Infection Prevention in AFH’s (included Covid-19 and other respiratory diseases)

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.

The fall marks the start of respiratory disease season, when we see higher numbers of flu, respiratory syncytial virus (RSV), and COVID-19 cases. Every year, 3% to 11% of the U.S. population gets the flu.* Flu is a serious disease that causes illness, hospitalizations, and deaths every year, even among otherwise healthy people. Respiratory syncytial virus (RSV) also follows a similar seasonal pattern to flu. In most cases, RSV causes mild symptoms. However, some people are at higher risk for severe disease including older adults, and adults with certain medical condition.

Link to the Toolkit

DOH updated the infection prevention and control guidance following the end of the Secretary of Health’s masking requirement in long-term care facilities. The AFH Council has created a sample Infection Prevention and Control Policy that aligns with the new DOH guidelines. In addition to the sample policy, we have created masking and Covid Vaccination policies to ensure your policies align with your practices in your AFH. Both the vaccine and mask mandates have been lifted. Each provider can choose if they will require staff to be vaccinated or not and if universal masking will or will not be required in the AFH. 

 

DOH Checklist for Infection Preparedness and Control:

Updated deadlines and CE deadline examples

Accessing Covid Vaccine for New Residents and Staff

If you admit new residents or hire staff DOH suggests contacting these resources to access Covid vaccine:

  1. Work with your existing LTC Pharmacy providers to see if they can provide in house vaccine delivery/services.  Local storefront pharmacies may be willing to provide site visits/curb side service for those with mobility issues. Call and ask if possible and to prior arrange.
  2. Contact your local health jurisdictions to link with any available mobile vaccine teams that may be available to provide support.
  3. If none of these sources can provide, complete the DOH Survey to be contacted directly.  We will work to provide available linkages and help address sourcing issues. Long Term Care Facilities COVID-19 Vaccine Request Survey (surveymonkey.com)

Tight-fitting respirators like the N95, need to fit properly to provide protection. The Washington Department of Labor and Industries (L&I) regulates and enforces respirator safety standards, including how facilities conduct fit testing. Currently, the Department of Health (DOH) offers training to help Long Term Care Facilities (LTCF) learn how to do their own respirator fit testing. Click here to learn more and sign up for the fit testing training. 

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. While testing backlogs are cleared it is appropriate to delay routine retesting, but workers who have not been tested in more than one year need to be informed that they can request a retest. All workers must be retested within 2 years of their last fit test for a specific model and size of respirator that they are continuing to use. L&I will begin enforcing the requirement of annual fit testing on January 1, 2022.

Fit-tested respirators need to be worn when assisting residents with aerosol-generating procedures. Learn more here. 

Visit the DOH Respiratory Protection Program website for more information at Respiratory Protection Program :: Washington State Department of Health, or email HAI-FitTest@doh.wa.gov.

Fit testing announcement translations:

Respiratory Protection Program

Five Steps of the Respiratory Protection Program (PDF)

Diagram of Respiratory Protection Program

Enroll Employees at No-Cost for Online Respirator Medical Evaluations

To enroll your employees in no-cost, online respirator medical evaluations, please send the following information to HAI-FitTest@doh.wa.gov.

  • Facility/agency name and address
  • Number of employees requiring medical evaluation at your facility/agency
  • Contact person and e-mail address

Click here to learn more.

In light of the unprecedented emergency circumstances associated with the COVID-19
pandemic, the Department of Social and Health Services (DSHS), will be continuing the
temporary rate increase to Adult Family Homes (AFH), Assisted Living Facilities (ALF), and
Enhanced Services Facilities (ESF) serving residents whose care is paid by Medicaid. The
temporary rate increase will continue to be available through June 30, 2024.

The current enhancements will stay in place until 6/30/22.  Beginning on 7/1/22, the COVID rate add-ons are reduced by 20 percent every six months and are fully phased down by FY 2025.

COVID -Rate Enhancement

$     13.96

through 6/30/22

 $    11.17

July 2022

 $      8.38

January 2023

 $      5.58

July 2023

 $      2.79

January 2024

 $          0

 July 2024

If the public emergency is extended beyond June of 2022, this will likely be revisited.

The Department of Social and Health Services has filed CR-103E (WSR 21-23-015) 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 rule-filing extends the emergency rule until July 1, 2022. Click here to read the entire Dear Provider Letter.

If positive for symptoms of Covid-19 (Hotline 1-800-562-6078 and local health department)

Reporting requirement WAC 388-76-10225

AFH Guidebook (page 39 for reporting chart)

According to DOH guidance, all people in congregate settings must wear face masks. Following these requirements to wear face masks means visitors are not able to share meals with residents in the AFH at this time. However, residents are not restricted from leaving the home to spend time with family and friends during the holidays. Should residents choose to do this, providers must follow the Safe Start plan related to residents taking trips outside the home. This includes completing a risk assessment with the resident for each trip outside the home to determine if the resident will need to quarantine upon return. Here is a link to the Risk Assessment template: Risk Assessment Template to Assess COVID-19 (wa.gov)

On 11/12/2021 the Centers for Medicare and Medicaid sent out a directive to skilled nursing facilities stating that visitation is now allowed for all residents at all times. DSHS is meeting with the Department of Health and the Governor’s office to determine if this will also apply to all other long-term care settings. Until that is decided AFH’s need to continue to follow the Safe Start Plan for visitation.

The Safe Start for Long-Term Care plan establishes criteria for long-term care facilities to permit visitation. The plan also offers guidance on trips outside the facility, communal dining and group activities, testing and screening, source control and PPE, and staffing. 

Safe Start for Long-Term Care Plans Updated (10/7/2021)

The Governor has issued an update to Proclamation 20-66 the Safe Start for Long-Term Care Recommendations and Requirements Documents (plans).

Facilities should allow indoor visitations for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of COVID-19 transmission.

The scenarios for limiting indoor visitation include:

  • Unvaccinated residents, if the facility COVID-19 county transmission rate is HIGH and less than 70% of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue Transmission-Based Precautions; or
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

Compassionate care and essential support visits should be permitted at all times.

**RCS Management Bulletin outlining what inspectors/investigators will be looking for regarding the vaccine mandate

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.

Accessing Covid Vaccine for New Residents and Staff

If you admit new residents or hire staff DOH suggests contacting these resources to access Covid vaccine:

  1. Work with your existing LTC Pharmacy providers to see if they can provide in house vaccine delivery/services.  Local storefront pharmacies may be willing to provide site visits/curb side service for those with mobility issues. Call and ask if possible and to prior arrange.
  2. Contact your local health jurisdictions to link with any available mobile vaccine teams that may be available to provide support.
  3. If none of these sources can provide, complete the DOH Survey to be contacted directly.  We will work to provide available linkages and help address sourcing issues. Long Term Care Facilities COVID-19 Vaccine Request Survey (surveymonkey.com)

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 

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 (https://lni.wa.gov/dA/1d2a778d31/DD1180.pdf) 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 HAI-FitTest@doh.wa.gov.

Fit testing announcement translations:

Respiratory Protection Program

Five Steps of the Respiratory Protection Program (PDF)

Diagram of Respiratory Protection Program

Enroll Employees at No-Cost for Online Respirator Medical Evaluations

To enroll your employees in no-cost, online respirator medical evaluations, please send the following information to HAI-FitTest@doh.wa.gov.

  • Facility/agency name and address
  • Number of employees requiring medical evaluation at your facility/agency
  • Contact person and e-mail address

Click here to learn more.

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

The Department of Social and Health Services (DSHS) has contracted with multiple nursing facilities to establish dedicated units to care for residents with a confirmed COVID-19+ diagnosis. The intent of establishing these units is to allow COVID-19+ residents from other residential care or acute care settings to move to a setting where they can receive appropriate care in an environment where there will be less risk of COVID-19 virus transmission to other residents and staff. Effective November 1, 2021, multiple nursing facilities across the state will have dedicated COVID-19+ units (COVID Unit Directory). These dedicated COVID-19 units will be available through December 31, 2021. Click here to read the entire Dear Provider Letter.

  • 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)
    • Healthcare providers-clarification on screening (Dear Provider Letter 9/18/2021)
  • Updated Screening Questions (DOH screening questions and flow Chart):
    1. Symptoms:
      • Fever (100.4 or more)
      • Cough
      • Shortness of breath or difficulty breathing
      • Fatigue
      • Muscle or body aches
      • Headache
      • Recent loss of taste or smell
      • Sore throat
      • Congestion
      • Nausea or vomiting
      • Diarrhea
    2. 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).
    3. Have you had a positive COVID-19 test for active virus in the past 10 days?
    4. 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:
    1. Visitors
    2. Residents
    3. Staff (should include record of other facilities/hospitals s/he works in)
  • If positive for symptoms of Covid-19 (Hotline 1-800-562-6078 and local health department):

During this public health emergency 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
  • TB testing requirement suspended
  • RN Delegation-training and testing for this self study course can be completed remotely

See 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 9/30/20204/30/2022
10/1/2020 to 4/30/20216/30/2022
5/1/2021 to 3/31/20228/31/2022
After 3/31/2022Standard 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 9/30/20207/19/2022
10/1/2020 to 4/30/20219/18/2022
5/1/2021 to 3/31/202211/19/2022
After 3/31/2022Based 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

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.

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.

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.

    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.

Archives

SBA Administrator Guzman Enhances COVID Economic Injury Disaster Loan Program to Aid Small Businesses Facing Challenges from Delta Variant

The Small Business Administration has improved the Covid Economic Injury Disaster Loan (EIDL) program to better meet the needs of small businesses, especially those hardest hit industries and smallest entities that still need relief. The SBA is making the program more flexible to meet small business needs. Click here to read more.

Flex Fund Loan Program for Washington Small Businesses and Nonprofits

As businesses look to COVID-19 reopening and recovery, Commerce announces new public-private Flex Fund loan program for Washington small businesses and nonprofits. Small business owners and nonprofits across Washington can start applying today for low interest loans of up to $150,000 through the newly-launched Small Business Flex Fund. The Fund is a public-private partnership aimed at helping small businesses and nonprofits – particularly those in low-income communities – recover and grow as communities across the state reopen for business. Click here to learn more.

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.

SBA Loan Funding is Available

See What You Qualify For

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.