Tennessee Health Disparities Task Force Agenda COVID-19 Long-Term Care Facilities and Task Force TN Nursing Home Civil Monetary Penalty Reinvestment Program Member Comments/Announcements Office of Health Disparities Elimination November 5, 2020 https://www.tn.gov/health/health-program-areas/dmhde/covid-19-health-disparity-task-force.html
COVID-19 Long -Term Care Facilities
Presenters Sally Pitt , Director, Office of Patient Care Advocacy, Tennessee Department of Health Caroline Tippens, Esq., CHC, Senior Associate General Counsel, Office of General Counsel, Tennessee Department of Health
Discussion • Brief overview of TN COVID-19 Long Term Care Task Force • CMS and TDH Long-Term Care Visitation Guidance: Compassionate Care and Essential Caregivers
COVID-19 LTC Task Force
Task Force Members Long-Term Care Resident and Family Department of Health • • Members Department of Mental Health and Long-Term Care Administrators • • Substance Abuse Long-Term Care Providers • Department of Intellectual and AARP Tennessee • • Developmental Disability Alzheimer’s Tennessee • Alzheimer’s Association Commission on Aging and Disability • • Community Advocates State Long-Term Care Ombudsman • Tennessee Health Care Association Tennessee Division of TennCare • • Tennessee LeadingAge Quality Improvement Organization • • Tennessee Hospital Association • Medicaid Managed Care Organizations Tennessee Nurses Association • • Industry Leaders and Organizations Tennessee Association for Home Care • • Tennessee General Assembly ( State Community Behavioral Health • • Senator and State Representative) Tennessee Latin American Chamber of • Area on Agency on Aging and Disability Commerce •
Charge for the COVID-19 LTC Task Force • Purpose – Engage state, local and community stakeholders and state government to establish a formal structure for collaboration in the conceptualization and implementation of policies and strategies to minimize the spread and impact of COVID-19 in long term care facilities and health care systems. • Objectives – Monitor the safety and effectiveness of the expanded visitation and activity guidelines and refine them, as necessary. – Identify emerging issues to create visibility and focus on key priorities across the long-term care system.
Focus Areas • Staffing/Delivery of Care • Visitation • Transitions of Care • Mental Health
COVID-19 Visitation Guidance: Compassionate Care and Essential Caregivers
Compassionate Care and Essential Caregivers Defining “compassionate care” visitation situations
CMS Guidance: Compassionate Care Visitation March 13, 2020 : CMS guidance allows visitors in nursing facilities only in compassionate care situations. • The guidance gives one example of a compassionate care situation – “an end-of-life situation.” Reference: https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf
CMS Guidance: Compassionate Care Visitation Continued June 23, 2020 : CMS clarifies provisions for compassionate care situations. It is allowed for more than just end-of-life situations, but should not be allowed routinely, and should be governed by local authorities and managers. • Facilities are encouraged to consult with state leadership, families, and long- term care ombudsman, to help determine if a visit should be conducted for compassionate care. • Visits should not be routine and allowed on a limited basis as an exception to restricting visitation. Reference: https://www.cms.gov/files/document/covid-visitation-nursing-home-residents.pdf
CMS Guidance: Compassionate Care Visitation Continued Examples of compassionate care situations: • A resident who was living with their family before recently being admitted to a nursing home. • Allowing someone to visit a resident whose friend or family member recently passed away. Reference: https://www.cms.gov/files/document/covid-visitation-nursing-home-residents.pdf
Governor Lee’s Executive Order: Visitation Guidance May 22, 2020: Nursing home and long-term care facility visitation restrictions were initially implemented in Executive Order #38. No guidance specific to “compassionate care visitation” was issued. Instead, the term “end of • life care” was used. The Facility determines in its judgment that: (1) the visit involves the provision of critical • assistance to a Resident; or (2) the visit is to a Resident receiving end-of-life care. (Emphasis added.) Amendments: Executive Order #49 was issued on June 12, 2020 and deleted paragraph 6 in its • entirety. Executive Order #50 was issued on June 29, 2020 which extended the provisions of • Executive Order #49 through August 29, 2020. References: https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee38.pdf; https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee49.pdf ; https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee50.pdf
Tennessee Department of Health Guidance: Compassionate Care Visitation June 15, 2020 ( updated): Tennessee Department of Health’s COVID-19 Long-Term Care Facility Guidance: • No guidance was issued specifically regarding “compassionate care visitation.” Persons should not visit a Resident in a Facility unless: • The Facility determines that the visit: 1. (A) Involves accommodations for support for Residents with disabilities, the provision of critical assistance to a Resident, or religious exercise; or (B) Is to a Resident receiving end-of- life care. • The phrase “end-of-life care” was used in Executive Order #38. Reference: https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/LTCF_Visitation.pdf
Essential Caregivers – LTCF Visitation Guidance – September 17, 2020 Essential Caregivers Essential caregivers (EC) are defined by designating a family member or guardian who, prior to visitation restrictions, was regularly engaged with the resident in activities of daily living (bathing, feeding, clothing, etc.) Essential caregiving visitation includes the following: Visitation should be scheduled with time restrictions. • Each resident may have up to five (5) individuals designated as an EC although no • more than two (2) at a time can visit per resident. ECs should be screened before entry into the facility including temperature checks • and proper hand sanitization. Residents and ECs should wear a face covering and maintain physical distancing from • other residents and staff. ECs are subject to the regular testing required of the staff (see testing frequency table • below as established by CMS Rules). This could be accomplished by: EC has negative PCR test collected within previous 72 hours OR EC has negative onsite point-of-care test at the facility. Reference: https://www.tn.gov/content/dam/tn/health/documents/cedep/novel- coronavirus/LTCF%20Guidelines_Visitation.pdf
Essential Caregivers – State LTCF Visitation Guidance Table 2 2: R Routine T Testing I Intervals V Vary b by C Community C COVID-19 A Activi vity L Leve vel Commu mmunity C COVID-19 19 County P Positivity R Rat ate i in t the p pas ast w week Minimum T Testing Activity Frequency Low ow <5% Once a a m month th Medium 5% - 10% 10% Once a e a w week eek* High gh >10% Twice a e a w week eek* *This frequency presumes availability of Point of Care testing on-site at the nursing home or where off- site testing turnaround time is <48 hours. Reference: https://www.tn.gov/content/dam/tn/health/documents/cedep/novel- coronavirus/LTCF%20Guidelines_Visitation.pdf
CMS QSO-20-39-NH – September 17, 2020 Compassionate Care Visits While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations include, but are not limited to: A resident, who was living with their family before recently being admitted to a • nursing home, is struggling with the change in environment and lack of physical family support. A resident who is grieving after a friend or family member recently passed • away. A resident who needs cueing and encouragement with eating or drinking, • previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration. A resident, who used to talk and interact with others, is experiencing • emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past). Allowing a visit in these situations would be consistent with the intent of, “compassionate care situations.”
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