New/updated information is tagged with “**”
- **AFH Covid-19 Point Prevalence Testing-Another Updated Dear Provider Letter
- **N95 Masks
- **Safe Start for Long-term Care Modifications Coming Soon
- **Paycheck Protection Program (PPP) Forgiveness Applications Still Being Accepted
- Covid-19 FAQ’s for AFH’s
- Department of Health Webinar Q&A 4/16/2020
- Department of Health Webinar Q&A 5/7/2020
- Department of Health Webinar Q&A 5/14/2020
- Department of Health Webinar Q&A 5/21/2020
- Department of Health Webinar Q&A 5/28/2020
- Department of Health Webinar Q&A 6/4/2020
- Department of Health Webinar Q&A 6/11/2020
- Department of Health Webinar Q&A 6/18/2020
- Department of Health Webinar Q&A 6/25/2020
- Department of Health Webinar Q&A 7/23/2020
- Department of Health Webinar Q&A 8/6/2020
- Department of Health Webinar Q&A 8/13/2020
- Department of Health Webinar Q&A 8/20/2020
- Department of Health Webinar Q&A 8/27/2020
- Department of Health Webinar Q&A 9/3/2020
- Department of Health Webinar Q&A 9/10/2020
- Department of Health Webinar Q&A 9/24/2020
- Department of Health Webinar Q&A 10/1/2020
- Department of Health Webinar Q&A 10/15/2020
- Department of Health Webinar Q&A 10/22/2020
- Department of Health Webinar Q&A 10/29/2020
- Centers for Disease Control and Prevention (CDC) Guidance Documents
- DSHS Recorded Presentation-Phased Reopening Plan for Adult Family Homes
- FamHelp: COVID-19 Resources for Family and Friends
In response to the outbreak of the COVID-19 virus, Center for Medicare & Medicaid Services (CMS), the Department of Health and the Department of Social and Health Services are providing information about how to manage and contain the outbreak.
What may be most important to know is that using infection controls and universal precautions can reduce the risk of the virus spreading. The population of adult family homes residents, considering their comorbidity and often frail health are at increased risk from the virus.
RCS Reimplementation of Inspection and Investigation Activities
A Dear Provider Letter dated today, October 9, 2020 states that annual inspections, investigations and other field work will resume on November 1, 2020. Click here to read the letter.
**Safe Start for Long-Term Care
DSHS, DOH, LHJs and long-term care advocates are working to revise the safe start for long-term care guidance. The revised guidance is intended to address visitation in the winter months. A draft of the plan is intended to be delivered to the Governor’s office on Nov 13th. We are hopeful that guidance will be published and available prior to the Thanksgiving holiday.
Safe Start for Long-Term Care Recommendations & Requirements: Adult Family Homes, Assisted Living Facilities & Enhanced Services Facilities
This new guidance goes into effect on August 12, 2020. No application is required. Check the Covid-19 Risk Assessment Dashboard (link below) to find out what phase your home is in. Visitation phases are based on the infection rate per 100,000 people and may be different than your county’s phase. Use COVID-19-Risk Assessment Dashboard to find out which phase is your county in.
- Phase 1: greater than 75 cases per 100,000
- Phase 2: between 25-75 cases per 100,000
- Phase 3: between 10-25 cases per 100,000
- Phase 4: less than 10 cases per 100,000
- Safe Start for Long-Term Care Recommendations & Requirements: Adult Family Homes, Assisted Living Facilities & Enhanced Services Facilities
- Long-term Care Phases 7.31
- What is Allowed Long-Term Care
- DOH Risk Assessment Template and Letter for Community Visits
- DOH Definition of LTC Facility Outbreak
- Safe Start for AFH ALF & ESF July 31, 2020 PowerPoint Slides as presented by DSHS
- Sample Pandemic Disaster Planning with Safe Start Considerations
- Sample Visitation Policy for Safe Start
- COVID-19 Policy Regarding Indoor and Outdoor Visits-Updated 9.13.20 (shared by Amy Thomas-thank you!)
- Sample LTC Safe Start Visitation Protocol for Phases 1-3 (updated 11/2/20)
- DOH Coronavirus Announcement for Visitors
- Visitor Screening Poster and Updated Visitor Log
Additional Sample Documents (shared by Jennifer Gastineau, ARNP-thank you!)
- Sample Letter to Families (recommend including these documents with the letter to the family-(What is Allowed Long-Term Care, LTC Outdoor Visits)
- Sample Caregiver Responsibilities for Visitation
Personal Protective Equipment (PPE)
- PPE Requests for AFH’s with positive Covid-19 cases-UPDATED Dear Provider Letter 2020-011
- PPE Requests for King County Only.
- PPE requests for Pierce County Only
- PPE requests for Spokane County Only
- PPE request through the Association of Washington Businesses
- **PPE Resources for Thurston County
The Adult Family Home Council and the Office of Financial Management have signed an agreement that will allocate $1,000,000 for the purchase and distribution of N95 masks to all adult family homes. We are continuing to discuss access to fit testing resources and additional supports for homes serving residents with aerosol generating procedures.
N95 and other PPE Resource and Fit-testing for N95s
As you may know, The Department of Labor and Industries (L&I) requires the use of fit-tested N95 masks when performing “high-risk” or “extremely high-risk” work. Working directly with individuals with suspected or known Covid-19 and/or being within 3 feet of persons during an aerosol generating procedure (i.e. using a cpap, bi-pap, nebulizer, etc.) fit into these categories. There are many challenges for adult family homes because of this requirement. The AFH Council is continuing discussion with L&I, seeking AFH-specific guidance.
- We recently learned about a not-for-profit organization called Project N95. They are a clearinghouse for personal protective equipment. Their mission is to deliver critical equipment to frontline workers as quickly as possible by driving transparency in the market and procurement best practices. They connect frontline and healthcare organizations with suppliers.
- DSHS resources for masks and fit-testing: click here
**AFH Covid-19 Point Prevalence Testing-Another Updated Dear Provider Letter
Another updated Dear Provider letter is expected to be released today, November 6, 2020 outlining the plan to offer Covid-19 testing to all AFH staff, residents, and any others who live in the home. The amended letter includes more information about the standing physicians order and how the Department of Health will be contacting AFHs. The letter also extends the date for recommended completion of testing and changes the date of exemption for testing from July 1, 2020 to September 1, 2020.
This testing is being offered with the intention of identifying anyone in the AFH who may be living with asymptomatic Covid-19 infections.
Here are a few key points:
- Testing is recommended, not required
- DOH has emailed each home to begin the process of requesting test kits. Please search your inbox or junk folder for an email from “Tammi Leclerc via SmartSheets.”.
- Testing is available for all staff, residents and family members living in the home regardless of suspected COVID status
- One-time testing cost will be covered by the Department of Health
- Anyone who has been tested since September 1, 2020 is exempt
- DSHS recommends testing be completed by December 31, 2020
- PPE and testing kits will be sent in separate shipments
- Two methods of testing are being offered
- Everlywell-for those with email addresses who can self-swab
- DOH-for those without email addresses or who cannot self-swab (nurse delegators can perform these tests). This testing method requires a health care practitioner’s order which the Washington State Health Officer has provided in the standing order.
Washington Adult Family Home Infection Prevention Collaborative-New “Office Hours” Added
Please join Comagine Health and the Washington Department of Social and Human Services for a special Infection Prevention Collaborative designed for adult family homes. Our Infection Prevention specialists will present educational sessions and consultation services to support your COVID-19 preparedness and management with deep dives into infection prevention strategies useful during the COVID-19 pandemic and beyond! ! In addition to the following educational sessions, Comagine will be providing regional infection prevention “Office Hours”. Click here to see the schedule and register. Or here to access Comagine’s website for links to previous webinars to to contact them for infection prevention assistance.
- October 21 – Role of Public Health in Outbreak Investigation-register here
- November 4 – Improving quality – hand hygiene and environmental cleaning- register here
- November 18 – Staffing and Caregiver Challenges- register here
- December 2 – Communication with clients, residents and visitors- register here
Temporary Medicaid Rate Increase and Retainer Payments Extended
These payments have been extended from October 1, 2020 through December 31, 2020.
- Temporary Medicaid rate increase rate of $13.54/Day
Homes that need to displace residents due to COVID-19 will continue to be able to obtain retainer payments of 70% of the base rate for up to 90 days. Contact your Case Manager to have this authorization opened if this applies to one or more of your residents.
COVID-19 Budget Impact
The impact of COVID-19 on our state’s economy is staggering. As we negotiate the next state budget, we will be advocating to protect rates, programs, and resident eligibility. The Office of Financial Management prepared this overview of the economic picture based on the June 2020 revenue forecasts. Despite the grim outlook, we believe that as front-line workers in the middle of a pandemic, fighting to protect the vulnerable, we need more support, not cuts.
In a Dear Provider Letter from August 6, 2020, the Secretary of Health ordered that all residents need to be wearing a face mask when they are out of their bedroom. Staff are required to wear face masks at all times in the home (unless they live in the home and are in their own quarters). Please read the Dear Provider letter for more details and for a list of exemptions.
Help for Your Residents! Access the “Stay Connected” Campaign
The funding for this program has been expended. We are currently working with the LTCOP to seek additional resources to resume distribution of technology to AFHs.
This health crisis has us all “social distancing’ and in self-isolation. For Washington residents, most facilities have been in LOCKDOWN since March 5, which means residents have not had visitors since then. Through the generosity of individual and corporate donors, the Long-Term Care Ombudsman Program is giving out Amazon Fire Tablets (7 inches) to long-term facilities to be used to help residents stay connected to their loved ones. When family members have a smart phone or mobile device, residents can even do video chats and see their loved ones if they also have a mobile device. Click here for more information and to apply.
Continuing to Practice Good Infection Control While at Home
- Guidance from DOH for writing an Infection Control Plan
- Infection Control Essentials-Training provided by DSHS
- Wash hands using hot water and soap for at least 20 seconds throughout the day (CDC Handwashing: Clean Hands Saves Lives)
- Use alcohol-based hand sanitizer in between handwashing (60-90% alcohol content). Document in care plan if residents are safe around hand sanitizer or keep out of reach if even one resident is unsafe.
- Practice social distancing (6 feet or 2 meters) from others
- Disinfect frequently touched surfaces several times daily (i.e. doorknobs, table surfaces, countertops, chair arms, etc.)
- Additional training for you and your staff (Fundamentals of Caregiving Curriculum): Infection Control Training Curriculum
- Updated Screening Questions (DOH screening questions and flow Chart):
- Fever (100.4 or more)
- Shortness of breath or difficulty breathing
- Muscle or body aches
- Recent loss of taste or smell
- Sore throat
- Nausea or vomiting
- Within the past 14 days, have you had contact with anyone that you know had COVID-19 or COVID-like symptoms? Contact is being 6 feet (2 meters) or closer for more than 15 minutes with a person, or having direct contact with fluids from a person with COVID-19 (for example, being coughed or sneezed on).
- Have you had a positive COVID-19 test for active virus in the past 10 days?
- Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?
- Updated Screening Logs:
- Who to screen and when:
- Visitors prior to outdoor visits or entering facility (when allowed-see Safe Start for LTC)
- Residents screen daily and after returning from community outing
- Staff screened prior to each shift or daily if live-in (include other facilities/hospitals worked in)
- If positive for symptoms of Covid-19 (Hotline 1-800-562-6078 and local health department):
- Visitors: do not allow entry into the home and advise to get tested for Covid-19
- Residents: contact primary care physician and local health department to seek testing for Covid-19
- Staff: call the local health department to seek testing for Covid-19
- If tested positive for Covid-19
- Residents: report to the Hotline 1-800-562-6078 and local health department and those listed in resident’s care plan
- Staff: follow return to work guidance below
- Updated Screening Questions (DOH screening questions and flow Chart):
- The Department of Health is providing some guidance regarding returning to work for healthcare workers who are recovering from Covid-19, symptomatic (prior to testing) and asymptomatic.
Updating Your Emergency/Disaster Plans
- Potential resource to find back-up caregivers
- The Department of Health has activated the Emergency Volunteer Health Practitioners If you are experiencing a staffing shortage due to Covid-19, you may be able to find a caregiver through this site.
- Sample Disaster Plans (graciously shared by Jennifer Gastineau, ARNP a big thank you to you!)
PLEASE NOTE THAT THESE ARE SAMPLES-IF YOU CHOOSE TO USE ANY OR ALL CONTENT IN THE DOCUMENTS, BE SURE TO UPDATE THEM TO MEET THE NEEDS OF YOUR BUSINESS/AFH
- Policy-Infection Control and Handwashing
- Isolation Protocol
- Isolation Sign
- Pandemic Disaster Planning
Identifying a Backup for Your Home
Dear Provider Letter 2020-016 directs providers to update their emergency plan to specifically address actions to be taken if there is a staffing shortage at any time, but especially now during this pandemic. Here are some considerations:
- Contingency planning with sister facilities or other AFH’s in your community
- Are residents’ families able to care for residents at home during this time?
- Contact the AFH Council to troubleshoot staffing backups
Covid-19 Status Updates-Monday/Thursday Reports
Dear Provider letter 2020-017 states the Department is requesting each AFH complete an online report every Monday and Thursday to determine where Personal Protective Equipment (PPE) and Covid-19 testing is needed.
Protocol for Accepting Residents from the Hospital or Another Long-term Care Facility
We receive many calls requesting guidance for admitting residents from the hospital or another long-term care facility. There are no restrictions to admitting residents at this time, however, along with the guidance in the document produced by Seattle-King County Public Health, there are some additional things to think about prior to bringing the resident into the home:
- Ability to quarantine a new/returning resident for 14 days
- Use of universal masking by staff and residents when they are out of their rooms
- No restrictions on admitting new residents (be sure to update your openings on the AFH Council’s ‘Find a Home’ locator page)
- Virtual tours are recommended since in-person visits are prohibited
- Hospitals are unable to provide Covid-19 testing prior to admission in the home due to scarcity of tests
- Upon move-in family should be aware they will not be able to visit to help with transition during this time other than via video visitations
- Recommend limiting number of personal belongings a resident brings with them until restrictions are lifted
- Consider enhanced social distancing in addition to daily screening for two weeks following admission to monitor for Covid-19 symptoms
- Management Bulletin 20-016-temporary policy changes for long-term care workers
- WAC 388-112A chapter requirements are temporarily suspended
- 120-day training and 200-day certification requirements are paused if training has started
- Specialty Training timelines are paused
- First Aid/CPR requirement paused
- Continuing Education requirements are paused
- RN Delegation-training and testing for this self study course can be completed remotely
Hiring New Staff
During this outbreak, while the rules are suspended the only requirement for hiring caregiving staff are:
- Name & Date of Birth Background Check (federal fingerprint testing paused)
- Orientation and Safety Training
- Facility Orientation
- TB testing requirement suspended
- Management Bulletin MB 20-017 for information about assessments
- Assessment will be completed by phone or using other technology whenever possible
- If there is a concern for client health or safety or a client requests a visit, Case Managers will use their professional judgement to determine how to respond
- Private pay assessments: there is no requirement for these to be in-person (WAC 388-76-10335 through 10350)
Dear Provider Letters Listserv
- It is very important to stay informed during this time when things are changing quickly. Make sure you are signed up to receive Dear Provider letters from the department.
Potential Economic Relief Resources
Small business relief funding may be available in your community.
Check with your Associate Development Organization to learn about local relief programs.
Small business webinars provide up-to-date info and live responses to questions
A monthly webinar series presents information specific to Washington small businesses. The series features brief presentations from state and federal partners and open-mic Q&A time. Topics include unemployment insurance, returning employees to work, relief funding, workplace safety, face coverings and other timely topics. The next webinar will be held on Oct.15 at 1:30 p.m.
SBA Loan Funding is Available
Small Business Stabilization Grants
Many local economic development agencies have received funds from the Washington State Department of Commerce to offer stabilization grants to small businesses.
- Getting Ready to Reopen Fund (Chelan and Douglas counties – apply by Dec. 31)
- Rent Participation Fund (Chelan and Douglas counties – apply by Dec. 31)
- Kitsap County Small Business Rental Relief
- Pierce County COVID-19 Adaptation Grant Program
- Pierce County COVID-19 Commercial Rent and Mortgage Assistance Program
- Southeast Washington Economic Development Small Business Stabilization Grant (Asotin, Garfield, and Whitman counties)
- Stevens County Small Business Stabilization Grant
- Thurston Childcare Provider Grant Program
- Thurston Strong Micro-Business Standup Grant
- Coastal Communities Loan Fund(Clallam, Jefferson, Grays Harbor, Pacific, Wahkiakum counties)
- Business Resilience Loan Program (City of Spokane)
- Emergency Small Business Relief Loan Program (Pierce county)
- Pend Oreille County Small Business Stabilization Grant
Economic Injury Disaster Loan (EIDL)
Small businesses, private non-profits and agricultural businesses impacted by the Coronavirus (COVID-19) pandemic, can still apply for an Economic Injury Disaster Loan. EIDL proceeds can be used to cover a wide array of working capital and normal operating expenses, such as continuation to health care benefits, rent, utilities and fixed debt payments.
EDA CARES Act Recovery Assistance
US Economic Development Administration
Coronavirus Relief Options