LONG-TERM CARE TASK FORCE GOVERNOR’S COVID-19 Supports/COVID...2020/07/23 · Slide 1 office of the governor of the commonwealth of virginia GOVERNOR’S COVID-19 LONG-TERM CARE

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office of the governor of the commonwealth of virginia

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GOVERNOR’S COVID-19 LONG-TERM CARE TASK FORCE

Dr. Laurie Forlano, Deputy Commissioner of Population Health, VDHGena Berger, Chief Deputy Commissioner, DSS

July 23, 2020

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Welcome and Housekeeping Items• Please mute your phone (do NOT put us on hold) if you are not

speaking• We prefer to take questions/comments at the end of each agenda

item • Feel free to utilize the chat box

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Overview of Agenda• Data Update• Medical Reserve Corps & Staffing Update• VHHA LTCF Support Update• Hurricane Season Planning• ALF & SNF Survey Recap• Testing Update

• Testing Advisory Council• Updated CDC Guidelines

• Financing • Discussion• Next Steps

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COVID-19 Outbreaks in Virginia

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Long-Term Care Facility PPS’: Between 4/21 & 7/21 Requests Received:

4 On Hold5 Received49 Scheduled 5 Specimen Collection22 Testing22 Withdrawn294 Closed

By LTCF Type:

Status ALF SNF

Received 3 2

Scheduled 10 38

Specimen Collection 2 3

Testing 5 17

Closed 55 227

On Hold 0 2

Withdrawn 9 13

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Phased Reopening: Nursing Home StatusNumber of New LTCF Outbreaks Reported to VDH in the Last 7 Days (July 22)

● Central Region: 1● Eastern Region: 6 ● Northern Region: 0● Northwest Region: 1● Southwest Region: 1

Statewide (July 22) ● Nursing homes in Phase I: 84● Nursing homes in Phase II: 15

Note these data are not being posted publicly; for internal situational awareness.Data are considered incomplete, as nursing homes are not required to report phase changes.

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Medical Reserve Corps

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VHEMP Long Term Care Facility SupportThe Virginia Healthcare Emergency Management Program (VHEMP), in partnership with Russell Phillips & Associates, conducted a statewide assessment of licensed Skilled Nursing Facilities (SNF) COVID-19 capabilities and needs from May 27, 2020 – June 8, 2020. The assessment was conducted by the Commonwealth’s six Regional Healthcare Coalitions and completed by 197 out of the 283 licensed SNFs- a completion rate of 70%.

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LTC Facilities and COVID-19

Prepared by Hannah Shadowen, MPH and Kurt Elward, MD on behalf of DMAS

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Methods

• LTC facilities in Virginia (nursing homes, assisted living facilities, memory care, long term care) were invited to participate in a survey administered by RedCap.

• Survey created in partnership with DMAS, VDH, VALA, VHHA, and LeadingAge

• Survey focused on • Ability to perform technical COVID testing on site• Ability to increase testing frequency• Staffing and supply status

• Survey administered from May 29 through June 20

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Response Rate

• 398 responses for Assisted Living Facilities survey – 76.2% response rate

• 72 responses for the Nursing home survey

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Characteristics of Assisted Living Facilities with having at least one case in staff OR residents.

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Characteristics of Skilled Nursing Homes with having at least one case in residents*Data from the CMS COVID-19 in nursing homes, Nursing Home Compare, Census Bureau, and Minimum Data Set

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Characteristics of Skilled Nursing Homes with at least one case in residents

*Data from the CMS COVID-19 in nursing homes, Nursing Home Compare, Census Bureau, and Minimum Data Set

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Current Testing Capacity in Assisted Living Facilities

• 53.2% of facilities offer testing to residents OR staff.• Offering testing to residents and/or staff was significantly associated with having a

case, the size of the facility, the location of the facility, monitoring residents more frequently, providing a PPS, testing asymptomatic staff, being able to test 20% of residents weekly, having a staffing plan, and cohorting staff

• 31.6% have planned for or completed a PPS• Planning for or completing a PPS is significantly associated with having a case in the

facility, being larger in size, testing asymptomatic staff, having the ability to test 20% of residents weekly, having a staffing plan, and cohorting staff

• 68.2% of facilities reported that they COULD NOT perform testing on 20% of their residents weekly

• 87.5% of facilities COULD NOT perform testing on all staff weekly• Having the ability to test 20% of residents weekly and having the ability to test all staff

weekly was significantly associated with having a case in the facility but not with size of facility or location (Figure 4.1, 4.4, 4.5)

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Staffing Shortages in Assisted Living Facilities

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Characteristics of Skilled Nursing Homes with Staffing Shortage


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Characteristics of Skilled Nursing Homes with Staffing Shortage


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Virginia Testing Advisory Council

● Achieved the Governor’s initial testing goals of > 10,000 tests/day and a test positivity rate of < 10% statewide and regionally, however since late June testing challenges have returned including an extension of testing turnaround times (TAT) and increase in positivity rates in certain regions of the state.

● We are doing more testing, in more settings, but recognizing that PCR diagnostic testing is a finite resource, the question the TAC is focusing now on whether we are ensuring the highest priority individuals are receiving timely testing?

● Test volumes continue to grow, but turnaround times (TAT) – primarily from our commercial lab partners who perform 2/3 of the tests - now exceeds 6 days

● Test positivity rate is trending up statewide, and now exceeds the 10% positivity threshold in parts of Tidewater Region.

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Virginia Testing Advisory Council● TAT for CDC Priority 1 groups – hospitalized patients and symptomatic healthcare

workers – are still within a 2 day range at the moment.● But hospital testing capacity which had been growing steadily is now being constrained

by interruptions in reagent and other supplies:○ Making it a challenge to ensure pre-procedure test are available in time; and○ Limiting the capacity for post-discharge PCR testing for non-COVID, asymptomatic

transfers to post-acute settings.● Large commercial labs are being impacted by national trends and international supply

chain issues● Opportunities for remedy of delayed TAT and focus of the Testing Advisory Council

○ Pooled testing, Antigen Testing/Growing point of care options○ Refining of testing priority populations – outbreaks, congregate living, vulnerable

populations, etc.○ Increasing lab capacity (One Lab)

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CDC Testing Recommendations Update

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CDC Guidance Addressing Duration of Isolation and Precautions for Adults with COVID-19

Updated July 17, 2020

•Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance)

https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html

•Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)

https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html

•Summary of current evidence and rationale for these changes - Decision Memo

https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html



https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html

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Criteria for Return to Work for Healthcare Personnel (HCP) with SARS-CoV-2 Infection (Interim Guidance)Summary of recent changes:

● Except for rare situations, a test-based strategy is no longer recommended to determine when to allow HCP to return to work

● For HCP with severe to critical illness or who are severely immunocompromised, the recommended duration for work exclusion was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised HCP, 20 days after their initial positive SARS-CoV-2 diagnostic test)

● Other symptom-based criteria were modified as follows:○ Changed from “at least 72 hours” to “at least 24 hours” have passed since last

fever without the use of fever-reducing medications○ Changed from “improvement in respiratory symptoms” to “improvement in

symptoms” to address expanding list of symptoms associated with COVID-19

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Discontinuation of Transmission-Based Precautions (TBP) and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)Summary of recent changes:

● Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue TBP

● For patients with severe to critical illness or who are severely immunocompromised, the recommended duration for TBP was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised patients, 20 days after their initial positive SARS-CoV-2 diagnostic test)

● Other symptom-based criteria were modified as follows:○ Changed from “at least 72 hours” to “at least 24 hours” have passed since last

fever without the use of fever-reducing medications○ Changed from “improvement in respiratory symptoms” to “improvement in

symptoms” to address expanding list of symptoms associated with COVID-19

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Notes for Discontinuing TBP

● Review guidance document for complete description of discontinuation of TBP for patients with COVID-19

● Time period used depends on the patient’s severity of illness and if they are severely immunocompromised (*guidance document further defines)

● Decision Memo describes accumulating evidence supporting ending isolation and precautions for persons with COVID-19 using a symptom-based strategy

● VDH is updating LTC guidance documents and FAQs to reflect changes

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Preparing for CARES Act Fund Reimbursement

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Discussion

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Next steps• Testing & Staffing Best Practices Webinars

Documents

LONG-TERM CARE TASK FORCE GOVERNOR’S COVID-19 Supports/COVID...2020/07/23 · Slide 1 office of the governor of the commonwealth of virginia GOVERNOR’S COVID-19 LONG-TERM CARE