Health released a long-term care toolkit to help providers prepare for COVID-19. This toolkit includes:

  • an abbreviated preparedness assessment,
  • active screening checklist for residents,
  • a compilation of CDC guidance for long-term care communities,
  • a symptomatic line list template,
  • a list of EPA’s registered antimicrobial products for use against COVID-19,
  • a template letter to be sent to families should a case of COVID-19 be confirmed in your facility or community,
  • healthcare facility COVID-19 exposure tracking log,
  • a step-by-step guide to conduct contact tracing for COVID-19 cases, and
  • ten steps to consider should a case of COVID-19 be confirmed in your community.

This toolkit can be downloaded here. The link will take you to a zip folder containing all nine documents.

Guidance on Communication after a Confirmed Case
It’s important to keep families and staff informed if you do have a confirmed case of COVID-19 in your facility. To help with communication, AHCA/NCAL has developed a sample letter for families and staff and talking points for the media and broader public.

We would ask you to also reach out to Shayna Varner, our Director of Communications, at svarner@phca.org to help with media inquiries and public statements.

Honor our Healthcare Heroes
We’ve already asked you to send us heartwarming pictures, messages and stories about your residents, and how staff is helping them communicate with family, friends and loved ones during this crisis.

But we cannot forget about your staff. They are heroes, in every sense of the word.

As this crisis worsens, and our direct care workers continue to risk their health and safety to protect their residents, we believe it’s our duty to share this story with state government, elected officials and the general public.

When you see something like this, tell us. Because it’s a message that must be delivered.

 

 

Saturday, March 21, 2020 – 3:53 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 103 additional positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 371 cases.

Additionally, the Secretary announced that a second Pennsylvanian has died as a result of COVID-19.

Staffing
Throughout the last few weeks, PHCA has urged the Department of Health, as well as the Departments of State and Education, to relax certain licensing requirements for our direct care workers – especially nurses.

During today’s press conference, Secretary Levine announced an initiative to do just that.

The following requirements for nurses have been changed to help combat COVID-19:

  • Temporary nursing practice permits and graduate permits will be extended beyond one year and extension fees will be waived.
  • Registered Nurses will not have to apply for extensions of their RN graduate or temporary permits. All temporary and graduate permits that would normally expire during the next 90 days will be automatically extended for an additional 90 days.
  • Practical Nurses will not have to apply for extensions of their PN graduate or temporary permits. All temporary and graduate permits that would normally expire during the next 90 days will be automatically extended for an additional 90 days.
  • Registered Nurses, Certified Registered Nurse Practitioners (CRNPs) and Certified Nurse Specialists (CNS) can continue to care for patients if their licenses are currently “in renewal” and set to expire on April 30, 2020. These licenses will be extended for an additional three months until July 31, 2020.
  • Nursing school graduates who have been issued “Authorizations to Test” by the board, and have been unable to sit for the licensure examinations due to cancellation of the examinations because of COVID-19, and do not already have a graduate permit, can immediately apply for a graduate permit so they can assist in the COVID-19 response. Note: This graduate permit authorizes graduate nurses to practice under the supervision of a registered nurse until they can take the examinations. The permits expire if the graduate permit holder fails the examination.
  • More than 14,000 CRNPs can practice to their full capabilities and assist in the COVID-19 response without the usual requirement that they practice within a specific clinical specialty. They also are allowed to prescribe drugs outside the established formulary.
  • On a CRNP’s initial application for prescription-writing authority, the State Board of Nursing will require only one collaborative physician and one substitute physician, rather than the entire list of substitutes.
  • In the event that board-recognized national CRNP certification examinations become unavailable during the coronavirus emergency, CRNPs will not have to hold national certification in a particular specialty.
  • Out-of-state applicants for certification as a CRNP by endorsement in Pennsylvania, who are active licensees of other states and have national certification, will not have to meet the educational equivalence requirement.

COVID-19 in Long-Term Care
Last night, we learned a Sodexo employee working at the Allentown campus of Cedarbrook Senior Care and Rehabilitation has tested positive for COVID-19. An investigation determined the employee had no direct contact with residents.

Earlier today, Philadelphia Health Commissioner Thomas Farley announced the first confirmed case of COVID-19 in a city nursing home.

We are working to obtain additional information on these cases, and we’ll keep you updated as we learn more.

Update on PPE
PHCA has reached out to other associations whose membership has also been impacted by COVID-19. We’ve asked them to consider donating any PPE supplies that aren’t immediately needed – especially gowns, masks, gloves and goggles (whether they are surgical, N95 or other) – to help our caregivers on the front lines who are protecting Pennsylvania’s most vulnerable population. We have received an overwhelmingly positive response.

If you are in dire need of PPE supplies, please reach out to Shayna Varner, our Director of Communications, at svarner@phca.org. She will be coordinating to make sure supplies are distributed to our provider communities most in need.

Honor our Healthcare Heroes
We’ve already asked you to send us heartwarming pictures, messages and stories about your residents, and how staff is helping them communicate with family, friends and loved ones during this crisis.

But we cannot forget about your staff. They are heroes, in every sense of the word.

As this crisis worsens, and our direct care workers continue to risk their health and safety to protect their residents, we believe it’s our duty to share this story with state government, elected officials and the general public.

When you see something like this, tell us. Because it’s a message that must be delivered.

 

 

Friday, March 20, 2020 – 4:48 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 83 additional positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 268 cases.

In keeping with Governor Wolf’s mandatory closure of all non-life-sustaining businesses, we have been forced to close the PHCA office in Harrisburg. However, our team is working remotely, and we stand ready to help you any way we can.

Update on PPE
PHCA has reached out to other associations whose membership has also been impacted by COVID-19. We’ve asked them to consider donating any PPE supplies that aren’t immediately needed – especially gowns, masks, gloves and goggles (whether they are surgical, N95 or other) – to help our caregivers on the front lines who are protecting Pennsylvania’s most vulnerable population. We have received an overwhelmingly positive response.

If you are in dire need of PPE supplies, please reach out to Shayna Varner, our Director of Communications, at svarner@phca.org. She will be coordinating to make sure supplies are distributed to our provider communities most in need.

Clarification on Restricted Visitation Policies and Ancillary Services
While restricted visitation policies do limit visitation for all volunteers, non-essential health care personnel and others, these restrictions do not include:

  • Home-health and dialysis services;
  • the Department of Aging/Area Agency on Aging and the Department of Human Services where there is a concern for serious bodily injury, sexual abuse, or serious physical injury;
  • or hospice services offered by licensed providers within the nursing home facility.

If you have any questions, please don’t hesitate to reach out to Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org.

Interim Guidance on SNFs Accepting Patients from Hospitals
AHCA has issued interim guidance to help skilled nursing facilities when accepting hospital discharges during the COVID-19 pandemic. This guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases. This guidance is designed to help reduce the risk of admitting someone with COVID-19 into your facility, along with the steps you should take to prevent spread.

We strongly urge SNFs to begin creating separate wings, units and/or floors by moving current residents to handle admissions from the hospital and keep current residents separate, if possible. 

BHSL Releases New Guidance for AL/PC Members
Earlier today, BHSL released new guidance for assisted living residences and personal care homes, with the exception of the requirement to accept new admissions. Although this document mentions nursing facilities specifically, it applies to AL/PC as well. AL/PC communities are encouraged to accept new admissions but are not required to do so. However, you must continue to receive current residents from hospitals or nursing facilities if they are ready to be discharged and can be served in the home, including stable patients who have had the COVID-19 virus. Please send any questions to RA-PWARLHEADQUARTERS@pa.gov or contact your regional office.

DOH Outlines Quick Response Team Notification Process
The Department of Health Departmental Operations Center (DOC) is closely monitoring the changing conditions within the Commonwealth’s post-acute and long-term care facilities as it relates to COVID-19. Facilities with individuals who have been identified as presumed positive should report their status to the Bureau of Emergency Preparedness and Response through their Regional Healthcare Coalition (HCC)/HAP Regional Manager. The QRT notification process is outlined here.

CHC-MCOs to Host Webinars to Discuss Changes re: COVID-19
The Community HealthChoices Managed Care Organization (CHC-MCO) Coalition will be hosting two webinars for all nursing facilities to discuss changes and updates occurring as a result of the novel coronavirus (COVID-19) situation. These webinars are scheduled for:
Tuesday, March 24, 2020: 10 a.m. to 10:30 a.m.
Thursday, March 26, 2020: 10 a.m. to 10:30 a.m.
Register for the session of your choice here. Your confirmation email will include details for the webinar.

Online Certification for CNA Now Available
The National Association of Health Care Assistants is now offering free COVID-19 training for Certified Nursing Assistants and anyone else that would like to take the course. We understand you are extremely busy; however, this course is available to any staff who may benefit from the training. To register and complete the online certification, click here.

Reminder: Our AL/PC Summit is Postponed
As a result of the COVID-19 pandemic, PHCA will not be hosting our annual AL/PC Summit this Tuesday, March 24.

We had hoped to offer the Summit sessions via webinar; however, we have made the decision to postpone all educational opportunities until a later date. We will be issuing full refunds for all attendees and sponsors. If you have questions about your Summit refund, please contact Beth Graham at bgraham@phca.org.

 

 

Thursday, March 19, 2020 – 6:06 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 52 additional positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 185 cases.

As a result of this rapid increase, as well as continued non-compliance with previous requests to close non-essential store locations, Governor Wolf has ordered the closure of all non-life-sustaining businesses in Pennsylvania as of 8 p.m. today, March 19, to slow the spread of COVID-19. Enforcement actions against businesses that do not close their physical locations will begin at 12:01 a.m. Saturday, March 21.

In addition, the White House announced this morning the number of positive COVID-19 cases has surpassed 10,000, doubling over two days as states across the country expand testing.

Here are other relevant updates:

Recommendations for Patient Transfers
In keeping with visitation restrictions in your communities, we strongly recommend you apply these same restrictions when arranging for patient transfers. The shortage of PPE also exists within the ambulance and transport community. If you need to transport a patient using these services, we strongly recommend you make arrangements to do so in the lobby or at the front door of your facility in an effort to reduce the opportunity for COVID-19 to enter.

Make sure you have the appropriate equipment to transport a bed-bound patient to the lobby or the entrance of your facility. If you do not, ask your transport provider NOW if there are extra stretchers available to give you time to sanitize and clean the equipment before use.

New Hospital to Post-Acute Care Facility Transfer Form
We have partnered with the Hospital and Healthsystem Association of Pennsylvania and LeadingAge PA to create a consistent, streamlined transfer form to be used when a resident is admitted or re-admitted to your facility from a hospital. You can download this form here.

#PHCACares Initiative
Yesterday, we launched #PHCACares on our social channels to encourage Pennsylvanians to share messages of encouragement, love and support to the residents of Pennsylvania’s long-term care communities.

We’re asking you to visit phca.org/PHCACares and share letters, drawings, photos and videos with our state’s long-term care residents – and their providers of care. We’ll send these well wishes to your facilities, and we’ll be featuring submissions on our Facebook page.

And if you’re posting on social media, please use #PHCACares so we can share your wishes with residents near you.

 

 

Wednesday, March 18, 2020 – 6:24 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 37 additional positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 133 cases.

The numbers are beginning to rise more rapidly as more testing is being conducted across the state, both by the Department of Health and commercial laboratories.

Additionally, late this afternoon, Governor Tom Wolf confirmed the state’s first COVID-19-related death.

A few relevant updates:

New CDC Guidance on PPE
This morning, the CDC issued new guidance on the use and reuse of masks, gowns and face shields. We strongly urge you to begin taking steps today to significantly conserve masks and gowns and extend the availability of your remaining PPE until the supply improves, or we are able to obtain masks and gowns from our association partners.

At this time, the Department of Health has stated that any emergency supply of PPE will only be provided should an active case of COVID-19 occur within a facility.

Congress Passes Families First Coronavirus Response Act – HR 6201 
Late today, the U.S. Senate passed a multibillion-dollar emergency aid package to confront the economic impacts of the coronavirus. The bill will now go to President Trump for his signature.

Among other things, the bill increases the federal Medicaid match (FMAP) by 6.2%. This will bring an additional $1.5 billion to Pennsylvania.

States will be required to use these funds for COVID-19 related expenses. Keep in mind: the enhanced FMAP does not result in automatic rate increases for our sector. It’s up to each state to decide how to spend the funds, which means we’ll need to advocate for our fair share – and we will need your help.

Congress will begin working on another bill this week to provide further stimulus to the economy. We will be seeking funding in that bill as well.

Share Your Positive Stories!
Today, ABC27 (the ABC affiliate here in Harrisburg) aired a story highlighting the good work an IntegraCare community, the Woods at Cedar Run, has been doing for their residents during this trying time.

And yesterday, Carbondale Nursing and Rehabilitation Center was featured on ABC16 for their dedication to their residents.

We need more stories like this!

We’d love to showcase these efforts and highlight the good work you’re doing on our social media channels. Please share photos, videos and other anecdotes with Kara Barmoy, our Digital and Social Media Manager, at kbarmoy@phca.org. Remember: every story is worth sharing.

And if you share on social media, please use #PHCACares in your post!

 

 

Tuesday, March 17, 2020 – 5:31 p.m.

Today, Department of Health Secretary Rachel Levine confirmed 20 additional positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 96 cases.

A few additional updates:

Governor Wolf Approves Staffing Requests
Earlier today, we shared that Governor Tom Wolf, the Department of Health and Department of Human Services approved three of our four requests for emergency regulatory and staffing relief. A formal announcement will be forthcoming, but we are proud to advocate on your behalf for these much-needed steps in support of your facilities and communities.

Townhall with U.S. Senator Pat Toomey
This morning, we joined a healthcare provider townhall conference call with U.S. Senator Pat Toomey (R-PA) to share policy and regulatory concerns related to COVID-19 response efforts. Senator Toomey offered an update on congressional activity pertaining to COVID-19 and discussed the Families First Coronavirus Response Act, federal legislation aimed at helping workers and businesses through these turbulent times. Senator Toomey also recognized the PPE shortages and challenges existing in Pennsylvania and across the country.

The federal legislation has passed the U.S. House of Representatives and is awaiting a vote in the Senate.

U.S. Senator Bob Casey sends letter to Trump Administration
We received word today that Sen. Bob Casey (D-PA) has sent a letter to Vice President Mike Pence, asking for additional information on the Administration’s efforts to protect nursing home residents, staff and their families.

We will be participating in a roundtable discussion with Senator Casey this Friday regarding COVID-19 and much-needed support for long-term care facilities.

CMS
As a reminder: CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission. If you have any questions, please contact PHCA staff.

Share Your Positive Stories!
Throughout the last few days, we’ve received pictures, videos and stories from member facilities and communities regarding the innovative ways in which they’re keeping residents engaged with family members and each other – whether through messages on social media, Facetime calls or video-conferencing.

We’d love to showcase these efforts and highlight the good work you’re doing on our social media channels. Please share photos, videos and other anecdotes with Kara Barmoy, our Digital and Social Media Manager, at kbarmoy@phca.org. Remember: every story is worth sharing.

 

 

Tuesday, March 17, 2020 – 11:21 a.m.

Late last night, we received updated guidance from the Wolf Administration in response to our joint letter with LeadingAge PA requesting emergency regulatory and staffing relief to ensure you are prepared to combat COVID-19 in your facilities. A formal announcement will be forthcoming, but we wanted to get this information to you right away as you plan daily operations.

Governor Wolf has agreed to grant three of our four requests:

  • We asked for a waiver or temporary relief from staffing requirements if facilities are not able to meet minimums but are still providing adequate quality of care to residents.
    • The Governor will be GRANTING this request. DOH will permit a facility to continue operations if the facility’s minimum number of nursing hours per resident per day (PPD) is below the required 2.7. DHS will waive Personal Care Home and Assisted Living Residence staffing requirements if the facilities are not able to meet minimums but are still providing adequate quality of care residents. DHS will require notification at the time the staffing complement drops below the minimum level for monitoring purposes and the facility should document the reasons for subsequent inspection.
  • We asked to allow for flexibility in the individuals that perform certain activities with proper abbreviated training.
    • The Governor will be GRANTING this request. DHS and DOH will provide flexibility for individuals to perform certain tasks with abbreviated, focused training. This does not extend to permit the performance of licensed functions without a license or to provide services beyond the scope of the license. Adequate documentation is required.
  • We asked for temporary Pennsylvania licensure to physicians, nurses and nursing assistants licensed in other states who can help providers here and now.
    • The Governor will be GRANTING this request. For nurses specifically, temporary permits for nurses licensed in other states can be issued immediately upon application, with the Board waiving the administrative paperwork requirements by verifying licensure in the other state through NURSYS (a national database of nurses provided by the National Council of State Boards of Nursing).
  • We also asked to allow for flexibility in Department of Human Services daycare regulation requirements so that long term care providers with space can allow workers to bring their children to these settings.
    • At this point, the Governor will NOT be granting this request. The Governor is committed, however, to working through alternative solutions to accommodate long-term care provider staff without the arrangement being on site.

We are grateful for the emergency regulatory and staffing relief promised by Governor Wolf, the Department of Health and the Department of Human Services to help our long-term care providers as they navigate the emerging impacts of COVID-19 and continue their tireless efforts to protect Pennsylvania’s most at-risk and vulnerable population: those in long-term care facilities.

This additional flexibility will allow our providers to continue providing the best possible care for residents while also helping to address some of the acute workforce challenges facing the long-term care sector and the unique challenges of this virus.

 

 

Monday, March 16, 2020 – 8:48 p.m.

Earlier today, Governor Wolf and Department of Health Secretary Rachel Levine confirmed 13 additional positive cases of COVID-19 in Pennsylvania. This brings the statewide total to 76 cases.

In addition, Governor Wolf announced mitigation (or ‘quarantine’) efforts have been expanded to include the entire state. These efforts include the recommended closure of all non-essential stores. Restaurants and bars will be open for takeout and/or delivery only. Grocery stores, pharmacies, gas stations and medical facilities will remain open.

This statewide mitigation effort will be in place for the next two weeks.

President Trump Remarks
Late this afternoon, President Donald Trump offered the federal government’s take on the COVID-19 outbreak, advising that Americans should avoid social gatherings involving groups of 10 or more.

Early news reports indicated the White House was considering imposing curfews and a national quarantine, but that was proven to be untrue (for now).

CMS
We wanted to ensure you received this important update: to aid skilled nursing facilities in addressing the COVID-19 outbreak, CMS is waiving both the 3-Day Stay and Spell of Illness requirements.  

This means that skilled nursing facility care without a 3-day inpatient hospital stay will be covered for beneficiaries, regardless of whether there is COVID-19 present in the hospital or not.

CMS also is utilizing the authority under section l8l2(f) providing renewed SNF coverage to beneficiaries without starting a new spell of illness and allowing them to receive up to an additional 100 days of SNF Part A coverage.

 

 

Sunday, March 15, 2020 – 6:36 p.m.

Earlier today, the Pennsylvania Department of Health confirmed 16 additional positive cases of COVID-19. This brings the statewide total to 63 cases.

It’s worth noting there have been 446 patients to date who have been tested or are in the process of being tested. 205 of those tests were negative; 63 have been confirmed, and 183 patient samples are either at the lab for testing or on their way to the lab.

PPE (Personal Protective Equipment)
As we told you yesterday, we have received many questions and concerns from providers across the state regarding shortages of masks, gowns, gloves, goggles and hand sanitizer.

We recommend initiating as many conservation approaches as you possibly can at this time. If you are imminently (within 3-4 days) about to exhaust specific PPE supplies, you should take these steps in this order:

CMS and the Federal Government
As a reminder: Late Friday, CMS released new guidance directing all skilled nursing facilities to cancel all group activities and communal dining, and implement active screening of residents and healthcare personnel for fever and respiratory symptoms based on the newest recommendations from the Centers for Disease Control and Prevention.

Implementing this will be a challenge for providers, and will likely require changes in staffing patterns. How this is implemented must be viewed on a facility-by-facility and day-to-day basis, depending on your physical plant, staff availability, and resident needs.

Please review this recommended approach on how to implement social distancing in your dining practices.

 

 

Saturday, March 14, 2020 – 3:22 p.m.

Today, Governor Tom Wolf and Department of Health Secretary Rachel Levine announced there are now 41 “presumptive positive” cases and 6 confirmed cases of COVID-19, including 2 new cases in Allegheny county.

In addition, Governor Wolf expanded county-specific quarantine restrictions to Chester and Bucks Counties, which requires the closure of all non-essential public spaces.

As a reminder: all public schools will close starting this Monday, March 16th until Friday, March 27.

Staffing
We recognize these new quarantine restrictions, as well as the impending school closures, will dramatically impact the available workforce in your facilities and communities.

We continue to put pressure on the Wolf Administration and DOH for guidance on proactive regulatory and staffing relief for providers as we navigate the emerging impacts of COVID-19.

Yesterday, we sent a joint letter with LeadingAge PA to the Governor, his senior staff and the Department of Health. We have received confirmation they are reviewing, and we hope to have guidance for providers soon.

PPE (Personal Protective Equipment)
We have received many questions and concerns from providers across the state regarding shortages of masks, gowns, gloves, goggles and hand sanitizer.

Late last night and this morning, we engaged in conversations with members from the Hospital and Healthsystem Association of PA, the PA Chamber, the PA Food Merchants Association and other stakeholders to see if supplies could be diverted from public stores to the healthcare providers who need them most. We will continue to work with our partners in Harrisburg on ways to get you supplies.

CMS and the Federal Government
Late yesterday, CMS released new guidance directing all skilled nursing facilities nationwide to restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, such as end-of-life.

This guidance also directs nursing facilities to cancel all group activities and communal dining, and implement active screening of residents and healthcare personnel for fever and respiratory symptoms based on the newest recommendations from the Centers for Disease Control and Prevention.

Because assisted living and personal care communities are regulated at the state level, this CMS guidance does not directly apply to AL/PC; however, the risk to our population in assisted living and personal care is just as serious. Unless we hear otherwise, these visitation guidelines should be applied throughout our entire continuum of care.

Additionally, both President Donald Trump and CMS Administrator Seema Verma have stated publicly that they are suspending the Medicare three-day stay requirement before a SNF admission. We have not yet seen an official CMS waiver for this, so please don’t assume this rule is in effect until we have received formal confirmation.

For More Information
We will continue to share updates via email and on our social media channels. Please follow PHCA on Facebook and Twitter for the most up-to-date guidance and resources for long-term facilities from federal and state partners.

 

Friday, March 13, 2020 – 5:58 p.m.

This afternoon, Governor Tom Wolf and Department of Health Secretary Rachel Levine announced there are now 35 “presumptive positive” cases and 6 confirmed cases of COVID-19, including cases in three new counties: Cumberland, Bucks and Washington.

In addition, Governor Wolf expanded county-specific quarantine restrictions to Delaware County.

And perhaps most important: all public schools will close starting Monday, March 16th until Friday, March 27.

We recognize these new quarantine restrictions, as well as the impending school closures, will dramatically impact the available workforce in your facilities and communities.

Earlier today, we sent a joint letter to Governor Wolf, co-signed by LeadingAge PA, urging him and his administration to provide proactive regulatory and staffing relief for long-term care providers as we navigate the emerging impacts of COVID-19.

Based on the strong recommendations and learned best practices from our counterparts in other states, including Washington, we have requested an executive order that provides for the following:

  • Granting temporary relief or waivers from the staffing requirements issued by DOH and DHS;
  • Allowing for staffing flexibility for ancillary or administrative staff to perform certain resident-specific activities after the proper, abbreviated training;
  • Allowing for flexibility from DHS daycare regulation requirements so long-term care providers with space can allow workers to bring their children to these settings;
  • Immediately granting temporary Pennsylvania licensure to physicians, nurses and nursing assistants licensed in other states to help providers here and now.

We await additional guidance from the Wolf Administration and DOH on these recommendations.

In Washington, D.C., CMS Administrator Seema Verma said the agency would be ratcheting up restrictions on nursing home visitors in soon-to-be issued guidance. We will keep you updated as soon as we know more.

 

 

Friday, March 13, 2020 – 2:50 p.m.

Yesterday, the Department of Health (DOH) issued guidance on Visitation in Nursing Facilities due to COVID-19. The Department of Human Services, Office of Long-Term Living is asking that all Personal Care Homes and Assisted Living Residences adopt and implement the guidance attached.

Information will continue to be shared and disseminated going forward to address questions and concerns that have been brought to our attention. We continue to monitor information from the Pennsylvania Department of Health and the U.S. Centers for Disease Control and Prevention. Guidance developed by DHS will be centrally located on this page, which will be updated as additional guidance becomes available. We encourage you to continue to consult these resources for updates on COVID-19, information on staying healthy, and updates on the situation in Pennsylvania.

 

 

Thursday, March 12, 2020 – 6:10 p.m.

As a result of our meeting with the Department of Health earlier this week, we have received interim guidance from the state that takes into account our input as it relates to visitation policies for skilled nursing providers during the response efforts to COVID-19.

The Department is currently advising the following:

  • If a nursing facility is located in an area in which there are known cases of COVID-19, the Department recommends a no visitor policy in nursing facilities, except in instances of end-of-life events that require visitation from immediate family members, friends, and religious leaders.
  • This is immediately applicable to homes in Montgomery County and any bordering counties.
  • If a nursing facility is not located in a county or area in which there are known cases of COVID-19, but assesses a ‘no visitor’ policy to be in the best interest of residents, the Department supports that step at this time.
  • Nursing facility staff and administrators should use screening protocols per their Emergency Preparedness and Infection Control Plan, and any health care providers who have signs or symptoms of a respiratory infection should not report to work.

This interim guidance from DOH can be found here.

We would urge you to continue to over-communicate with residents, staff and family members.

We will continue to share updates via email and on our social media channels. Please follow PHCA on Facebook and Twitter for the most up-to-date guidance and resources for long-term facilities from federal and state partners.

 

 

Thursday, March 12, 2020 – 2:57 p.m.

This afternoon, Governor Tom Wolf and Department of Health Secretary Rachel Levine announced 22 individuals have tested “presumptive positive” for COVID-19 in Pennsylvania. There are currently 81 tests pending.

During the press conference, Governor Wolf issued the following guidance for Pennsylvania and Montgomery County specifically:

Statewide

  • The Wolf Administration discourages individuals from traveling to recreational activities like gyms, movie theaters and shopping malls.
  • The Wolf Administration encourages religious leaders to exercise discretion in order to mitigate the spread of illness.

Montgomery County

  • A ‘no visitor’ policy will be implemented for nursing homes, and others to be evaluated.
  • Schools in Montgomery County will be closed starting tomorrow, as will child care centers licensed by the Commonwealth.
  • Adult daycare centers will be closed.
  • Freedom of travel will remain, but the Governor and the Commonwealth ask all people to refrain from non-essential travel.
  • Essential services will be available: police, fire, and emergency medical services, essential services for vulnerable populations.
  • Supermarkets, pharmacies, and gas stations will remain open. The Governor and the Commonwealth recommends that non-essential retail facilities close.
  • AMTRAK will begin operating a reduced schedule and the Ardmore stop will close to AMTRAK trains for two weeks, beginning tomorrow. The Wolf Administration is also working directly with SEPTA to evaluate potential impacts and will continue to provide service updates as things evolve.

Commonwealth Employees

  • The Commonwealth is authorizing a 10 workday paid absence for individuals who don’t have telework capabilities.
  • Facilities that are in Montgomery County that are Commonwealth facilities and provide essential services will remain open.
  • Facilities that are administered by Montgomery County will follow the same procedures as the county.

State correctional facilities and veterans homes have already introduced a statewide visitor ban to ensure the safety of inmates, residents, staff and visitors.

We will continue to share updates via email and on our social media channels. Please follow PHCA on Facebook and Twitter for the most up-to-date guidance and resources for long-term facilities from federal and state partners.

 

 

Tuesday, March 10, 2020 – 5:48 p.m.

Earlier today, Department of Health Secretary Rachel Levine announced there are now 12 total ‘presumptive positive’ cases of COVID-19 in Pennsylvania.

Late yesterday, the Centers for Medicare and Medicaid Services (CMS) issued revised guidance for skilled nursing facilities in order to prevent the spread of COVID-19. The guidance focused on limiting visitors to your facilities, and that can be found here.

The revised CMS guidelines are similar to those provided by AHCA/NCAL yesterday afternoon; however, there are a few very slight variations in how the guidance documents are written. Both aim at controlling or mitigating the spread of the virus. Here is a side-by-side comparison.

We would strongly encourage you to implement a visitation policy at your facilities or communities at this time. Though the AHCA/NCAL recommendations differ slightly from CMS, we must work to ensure the safety of our residents and staff. If you’re unclear on any of these policies or need a recommendation, please reach out to PHCA as soon as possible.

As you’re communicating with families of residents, AHCA/NCAL has prepared a template document for providers to help explain the need for restricting visitors.

A few state updates:

  • Tomorrow morning, PHCA will be meeting with Department of Health leadership to discuss specific guidance for providers. Following the meeting, we will send you pertinent updates.
  • PHCA has been invited by U.S. Senator Bob Casey to participate in a Congressional COVID-19 roundtable next Friday, March 20. We will share the results of that meeting as well.

 

 

Monday, March 9, 2020 – 9 p.m.

The Centers for Medicare & Medicaid Services (CMS) has released additional requirements and detailed guidance on the screening, treatment and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19. CMS is also issuing additional guidance specific to nursing homes to help control and prevent the spread of the virus.

To view, CMS’s guidance for nursing homes, click here.

 

Monday, March 9, 2020 – 6:18 p.m.

Earlier today, Department of Health Secretary Rachel Levine announced there are now 10 total ‘presumptive positive’ cases of COVID-19 in Pennsylvania. There is currently one case in Delaware County, one case in Monroe County, one case in Wayne County and seven cases in Montgomery County. Three of these individuals are currently hospitalized. DOH expects to see an increase in the number of COVID-19 cases in the coming weeks.

As you continue to implement heightened preventative measures and review infection control protocols to reduce risk within your communities, please consider the community visitation guidance (below), which has been issued by AHCA/NCAL:

These recommendations go above and beyond the CMS guidance issued last Wednesday, but are consistent with the guidance and regulations to restrict persons entering the building who may pose a health risk to our residents.

To reflect this new guidance, AHCA/NCAL has also created a screening checklist for SNF visitors.

You’re likely hearing concerns from residents, staff, family members and ancillary companies about this virus, and how best to handle a single confirmed case – or an outbreak.

If you have not done so already, please begin to compile family contact information for proactive communication in the event a single confirmed case – or an outbreak – occurs in your community.

It is critical to communicate with your residents’ families as quickly and as often as possible.

As a reminder: in the interest of long-term care operators and direct care workers across the state, we have opened our online resource on the PHCA website to both members and non-members.

If you have any questions, please don’t hesitate to contact staff at PHCA:
  • For regulatory questions, please contact Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org.
  • For quality questions, please contact Chris Fisher, Director of Quality Initiatives, at cfisher@phca.org.
  • For communications or questions related to responding to media inquiries, please contact Shayna Varner, Director of Communications, at svarner@phca.org.

 

Monday, March 9, 2020 – 12:33 p.m.

Today, the Pennsylvania Department of Health announced a Montgomery County resident is a presumed positive case for COVID-19. Pennsylvania now has seven presumptive positive cases of coronavirus, five in Montgomery County, one in Delaware County and one in Wayne County.

This individual, an adult, is in the Hospital of the University of Pennsylvania in critical condition, where they are being cared for under proper precautions to protect other patients and hospital staff. They tested presumptive positive after known international exposure.

For the most up-to-date information on the coronavirus, please visit here.

 

 

Sunday, March 8, 2020 – 6:09 p.m.

Today, the Pennsylvania Department of Health announced two additional patients have tested presumed positive in Montgomery County.

These two individuals, both adults, have mild symptoms and are isolated at home. They tested presumptive positive after known international exposure. This brings the total of Pennsylvania presumptive positive cases to six.

 

 

Saturday, March 7, 2020 – 5:40 p.m.

Governor Tom Wolf has confirmed two new presumptive positive cases of 2019 Novel Coronavirus (COVID-19) in Pennsylvania. Both individuals are from Montgomery County, have mild symptoms, are in isolation at home and were exposed to an area of the United States where COVID-19 is present.

According to a press release issued by the governor’s office, the Wolf Administration has been “coordinating with legislative leaders from both parties, and we have agreed to immediately work toward a package that would provide resources to ensure we are aggressively mitigating the spread of COVID-19.”

These resources will help mitigate the spread and strengthen state and local efforts by:

  • Supporting county and municipal health departments;
  • Securing necessary equipment and personnel;
  • Securing personal protective equipment (PPE);
  • Disseminating public health messaging; and
  • Supporting care for seniors, the most at-risk population.

“While we anticipate that there will be more Pennsylvanians with COVID-19 in the coming days and weeks, it is important for residents to know the commonwealth is prepared and that they should be, too,” Sec. of Health Dr. Rachel Levine said. “We are working with the health care community and local community leaders across Pennsylvania to keep them informed, consult on patient testing and ensuring they have the resources they need to care for patients. We are prepared to mitigate the spread of this virus in Pennsylvania.”

All are reminded to:

  • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
  • Cover any coughs or sneezes with your elbow, not your hands.
  • Clean surfaces frequently, such as countertops, light switches, cell phones and other frequently touched areas.
  • Contain if you are sick, you should stay home until you are feeling better.

 

 

Friday, March 6, 2020 – 4:18 p.m.

Pennsylvania Department of Health Secretary Rachel Levine hosted an afternoon briefing to provide stakeholders with additional guidance and information following this morning’s press conference indicating there are two “presumptive positive” cases of COVID-19 in Pennsylvania.

During the call, Secretary Levine shared the following information:

  • Both cases will remain “presumptive positive” until test results are confirmed by the CDC. One individual is an adult from Wayne County (international exposure); the other is an adult from Delaware County (exposure from another state).
  • At this time, these cases are not a result of community transmission as defined by public health criteria.
  • Both individuals have been quarantined in their homes and are being monitored closely by the Department of Health via phone calls and are in close communication with their respective physicians.
  • The state public health laboratory in Exton has expanded its ability to test for COVID-19. By this weekend, the state public health laboratory will be able to complete up to 125-150 tests per day.
  • Following this morning’s press conference, Governor Tom Wolf issued an emergency disaster declaration, providing more support to state agencies involved in the response to COVID-19.
  • Five schools in Central Bucks County School District were closed out of an abundance of caution related to an out-of-state exposure. These closures were not a result of the presumptive positive cases in Wayne and Delaware counties. This decision was made in conjunction with the superintendent and local health departments.
  • COVID-19 is spread and/or transmitted through air droplets (coughing and sneezing), close personal contact (touching or shaking hands) and through touching surfaces that may have come into contact with the virus. Individuals are encouraged to reduce the risk of spreading of the virus by taking the following precautions:
    • Washing your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
    • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
    • Clean surfaces frequently, including countertops, light switches, cell phones and other frequently touched items.
    • If you are sick, stay home and avoid contact with others.
  • Pennsylvania is monitoring travelers as per CDC guidelines. Travelers returning from impacted countries are subject to a 14-day quarantine.
  • The Department of Health continues to collaborate with federal, state and local partners to protect public health.

Secretary Levine also provided additional guidance and information related to:

TESTING
If you are ill and feel you may have been exposed to COVID-19, call 877-724-3258. You can speak directly with a state epidemiologist or contact your health care provider to discuss symptoms and potential exposure to determine if a test is needed. If a test is needed, you will be referred to have testing done. After a specimen is gathered, it will be sent to the state public health lab. The test takes about four hours to complete. At this time, there is no backlog of tests at the state public health laboratory. Testing at the state public health laboratory or the CDC testing is free – it is covered by state and federal government. The Department of Health is in discussions with DHS and Pennsylvania Insurance Department to make sure there are no economic disadvantages caused as a result of COVID-19 testing.

ADDITIONAL PRECAUTIONS FOR GENERAL PUBLIC
At this time, there are no additional precautions necessary for the general public. The general public should refrain from purchasing masks or gloves. We need to make sure those are available for health care providers. To reduce the risk of contracting COVID-19, wash your hands frequently and use hand sanitizer.

DOMESTIC TRAVEL RECOMMENDATIONS
There are no domestic travel recommendations at this time. If you feel you have been exposed to someone in another state that may have also had exposure to COVID-19, call your local health department. If a state has a widespread community transmission, it is possible there may be some level of travel restrictions put in place; however, none have been discussed at this time.

PROJECTED INCREASE IN CONFIRMED CASES
The Department of Health expects to see more confirmed cases of COVID-19 in Pennsylvania. There has been community spread, as defined by the public health criteria, in California, Washington state among others. The Department of Health will be monitoring the potential for this spread extremely carefully with county partners and other stakeholders and are prepared to address as necessary.

GUIDANCE FOR SCHOOLS
The Department of Health is working with superintendents and school personnel in conjunciton with the Department of Education to talk about school guidelines and the potential need for closures. Based on what is known about COVID-19, young people don’t seem to be as at risk for this virus but the department is planning to take all necessary precautions with schools.

CLEANING
The CDC recommends frequently deep cleaning surfaces in high traffic areas with ammonia-based cleaning supplies. COVID-19 can live on surfaces. It is important for businesses, restaurants and other crowded areas routinely clean frequently touched surfaces including work stations, countertops, doorknobs, etc. No additional disinfection is necessary.

We’ll continue to send you emails with updates and disseminate our information on our social media channels.

 

 

Friday, March 6, 2020 – 1:59 p.m.

The following documents have been posted to the Department of Health message board:

  • State Registrar Notice
    The Bureau of Health Statistics (BHSR) is awaiting formal detailed guidance from CDC’s National Center for Health Statistics on the reporting of deaths where Coronavirus Disease 2019 or COVID-19 has caused or is assumed to have caused or contributed to the death of a decedent. This document provides interim guidance that has been developed for medical professionals to be followed in reporting these deaths until further information is available.
  • Long-Term Care Facility (LTCF) Visitation Guidance
    This visitation guidance is provided to prevent the spread of COVID-19 and are many of the same strategies used every day to detect and prevent the spread of other respiratory viruses like influenza.

 

 

Friday, March 6, 2020 – 1:12 p.m.

Following the reports this week that COVID-19 is spreading in some communities and has impacted a nursing facility in Washington state, we feel it is necessary for AHCA/NCAL to cancel the 2020 Quality Summit and Independent Owner Conference next week (March 9-13) in Grapevine, Texas.

After carefully evaluating this situation, we have no doubt that this decision is in the best interest of our residents and our caregivers. Traveling across the country to attend a conference could slightly increase the risk that professionals who work in our long term care centers every day may become infected. We know that the frail and elderly residents in our care are the most vulnerable to this virus and we need to do everything we can to minimize every risk, no matter how small. We simply cannot take any action that puts our residents, our staff and their families at a higher risk for illness. The safety and well-being of our residents and staff come first.

We also hear from our members that they have a singular focus on the steps they need to take to provide high-quality care during this time: preparing our staff and buildings, following strict infection prevention and control procedures, reassuring our residents, and communicating with families. We also know that many of our members are struggling to fill supplies of masks and other protective equipment. Canceling our meetings next week ensures our focus is where it should be—with our residents.

We will continue to provide educational materials, tools and other resources as well as regular updates about COVID-19. You can find daily updates on our website at www.ahcancal.org/coronavirus.

Registered attendees of the Quality Summit and Independent Owner Leadership Conference will be issued a registration refund by Monday, March 9, 2020. Once the refund is processed, you will receive an email notification. We are working with the hotels now to determine the best way to cancel the reservations. We will send you a notification later today on the process.

We appreciate your understanding and wish you good luck as you prepare for the worst and hope for the best.

 

 

Friday, March 6, 2020 – 11:43 a.m.

Following a press conference announcing the first two presumptive positive cases of coronavirus, known as COVID-19, Governor Tom Wolf today signed an emergency disaster declaration to provide increased support to state agencies involved in the response to the virus.

The disaster declaration follows the Department of Health’s activation of its Department Operations Center at the Pennsylvania Emergency Management Agency’s headquarters to conduct public health and medical coordination for COVID-19 throughout the commonwealth and the governor’s announcement earlier this morning about two presumptive positive cases in Pennsylvania. One individual is an adult from Wayne County; the other is an adult from Delaware County.

To date the Wolf Administration has:

  • Activated of the Department of Health’s Emergency Operations Center to allow for enhanced response coordination;
  • Began testing for COVID-19 at the state laboratory;
  • Maintained communication and outreach with federal, state and local partners;
  • Provided symptom monitoring for residents returning from areas impacted by coronavirus;
  • Provided health care providers, businesses and education providers with information;
  • Reviewed and adapted current pandemic flu plans to prepare for spread of COVID-19;
  • Increased testing capacity to test 20-25 individuals a day;
  • Purchased equipment to increase testing capacity to 125-150 individuals within a day.

 

 

Friday, March 6, 2020 – 10:10 a.m.

Just this morning, Governor Tom Wolf and Department of Health Secretary Rachel Levine hosted a press conference in which they confirmed two presumed positive cases of COVID-19 – one in Delaware County and one in Wayne County. The cases will remain presumed positive until test results are confirmed by the CDC. Both individuals have been quarantined in their homes.

The Pennsylvania Department of Health is working with county and municipal health department partners to continue testing individuals who meet the criteria to be tested for COVID-19.

Later today, DOH will be holding a briefing call to provide additional guidance. We will provide any and all information updates with you as quickly as possible following this briefing.

As additional information is made available from our federal and state partners, we will continue to update this online portal. And we’ll continue to send you emails and disseminate our information on our social media channels.

Don’t forget – we’ve developed an online resource available only to PHCA members. Visit phca.org/COVID19 today to learn more.

We’ll continue to send you emails and disseminate our information on our social media channels.

If you have any questions, please don’t hesitate to contact staff at PHCA:

  • For regulatory questions, please contact Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org.
  • For quality questions, please contact Chris Fisher, Director of Quality Initiatives, at cfisher@phca.org.
  • For communications and questions about responding to media inquiries, please contact Shayna Varner, Director of Communications, at svarner@phca.org.

 

 

Thursday, March 5, 2020 – 4:45 p.m.

With last weekend’s news out of Washington state regarding COVID-19 (coronavirus), a great deal of media attention has been placed on long-term care providers across the country.

As of this email, there have been 13 states with either confirmed or presumptive positive cases of the virus (as reported to CDC).

You’re likely hearing concerns from residents, staff, family members and ancillary companies about this virus, and how best to handle a single confirmed case – or an outbreak.

PHCA is here to help you, every step of the way, and our team will ensure you receive all appropriate guidance to combat this virus in your communities.

As additional information is made available from our federal and state partners, we will continue to update this online portal. And we’ll continue to send you emails and disseminate our information on our social media channels.

While there have been no confirmed cases of COVID-19 here in PA, it’s critical we continue to plan ahead. Here are a few tips to consider:

  • Communicate frequently with staff to keep them informed on the expectations for prevention steps;
  • Review with staff potential situations that could interrupt their work schedule, like closed schools, daycare, illness, etc. and help them plan their steps;
  • Use CDC infographics for sharing information quickly and help staff to take action;
  • Maximize your front line defenses: implement a system for simple screening questions for visitors and staff before they are in contact with residents.

The CDC expects an increase of confirmed COVID-19 cases in the coming days and weeks and is relying on health care providers to take action and help prevent the spread of the virus.

If you have any questions, please don’t hesitate to contact staff at PHCA:

  • For regulatory questions, please contact Gail Weidman, Director of Policy and Regulatory Affairs, at gweidman@phca.org.
  • For quality questions, please contact Chris Fisher, Director of Quality Initiatives, at cfisher@phca.org.
  • For communications and questions about responding to media inquiries, please contact Shayna Varner, Director of Communications, at svarner@phca.org.

 

 

Wednesday, March 4, 2020 – 4:55 p.m.

The Centers for Medicare & Medicaid Services (CMS) issued two new Quality, Safety and Oversight memos today about COVID-19 – two apply to nursing homes and a third to hospitals that are listed below. We strongly encourage you to review:

  1. QSO 20-14-Nursing Homes (NH) at https://www.cms.gov/files/document/qso-20-14-nhpdf.pdf
  2. QSO 20-12-ALL at https://www.cms.gov/files/document/qso-20-12-allpdf.pdf-1

The first memo (QSO 20-14-NH) provide NEW and helpful guidance on:

  • Screening visitors and who should be restricted;
  • Screening employees and contractors and who should be asked to stay at home;
  • When patients should be managed in the facility vs sent to the hospital;
  • What to do when transferring residents with suspected COVID-19, and;
  • What criteria to use in accepting patients from the hospital with COVID-19

The second memo (QSO 20-12-ALL) announces that CMS will re-prioritize surveys to conduct focus surveys about infection control for facilities that have had an infection control deficiency in the past to assure that they are in compliance with the new regulations. Specifically:

  • Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years, and;
  • Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy.

The Agency also provided a copy of the critical elements pathway in QSO-20-12-ALL that will be used by the surveyors to assess compliance with current regulations. We encourage you to review and use these guidelines in your facility as a self-assessment tool.

We encourage all members to review closely the State Operating Manual’s guidance for F-880 related to infection control and take steps to assure consistent hand washing (or use alcohol hand gels) and contact precautions for residents with respiratory infections.

 

 

Wednesday, March 4, 2020 – 3:36 p.m.

The recording to AHCA/NCAL’s COVID-19 webinar on March 3 is now available here. Please note that there are two versions, depending on which web browser you are using.

This is a critical issue for long term care as evidenced by the more than 13,000 people who participated in the webinar.

Please continue to check AHCA/NCAL’s website for the latest information and resources that AHCA/NCAL has to share about COVID-19. Please email COVID19@ahca.org with any additional questions regarding this virus.

Thank you for everything you are doing to keep our residents, families and staff safe.

 

 

Tuesday, March 3, 2020 – 8:30 a.m.

The CDC expects an increase of confirmed COVID-19 cases in the coming days and weeks, and is relying on health care providers to take action and help prevent the spread of the virus. Due to the rapidly changing nature of the spread of COVID-19 around the world, it is important for families to be prepared.

But don’t panic! There are ways you can protect yourself at work and at home – and help prevent the spread of the virus in your area. Please consider the following information and resources to help you prepare.

Protect yourself at work:

  • Advise all staff to wear PPE when appropriate. At this time, the CDC does not recommend the use of PPE for workers who are not providing direct patient care.
  • When appropriate, use social distancing from anyone who may be displaying symptoms.
  • Wash and/or sanitize your hands after every interaction with a resident or visitor.
  • If you have reason to suspect a possible COVID-19 case, please follow these more stringent standards:
    • droplet precautions for the resident;
    • full PPE for all staff within a six-foot radius;
    • N95 masks;
    • isolation gowns;
    • and face/eye protection.
  • If you suspect a possible COVID-19 case, please report it to the Department of Public Health.

 Protect your building: 

  • Consider adding additional resources regarding COVID-19 at your entrance signs, such as warning signs in bold letters asking visitors having flu and/or respiratory symptoms to temporarily refrain from visiting the facility – even if they do not have travel history.
  • Encourage all staff to self-isolate at home if they display symptoms of the flu, especially if they have received the flu vaccine.
  • Take precautionary removal of care staff who identify as suspected cases. Ask them to self-isolate at home as well.
  • Prohibit staff from reporting to work if they are sick until cleared to return.
  • Consider restricting admissions or heightened screening of admissions.
  • Environmental cleaning: At this time, retrain to and follow these guidelines from the CDC about infection control and cleaning.
  • Post visual alerts that remind everyone to wash their hands and cover their coughs.

Protect yourself at home and in the community:

  • Practice social distancing, when possible. Stay away from anyone coughing or sneezing – particularly, if you do not know the person.
  • Practice good hand washing and cough etiquette.
  • If you are sick, have flu symptoms or a fever: Stay home and self-isolate.
  • Prepare for schools to close.
  • If you are sick, call your physician, clinic or hospital before you visit them. Do not go to a clinic or hospital with symptoms without calling first – they will instruct you on the proper procedures.

The CDC has offered strategies for health care providers on how to optimize supplies of N95 respirators in the face of decreasing supply, which can be found here. These strategies include minimizing the number of health care professionals who need to use respiratory protection, use alternatives to N95 respirators, such as facemasks where feasible, and prioritize the use of N95 respirators for those with the highest risk of acquiring an infection or experiencing complications from an infection.

You can learn more about the CDC’s strategies for optimizing the supply of PPE here. If you are having difficulty meeting PPE requests, please contact your local and state health departments.

While we are still taking a “wait and see” approach, the above-mentioned information can be used to minimize any potential impact or spread of the COVID-19 virus. As the situation evolves, it’s important to remember the most accurate and timely information regarding this outbreak is available through the Pennsylvania Department of Health as well as the CDC’s website and social media channels.

Providers are also reminded their emergency preparedness plans are required to address emerging infectious disease protocols. It is recommended all providers review their emergency plans to ensure their plan includes protocols and policies regarding emerging infectious diseases and to ensure all staff is trained on the appropriate steps to put into place if the situation should arise.

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