New/updated information is tagged with “**”
**Covid-19 Vaccine Mandate
**SBA Administrator Guzman Enhances COVID Economic Injury Disaster Loan Program to Aid Small Businesses Facing Challenges from Delta Variant (see Potential Economic Relief Resources below)
- Safe Start for LTC (updated 7/2/2021)
- Covid-19 Vaccine
- Respiratory Protection Program (N-95’s)
- Department of Health Webinar Q&A Library
- Covid-19 FAQ’s for AFH’s
- Centers for Disease Control and Prevention (CDC) Guidance Documents
- FamHelp: COVID-19 Resources for Family and Friends
- **Potential Economic Relief Resources
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.
On August 9th, Governor Inslee announced a mandate to require all state employees, healthcare workers and long-term care workers be fully vaccinated by October 18, 2021. Adult Family Homes are included in this mandate. Here is a link to the proclamation and a link to the Dear Provider letter. And a link to the FAQ from the Department of Health.
Please complete this brief survey each week to help us measure the impact of the vaccine mandate. Here is a link to our short survey.
RCS leadership stated licensors/investigators, when conducting investigations or surveys, will be looking at facility practices regarding the vaccine mandate. Here are some considerations when developing your AFH’s Covid vaccine policy:
- How are vaccination records reviewed/documented?
- What is the review process for medical and religious exemption requests?
- For unvaccinated workers with approved exemptions, what accommodations are put in place to protect residents, visitors and others in the home?
- Any accommodation needs to go above and beyond other safety measures that are already required (i.e., wearing fit-tested N95’s at all times instead of surgical masks, regularly scheduled testing, etc.)
Considerations for any accommodations put in place for those with approved exemptions.
The DOH FAQ states (page 10):
- Can an unvaccinated health care provider who is exempt from the vaccination requirement due to an accommodation still provide direct patient care?
It depends. Whether an appropriate reasonable accommodation for an unvaccinated health care provider includes continuing to provide direct patient care will depend on the person’s disability, limitations, duties, and work setting and be determined through an interactive process. Any accommodations provided must, to the extent permitted by law, require the individual to take COVID-19 safety measures that are consistent with DOH recommendations for the setting in which the individual works.
Since AFH’s are independent businesses, it is up to each business owner to put a policy in place for their home. If providers are choosing to put accommodations in place for exempted workers, we highly recommend these policies be reviewed by an attorney due to the liability concerns of having unvaccinated caregivers providing direct care to residents.
We received guidance from our attorneys and collected samples from the assisted living and skilled nursing facility associations. Copies of this guidance and templates are available for AFH Council members in our Document Library – Adult Family Home Council. This information is in the “Vaccine Exemption Information” folder.
Emergency Rules Filed for Certification Deadlines and Resumption of Training Requirements
Unless a worker is exempt from training as described in WAC 388-71-0839 or WAC 388-112A-0090, employees hired during the COVID-19 emergency must complete basic training, and required specialty training, as follows. Please encourage all employees who need training/certification to begin the process as soon as possible.
|Worker hired or rehired during the time frame of:||Must complete basic training no later than:|
|8/17/2019 to 9/30/2020||4/30/2022|
|10/1/2020 to 4/30/2021||6/30/2022|
|5/1/2021 to 3/31/2022||8/31/2022|
|After 3/31/2022||Standard training requirement|
For workers who are required to be certified as home care aides, certification must be obtained as follows:
|Worker hired or rehired during the time frame of:||Must be certified as a home care aide no later than:|
|8/17/2019 to 9/30/2020||7/19/2022|
|10/1/2020 to 4/30/2021||9/18/2022|
|5/1/2021 to 3/31/2022||11/19/2022|
|After 3/31/2022||Based on hire date|
(*A long-term care worker is considered “rehired” if they held previous employment as a long-term care worker and did not have an active home care aide credential when hired during the time frames outlined above.)
If a long-term care worker is limited-English proficient, the worker may request an additional sixty days to obtain certification.
- Emergency Rule for Continuing Education (CE) Training
We know that there are workers who were unable to complete required CE since training requirements were suspended. The department also recognizes that long-term care workers employed during the COVID-19 pandemic required emergent, intensive, and ongoing on-the-job training in the use of PPE, sanitation, health screening and more.
WHAT YOU NEED TO KNOW:
All long-term care workers employed for any duration between March 1, 2020, and February 28, 2021 are granted twelve hours of DSHS-approved continuing education credit for the training entitled “COVID-19 On-The-Job Training Protocols,” bearing the DSHS approval code CE2135218.
No physical certificate for this training will be issued or required.
The hours must be applied as any other continuing education hours and to a single renewal period as provided in chapter 246-12 WAC.
ADDITIONALLY: All long-term care workers will have one hundred-twenty days from the end of the public health emergency to complete any additional CE that may have become due while training waivers were in place in excess of the twelve hours of CE granted for on-the-job training.
EXAMPLE: Caregiver with birthday in December
December 2018-December 2019 = Caregiver was in compliance
December 2019 – December 2020 = 6 hours earned somehow = caregiver has 120 days after the PHE ends to make up the other six.
December 2020 – 2021 = Covered completely by COVID CE
December 2021-2022 = Twelve more hours needed by worker’s birthday
Updated CDC Guidance Requiring Masking in All Indoor Settings
On Friday, 9/10/2021, the Centers for Disease Control and Prevention (CDC) released updated guidance for healthcare settings. Recently, the Secretary for the Department of Health (DOH) also released updated orders requiring masking in all indoor settings. The Aging and Long-Term Support Administration (ALTSA) and DOH are working to update Washington State long-term care (LTC) setting guidance, including the Safe Start for LTC plans, to align with the CDC recommendations. Except as it relates to the area outlined below, please continue to follow the current Safe Start plans while these updates take place. New Washington State guidance, along with updated Safe Start Plans will be available very soon.
Area that needs to be implemented immediately:
- Masking is now required in all indoor settings, regardless of vaccination status. This also applies to long-term care settings. Residents will not be able to remove source control during activities or in the dining room except when actively eating or drinking. Vaccinated residents and visitors will not be able to remove source control when visiting indoors.
AFH’s Not Required to Send in Declarations to DSHS: Correction Regarding Long-term Care Setting Requirements Under Governor Proclamation 21-14, Covid-19 Vaccination Requirements
We have received several calls and emails at the Council with questions about the confusing letters many have received regarding sending in a declaration to Stacey Owens at DSHS. The answer is that AFH’s do not need to send in this declaration to DSHS. Because AFHs are healthcare facilities, you are still obligated to follow the requirements of the vaccine mandate, however you are not required to send the declaration in.
Click here to read the Dear Provider Letter.
Resident Rosters, Aggregate Contact Information, Communication, Resident Representative, and Essential Support Persons
This letter is to inform you of changes in law related to resident rosters, aggregated contact information, communication, long-term care Ombuds, and the definitions of a resident representative and essential support persons. Substitute House Bill 1218 was passed during the 2021 legislative session. The purpose of the bill is to improve health, safety and quality of life for residents in long-term care facilities. The letter has a detailed explanation of these changes, which are effective immediately. Click here to read the entire Dear Provider Letter.
AFH Incentive-Acute Care Hospital Discharges
The ongoing COVID-19 outbreak continues to impact medical and long-term care settings across the country. As the state is responding to another surge, we have a critical need to create capacity in acute care hospitals to serve those who need emergency and intensive care during this ongoing outbreak.
One of the top priorities of the Department of Social and Health Services (DSHS) is continuing to work with patients who no longer have a need for acute care in a hospital to transition to alternative settings. This will create capacity for hospitals to serve individuals who need acute care that can only be provided in a hospital setting. If you choose to admit a resident through this incentive program, please note that this is not a short-term placement.
Click here to read the full Dear Provider letter.
#StayConnected – Free Tablets for AFH’s-LAST CHANCE
The evidence is piling up that the ability to #StayConnected is key to overall health. To help residents in Adult Family Homes, the Washington State Long-Term Care Ombudsman Program offers free tablets to all AFH owners in the state. But be sure to apply today because the program ends this month! Take 3-minutes today to apply at https://www.waombudsman.org/stay-connected-campaign/.
With these tablets, residents can access social media, games, virtual healthcare, and much more! If you applied before September 1st and have not received a tablet, we encourage you to apply again. We do have a limited supply, so be sure to fill it out today! If you require assistance with the application, please email us at firstname.lastname@example.org.
*A limited supply is available, and the funding will end this month, so be sure to apply as soon as possible.
**Tablets require wi-fi access and filling out the application doesn’t guarantee a tablet. We review and vet all applicants.
Order Free PPE Through the State of Washington Between Now and October 31, 2021
The state personal protective equipment (PPE) stockpile (referred to as “the backstop”) has been available to help support state agencies, counties, tribes and other partners through the COVID-19 pandemic. The state backstop will be available to meet COVID-19 PPE requests through Oct. 31, 2021. Now is the time to submit requests for PPE through your county emergency managers.
State, local, and tribal agencies, partner associations, health care providers, including long-term services and supports providers (e.g., adult family homes, supported living agencies, home care agencies, assisted living facilities and skilled nursing facilities), and businesses are encouraged to order PPE to return state backstops to pre-COVID levels and allow entities to utilize existing, available PPE before it expires. Click here to learn how to order your PPE.
Emergency Rules Suspending TB Testing End November 18, 2021
The Department of Social and Health Services has filed CR-103E (WSR 21-15-113) emergency rules for tuberculosis (TB) testing requirements for long-term care workers. The new emergency rules continue the suspension of requirements related to TB testing in WACs. These rules are suspended in response to the significant threat of COVID-19 to our most vulnerable populations, especially for those receiving long-term care services in their homes and congregate settings, such as long-term care facilities. This will be the final extension. Providers are encouraged to start TB testing now to assure that staff testing is brought up to date by the end of this emergency rule. This rule-filing extends the emergency rule until November 18, 2021. Click here to read the full Dear Provider Letter.
Long-Term Care Proclamations Remain in Effect
The department issued a Dear Provider letter to remind everyone the proclamations relating to the COVID-19 pandemic have not ended. Senate Concurrent Resolution 8304 extended all proclamations suspending or waiving specific Long-Term Care requirements until Governor Inslee formally lifts the state of emergency. On June 30, 2021, Governor Inslee decreased or removed a number of restrictions for the general public. However, the Governor did not end the declared state of emergency in Washington state. All the Long-Term Care proclamations remain in place.
Creating Safer Air Movement for Cooling with Consideration of COVID-19
During the warmer months of the year facilities need to provide cooling for building occupants when air conditioning units and central heating, ventilation, and air conditioning (HVAC) systems are not available to provide a cool indoor environment. In this situation open windows and portable fans are often used to provide comfort for building occupants. DOH has created a document to provide guidance on safer ways to create air movement for cooling when air conditioning units and a central HVAC system are not available. Click here to access the document.
Long-Term Care Facilities to Follow Safe Start Plan Beyond June 30, 2021
The Safe Start for Long-Term Care Recommendations and Requirements Document (Safe Start Plan) is independent of the Healthy Washington Roadmap to Recovery, thus, all long-term care settings are required to follow the recommendations and requirements outlined in the Safe Start Plan, even after June 30, 2021. The opening of other programs in Washington under the Healthy Washington Roadmap to Recovery does not apply to Long-Term Care facilities/homes. Click here to read the entire Dear Provider Letter.
Expiration of the Eviction Moratorium
On August 13, 2020, Residential Care Services (RCS) issued a provider letter indicating Governor Proclamation 20-19.3 applied to long-term care (LTC) facilities and agencies. This proclamation pertained to the eviction moratorium during the COVID-19 outbreak and the RCS provider letter outlined activities prohibited by the moratorium including increasing rent/fees or issuing a notice to vacate for non-payment of fees.
On June 30, 2021 both the federal and state eviction moratoriums are set to expire. At that time, LTC providers will be able to resume issuing a notice of discharge if a resident has not paid fees. Providers will also be able to resume any standard activities related to fee increases.
Click here to read the entire Dear Provider Letter.
Extension of COVID Payments Through December 31, 2021
The Adult Family Home Council signed an agreement with the state of Washington to extend Covid-19 enhanced daily rate of $13.96 per day through the end of the calendar year.
Access to Free Covid-19 Testing in King County
Too busy or unable to go to a testing site? The University of Washington has a Covid Testing program that will come to you! The UW Covid-19 testing team is offering in-home Covid testing for Adult Family Homes in King County at no cost to you. If you are interested in having the UW team come and test you, your employees, and/or residents at your adult family home, please contact April Delgado at AFHcovidtesting@uw.edu
Covid-19 Vaccination Survey
Washington Department of Health released a COVID-19 vaccination survey for assisted living facilities and adult family homes and requests your participation. This will only take a few minutes of your time. The information you provide will be used to understand how vaccination rates fluctuate with staffing and resident movement, and to improve support for COVID-19 vaccination when barriers are identified. You will receive this Public Health vaccination survey monthly.
If your facility is in King County, you may have already been sent a unique survey link, please see additional instructions in the survey link below. Skilled nursing facilities do not have to complete this survey and should report COVID-19 vaccination data to the National Healthcare Safety Network as per CMS requirement.
You may open the survey in your web browser by clicking the link below: https://redcap.doh.wa.gov/surveys/?s=KFRMW8JN4P
For questions, contact LTC-COVID-Vaccination-Survey@doh.wa.gov using subject line: LTC COVID-19 Vaccination Survey.
Source Control Regardless of Vaccination Status
On April 27, 2021 the CDC updated select healthcare infection prevention and control recommendations in response to COVID-19 vaccination, which are summarized in guidance for Infection Control and Vaccination at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infectioncontrol-after-vaccination.html
Regardless of vaccination status, health care providers should continue to wear source control while at work. The new CDC guidance regarding vaccinated persons not needing to wear a mask does not apply in LTC settings, except in those specific cases outlined in the LTC Safe Start plans. Click here to view the updated Safe Start for Long-Term Care Recommendations and Requirements Document in its entirety. Click here to read the full Dear Provider Letter.
Resuming Fingerprint Background Checks
On March 18, 2020, Governor Inslee issued Proclamation 20-18, which suspended the fingerprint background check requirements for long-term care facilities. Once the temporary suspension of the requirement ends, long-term care workers will again need to complete a fingerprint-based background check as required by law.
Although the COVID-19 public health emergency continues to affect our state, many fingerprint background check locations are open and able to safely provide fingerprint background checks to long-term care staff. While providers have been very diligent in scheduling employee fingerprint appointments when they were able, Department records show that there may be over twenty thousand individuals who still need to complete their fingerprint-based background check. Click here to learn more from the Dear Provider letter.
Reimplementation of Surveys, Inspections and Evaluations by RCS
According to a Dear Provider Letter dated 3/31/21, Residential Care Services (RCS) is planning a gradual reimplementation of full surveys, inspections, and evaluations beginning in April. The process will be a hybrid using onsite and remote methods, and will combine the standard survey, inspection, or evaluation process with the focused infection prevention assessment process.
Inspections will include:
- AFH Standard Operating Procedures
- Infection Prevention Assessment Pathway and Infection Prevention Assessment Tool other guidance as outlined in updated Dear Provider Letter from 4/9/2021
Monoclonal Antibody Infusion Treatment for Covid-19
On November 21, 2020, the Food and Drug Administration issued an emergency use authorization for use of monoclonal antibodies (mAb) to treat mild to moderate COVID-19 in certain people. Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses.
The Department of Social and Health Services (DSHS) and the Department of Health (DOH) are working to provide infusion services for mAb treatments in long-term care settings. Click here to learn more.
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
- Fingerprints recently resumed 021-04-30-1.pdf (wa.gov)
- Orientation and Safety Training
- Facility Orientation
- TB testing requirement to be reinstated effective November 18, 2021
- 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
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.