COVID-19 Updates & Best Resources

UPDATED 10/29/2021

New/updated information is tagged with “**”

** PPE Ordering Opportunity


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.

Respiratory Protection Program and Fit-testing Requirements

The Delta variant has proven that at any time, COVID-19 cases can dramatically increase. Providing your workforce with respiratory protection (N95) against respiratory hazards, such as the virus that causes COVID-19, is a safety standard regulated and enforced by the Washington Department of Labor and Industries (L&I). Fit testing ensures the N95 respirator will filter out 95% of the airborne virus when used correctly. Keep your employees working by getting them fit tested and ready to properly use a respirator.

The DOSH Directive 11.80 Temporary Enforcement Guidance ( was updated on September 21, 2021. L&I will begin enforcing the requirement of annual fit testing on January 1, 2022. This means, for example, if your employees were fit tested on 11/1/2020, they will need to be fit tested again before 11/1/2021. If they are not, your facility may be cited on January 1, 2022 for not providing annual fit testing.

Now is the time to take advantage of the services DOH is offering for your caregivers that care for residents/clients in isolation or quarantine – FREE medical evaluation and fit testing for respirator use. This offer will expire at the end of 2021.

Visit the DOH Respiratory Protection Program website for more information at Respiratory Protection Program :: Washington State Department of Health, or email

** PPE Ordering Opportunity

How Does Ordering Work? Ordering is now very simple.

  • Go to between Monday, October 25, 2021 and close Friday November 5, 2021 at midnight and click on Shop.
  • On the right under Category click on “Washington State Group Order”
  • Select the product(s) you need and enter quantity, add to your cart and click checkout when done.
  • Use this discount code at checkout to receive the group order discount: WASUPPLY10
  • We offer bulk ordering (50 or more cases), please reach out to our Business Development team directly for other pricing option – (775) 636-4542

To contact bttn directly, email or call the support line – (206) 825-2042

Free shipping for all orders, no matter the size with a 7-14 day lead time.

AFH Incentive-Acute Care Hospital Discharges-EXTENDED THROUGH 12/31/2021

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 amended Dear Provider letter.

Regional contacts for acute care hospital teams to help coordinate discharges

Implementation of Vaccine Mandate Requirements and Review

A Dear Provider Letter dated September 28, 2021 addresses questions about medical and religious exemptions to vaccination and implementation of proclamation 21-14 requiring most state employees, private health care, and long-term care workers to be vaccinated against COVID-19.

Please review the following for a general outline of expectations:

  • On October 18, 2021, all health care providers who engage in work for your program, either through direct employment, by contract with your program, or as a volunteer for your program, must be fully vaccinated unless exempt for medical or religious reasons.
  • The provider must visually verify vaccination but does not need to retain copies of the employee vaccination record. At a minimum the provider must keep a written record of all vaccination confirmations;
  • If a person is not fully vaccinated and has not received an exemption, they must not be employed by your program after October 18, 2021.
  • If an employee has requested an exemption for religious or medical reasons, the employer/provider is required to follow the reasonable accommodation laws to decide regarding the request. If the employer/provider determines the accommodation request is approved, the employer/provider must document the following:
    • The employer’s/provider’s ability to meet the accommodation needs of the employee within the scope of the employer’s/provider’s business;
    • If the employer/provider can accommodate the employee, how will the accommodation be implemented while also assuring the health and safety of the residents/clients are protected;
    • If an accommodation allows for continued contact with others (residents/clients, staff, visitors) with safety measures such as use of more rigorous PPE (i.e., fit tested N95 always use in the building) and/or a stringent testing schedule, who will pay for the extra equipment and testing;
    • If the accommodation requires reassignment of the employee to a job that does not have in-person contact with others, or the employee already has a job that can easily transition to no in-person contact, how the employer/provider will assure the accommodated person is not in contact with others in the building/home
    • If stringent testing is used as a part of the accommodation, at what frequency the testing will be done. Note: testing frequency for the accommodation should be greater than the recommended testing frequency by the Local Health Jurisdiction, Department of Health, or Center for Medicare and Medicaid Services. How the employer/provider will verify each test is completed by the employee.
    • How will compliance with accommodation measures be monitored

Here is a link to the letter and a link to the FAQ from the Department of Health.

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.

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.

Critical Staffing Management in Long Term Care Settings

This letter is to notify you of procedures to manage resources and avert crisis when facing critical staffing levels.

During the COVID-19 pandemic, many Long-Term Care (LTC) settings have struggled with limited resources and staffing shortages. Management of staffing shortages should be done according to emergency preparedness plans. When faced with critical staffing shortages, LTC settings will activate emergency plans to adjust resources along a conventional, contingent and crisis continuum.

Providers should work with the Department of Social and Health Services, residents/clients, families, and LTC support systems to ensure that care needs are met. This letter addresses the following:

  1. Guidelines for critical staffing management and use of emergency preparedness plans;
  2. Department response, procedures, and assistance with critical staffing management; and
  3. Regulatory requirements for emergency preparedness in various LTC settings

Click here to read the entire letter. And here for the documents shared during the DSHS webinar.

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.


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

**Rapid Response Teams 2 Short-Term Staffing

The Department of Social and Health Services, Aging and Long-Term Support Administration has contracted with a temporary nurse staffing agency to provide Rapid Response Staffing teams located in multiple geographic areas across the state. The intent of establishing these teams is to provide short-term staffing support to providers who participate in incentive program to admit patients from acute care hospitals.

Department funding comes from the Coronavirus Aid Relief and Economic Security (CARES) Act. There will be no charge to the facilities or agencies for use of short-term nursing staff support through this program. Click here to read the entire Dear Provider letter.

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 (if able to tolerate wearing a mask) should wear source control during activities and in the dining room except when actively eating or drinking.  Vaccinated residents and visitors should wear source control when visiting indoors.

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.

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.

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

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:

For questions, contact using subject line: LTC COVID-19 Vaccination Survey.

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.

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:

Staff Training

  • 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.



  1. Are there any forms that can be used to record visitors that come to visit Adult Family Homes?

    ie, the visitors name, their temperature, date, it they traveled outside the country, and any other information needed.

    Thank you

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